Review of CGHS (Central Government Health Scheme)



Central Government Health Scheme

Senior citizens and retired personnel who have worked in Central Government bodies are assured of their health care needs through the Central Government Health Scheme (89 KB) (PDF file that opens in a new window) or CGHS. This scheme for pensioners provides medical assistance to retired central government officials along with their dependents, freedom fighters and widows of government officials. The CGHS Scheme also covers Delhi police personnel, retired judges of the Supreme Court, Parliament secretaries and their families.

Moreover, along with Ex-Governors and Ex-Vice Presidents of India, accredited journalists are also eligible to be covered under the Central Government’s Health Scheme. The Central Government Health Scheme initially started functioning in Delhi. After a few years, it spread to cities such as Allahabad, Ahmedabad, Bangalore, Mumbai, Chennai, Kolkata, Hyderabad, Jaipur and Patna.

The Central Government Health Scheme offers health services through Allopathic and Homeopathic systems as well as through traditional Indian forms of medicine such as Ayurveda, Unani, Yoga and Siddha. These medical facilities are provided through dispensaries and polyclinics. Chief medical officers and medical officers operate these dispensaries and are responsible for the smooth functioning of the scheme.

The main components of the scheme are dispensary services including domiciliary care, specialist consultation facilities, X-ray, Electro Cardiogram (ECG), laboratory testing, hospitalization, purchase and distribution of medicines and provision of health education. Here is a list of private hospitals and diagnostic centres (External website that opens in a new window) recognized under the Central Government Health Scheme.

The performance of the CGHS is regularly reviewed by the Government. The Committee of Secretaries has also been regularly reviewing the functioning of the CGHS since December, 2008, and has been giving directions to the Ministry of Health & Family Welfare for making it beneficiary friendly. Some of the recent initiatives are listed below:

(1)Extension of CGHS: CGHS today covers 24 cities, apart from Delhi. Dehradun, Ranchi, Bhubaneshwar and Jammu are the cities where CGHS was extended during the last four years. (2) Computerization: To keep pace with the modern times, a massive computerisation work has been taken up under CGHS in collaboration with the National Informatics Centre. Computerization of the CGHS will result in lesser waiting period for beneficiaries at the dispensaries; on-line placement of indents on local chemists; availability of patient profiles; availability of medicines / drugs usage pattern, which will enable the CGHS to prepare a realistic list of formulary drugs; reduction in use of paper; removal of jurisdictional restriction (as regards the dispensary) for the beneficiaries, etc.

(3) Introduction of Plastic Cards: As part of the computerisation process, it has been decided to issue plastic cards individually to each beneficiary of the CGHS. This will enable beneficiaries to avail CGHS facility in any city should they happen to be in that city either on official work or on leave. Inter-city treatment will be possible after all cities are computerised and networked.

(4) Accreditation of labs with National Accreditation Board for Testing and Calibration Laboratories (NABL) : With a view to providing better quality treatment to CGHS beneficiaries, it was decided that only those private hospitals and diagnostic centres would be empanelled under the CGHS, as have been cleared by the Quality Council of India after it carried out inspection of the facilities available at these hospitals and diagnostic centres. It has also been decided that all the laboratories on the panel of CGHS have to get certificate issued by the NABL under the Quality Council of India.

(5) Medical Audit of Hospital Bills is an important exercise to assess the quality of services offered and expenditure incurred. In order to be sure that the bills raised by private empanelled hospitals are genuine and that the beneficiaries were required to undergo only that treatment as was required and that the hospital has not forced the beneficiary to undergo unnecessary tests / treatment at the hospital. The job of medical audit of Hospital bills has been outsourced to TPAs.

(6) Holding of Claims Adalats: Complaints were received in the CGHS and in the Ministry that old cases of reimbursement of medical expenses incurred by pensioners were pending for settlement for long time. It was decided that claims adalats be held in each Zonal office of CGHS, Delhi, under the chairmanship of the Additional Directors of the respective zones. Claims adalats were held annually, in each zone (East, Central, South and North Zones) in Delhi, during 2007 and 2008 and over 95% of the claims were settled in those adalats.

(7) Local Advisory Committees: Local Advisory Committee meetings are held in each CGHS dispensary on second Saturday of the month, which is attended by Area Welfare Officer appointed by the Chief Welfare Officer, Department of Personnel & Training, representatives from pensioners’ association, local chemist to resolve problems at dispensary level.

(8) Decentralisation and delegation of powers: Ministries / Departments have been delegated powers to handle all cases of reimbursement claims if no relaxation of rules was involved. Earlier they had powers to handle requests upto Rupees two lakhs and beyond that amount, the cases were referred to CGHS.

(9) Insulin: Orders have been issued to permit issue of Analogue (Insulin Vial/Cartridge) to CGHS beneficiaries and the extra cost would be borne by the CGHS. The beneficiaries would have to purchase the pen for utilization the analogue insulin.

(10) Outsourcing of cleaning process of dispensaries: As there were shortage of Class IV Staff in a large number of dispensaries in Delhi, it was decided to relocate Class IV staff from a few deficient dispensaries to other deficient dispensaries. To overcome the vacuum so created in some dispensaries, it was decided to outsource cleaning work for mechanised cleaning. The agency has been handling this work for the last five months, and the work done by them has been appreciated by all.

(11) Rate contract for purchase of drugs: It has been decided to run a pilot project under which dispensaries in Delhi will be permitted to place indents directly on the manufacturers on rate contract basis. If the proposal proves to be a success, then it may be extended to cover the entire CGHS. The benefit of this arrangement is that dispensaries / CGHS do not have to carry huge inventory of medicines and indents can be placed on a monthly basis depending on the need.

The Sixth Central Pay Commission recommended the introduction of health insurance scheme for Central Government employees and pensioners. It had recommended that for existing employees and pensioners, the scheme should be available on the voluntary basis, subject to their paying prescribed contribution. It has also recommended that the health insurance scheme should be compulsory for new Government employees who would be joining service after the introduction of the scheme. Similarly, it had recommended that new retirees, after the introduction of the insurance would be covered under the scheme.

An expression of interest has been floated by the Ministry of Health & Family Welfare inviting suggestions from insurance companies providing health insurance and health consultants on the structure, feasibility and viability of such a scheme.

This information was given by Shri Ghulam Nabi Azad, Union Minister for Health & Family Welfare in a written reply to a question in the Lok Sabha today. Source:PIB

7 comments

Thanks for a wonderfully updated website that is providing a yeoman's service to the society.

I have provided a link to your blog from my own website about CGHS issues. http://www.healthbuzz.in

Reply

Sir,
What about those pensioners who had opted for annual contribution to avail CGHS benefit (insted of one time payment) and have completed 15 years and got the commuted value restored? should they continue to pay contribution? Kindly clarify.
A. Govindakrishnan

Reply

Sir, I would like to highlight the biased policy of central govt. they have been taking CGHS monthly subscription accordingly to grade pay but when its comes to the taking facility at hospital in case of hospitalization they fix the criteria of basic pay.Why their is a no uniformity ?
abhi

Reply

Few months back i read one g.o.i order to relax the medical bill reimbursement process to ease the process of this claim. In this it was mentioned that the employees need not be forced to produce the essentiality certificate as well as the doctors signature on cash memos is also not required. As per the circular this amendment has been incorporated looking to the difficulty in availability of the senior doctors and the inconvenience caused to the employees. I am searching this circular.If anybody have a copy of it or aware of any site link from where it can be dowloaded, i would be very much grateful...
Savita

Reply

my father,aged 84, is a retd.central govt.employee(Postal dept.) He does'nt know about the CGHS scheme. He retired at Mantralayam and stays with me in kurnool,Andhrapradesh. He may be kindly be enlightened about where and how has he to seek reimbursement,who to approach in the wake of 6th pay commission for central govt.retired employees.
vijayendra

Reply

we all senior citizen has to pass full in getting treatment in jabalpur. our request is to look in to miaserable condition paient are coming from far off & coming at about 04 o clock in morning. may request your honour to look in to personally and have survey carried and remedial action taken accordingly. with regards
s p mukhi

Reply

I am a non CGHS beneficiary working at Erode. My mother went to see my sister at chennai 2months before. she fall ill there. admitted at Vijaya Heart foundation hospital at night 11.00hrs. I claimed the medical claim as my mother is wholly depend upon me mentioning the above. My office asks for AMA certificate from HQ ie Erode. is it required to get treatment who was away from HQ two months before? As i am not a non CGHS Beneficiary which rule is applicable for me CGHS or any other. please inform me by email address: kannanaedd@gmail.com

S.Kannan

Reply

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