Reimbursement claims of CGHS Beneficiaries: Lok Sabha QA
“REIMBURSEMENT CLAIMS OF CGHS BENEFICIARIES”
Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:
(a) whether the Government has taken note of the difficulties being faced by CGHS beneficiaries due to making upfront payments to the medical institutes and seeking individual reimbursement claims and follow ups from the CGHS;
(b) if so, the details thereof along with steps taken by the Government for eliminating the need to submit individual reimbursement claims and follow ups for approvals;
(c) whether the Government has recognized any specific institutes which would provide such relief of cashless treatment to the beneficiaries, if so, the details thereof;
(d) the details of the criteria for determining the eligibility of CGHS beneficiaries for such relief at such recognized institutes, if any; and
(e) whether the Government plans to expand this facility to other medical institutes in the near future and if so, the details thereof?
ANSWER
(a) to (e) As per Memorandum of Association (MoA) signed between CGHS and empanelled Health Care Organizations (HCOs), in respect of the following categories of beneficiaries, treatment / procedures/services shall be provided on credit.
- Pensioners,
- Ex-Members of Parliament,
- Sitting Members of Parliament
- Freedom Fighters,
- Serving CGHS/DGHS/Ministry of H&FW employees,
- Such other categories of CGHS cardholders as notified by the Government.
No payment shall be sought from them and the bills should be submitted to the Bill Clearing Agency / Office of the Additional / Joint Additional Director, CGHS of the concerned city.
Further, the Government has also signed MoA with All India Institute of Medical Sciences, New Delhi, Post Graduate Institute of Medical Education and Research, Chandigarh, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry and All India Institute of Medical Sciences located in Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh to provide treatment on Cashless basis to CGHS pensioners and other entitled class of beneficiaries like ex-MPs. ex-Governors, former Judges of Supreme Court of India, former Judges of High Courts, Freedom Fighters, etc. No referral from CGHS is mandatory for availing treatment at these Medical Institutions.
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