Supreme Court Judgement on Reimbursement of Full Medical Expenses incurred in CGHS Non-Empanelled Hospitals –

Full Expenses for Medical Treatment in Emergency while admitted in CGHS Non-Empanelled Hospitals are to be reimbursed by Govt – Hon’ble Supreme Court Judgement

Here is the extract of Judgement delivered by Hon’ble Supreme Court on Admissibility on reimbursement of entire expenses incurred by a CGHS beneficiary while he / she was admitted to a non-empanelled hospital in Emergency.

The Central Government Health Scheme (CGHS) was propounded with a purpose of providing health facility scheme to the central government employees so that they are not left without medical care after retirement. It was in furtherance of the object of a welfare State, which must provide for such medical care that the scheme was brought in
force. In the facts of the present case, it cannot be denied that the writ petitioner was admitted in the above said hospitals in emergency conditions. Moreover, the law does not require that prior permission has to be taken in such situation where the
survival of the person is the prime consideration. The doctors did his operation and had implanted CRT-D device and have done so as one essential and timely. Though it is the claim of the respondent-State that the rates were exorbitant whereas the rates charged for such facility shall be only at the CGHS rates and that too after following a proper procedure given in the Circulars issued on time to time by the concerned Ministry, it also cannot be denied that the petitioner was taken to hospital under emergency conditions for survival of his life which requirement was above the sanctions and treatment in empanelled hospitals.

15) In the present view of the matter, we are of the considered opinion that the CGHS is responsible for taking care of healthcare needs and well being of the central
government employees and pensioners. In the facts and circumstances of the case, we are of opinion that the treatment of the petitioner in non-empanelled hospital was
genuine because there was no option left with him at the relevant time. We, therefore, direct the respondent-State to pay the balance amount

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