Reimbursement for purchase of Hearing Aid under CSMA and CGHS revised
Reimbursement for purchase of Hearing Aid under CSMA and CGHS revised – Govt also issues Revised Guidelines
Ministry of Health  and Family Welfare issued an OM regarding Revision of rate and guideline  for reimbursement of expenses on purchase  of Hearing AIDS Under CSMA Rules,1944  and CGHS
No.S.14025/10/2002/MS
Government  of India
Ministry of Health  and Family Welfare
Department of Health and Family Welfare
****
Nirman  Bhawan,  New Delhi
Dated the 26th May, 2015
OFFICE Â MEMORANDUM
Subject:  Revision  of rate and guideline  for reimbursement  of expenses  on purchase  of Hearing AIDS Under CSMA Rules,1944  and CGHS – Regarding
With reference  to the above  mentioned  subject  the undersigned  is directed to refer to the Office Memorandum  of even no dated 21.03.2012  ,  17.11.2006 and 28.10.2002   and  OM No  S.14025/36/93/MS  dated  26.03.94  and 17.08.99 and to state  that  on the basis  of recommendation  of an Expert  Committee,  it has been decided to revise the rates and guidelines for hearing aids  to be reimbursed  under CS(MA) Rules,  1944 and CGHS.
2.      The  revised  ceiling  rates  fixed for various  types  of hearing-aids  (for one ear) are as under:-
- Body worn/Pocket  type Rs.3000/-
- Analogue  BTE Digital – Rs. 7000/-
- BTE Digital                  Rs. 15000/-
- ITC/CIC Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Rs. 20000/-
The cost of hearing  aids shall include all taxes in including VAT and Shall carry 3 year  warranty. The cost  of analogue BTE/Digital  BTE/ITC/CIC  type hearing aid. shall also include  the cost of hearing  mould.
3.  Beneficiaries  covered  under  CS  (MA)  Rules  /CGHS  shall  be eligible  to obtain hearing  aid as per the following guidelines:
(i). Patients/Beneficiaries   should  be properly  referred  to  CGHS/Government hospital ENT  specialist    from  the  parent  CGHS  wellness  centre    (A computerized   referral  printout  should  be made  wherever  computerization has been done).
(ii). It  would  be mandatory  to carry CGHS  Beneficiary’s ID card (in original) whenever the CGHS  beneficiaries   visit the CGHS/Government  ENT specialist  for consultation  and Audiometric  test.
(iii).  The  ENT specialist  of CGHS /Government  hospital  shall  then recommend a  hearing  aid  on  basis  of  Audiometric  and  Audiological     assessment, specifying  the  type  of  hearing  aid  most  suited  for  the  Beneficiary.  The ‘Audiogram  report’  shall be authenticated  by the ENT specialist/Consultant of the CGHS/Government hospital.
4.       The   permission    to  procure   hearing   aid   shall   be  granted   by  the ADDITIONAL  DIRECTOR(Zonal) of CGI IS-ZONAL  OFFICE  in case of CGHS pensioner  beneficiaries,   and by the HEAD  OF DEPARTMENT/OFFICE in case of serving employees  and CGHS beneficiaries  of Autonomous  bodies on the basis of   Recommendation     of   a  CGHS/Government    ENT   specialist,    and   an ‘undertaking’  that  the beneficiary  has not been  reimbursed  the cost of hearing  – aid in the preceding  five years.
5.      Reimbursement  claim  shall  be  submitted  to  CGI IS  ZONAL  OFFICE through  the  CMO  – Incharge  of the Concerned  dispensary  by CGHS  Pensioner beneficiaries  in  the  prescribed  medical  reimbursement   claim for-along  with the following  documents  :-
a)  Referral letter  from  parent  CGHS Wellness  Centre  (computerized Slip where computerization  is done already).
b)  Copy  of ‘prescription’  of ENT consultant (CGIIS/Govt.Hospital)  with the ‘Audiogram’  report  duly authenticated by the  treating  ENT  consultant (CGI IS/Govt).
c) Â Copy of CGHS Â Card.
d)  Bill/Receipt  (in  original)  carrying  details  of  the  hearing  – aid  seller  i.e. NAME, QUALIFICATION  AND RCI/MCI  REGISTRATION  NUMBER of the hearing  – aid seller.
e)  The ‘permission letter’  to purchase hearing  – aid  (in original).
f)  Empty  Box/boxes  or the  Carton(s)  with  the  label  showing  details  of the hearing  aid supplied.
In case  of the  other  beneficiaries,  the medical  claim  shall  be submitted  to the concerned  Ministry/ Department  /Office.  Reimbursement  shall be limited to the ceiling rate or actual cost of the hearing –  aid, whichever  is less.
6.  Records  of permissions  granted  for procurement  of hearing-aids  shall be maintained  by  CGHS  in respect  of  pensioner  CGHS  beneficiaries  and  by the concerned  Ministry/Department/ Office  in  respect  of other beneficiaries.
7. Replacement  of hearing-aid may be permitted  after 5 years on the basis of condemnation  certificate  issued by a technical  expert and on approval of CGHS/Government ENT Surgeon.  Maintenance  and repair will be the responsibility of the beneficiary.
8.  These  orders shall supercede  all the earlier orders issued on the subject.
9. The  revised  rates  and  guidelines  shall  come  into  force  from  the date  of issue  and shall  be valid  for a period  of two year or till further  revision,  whichever is  earlier.
l0. This  issues  with the approval  of Integrated  Finance  Division  of Ministry of Health  &  Family  Welfare
(Sunil  Kumar Gupta)
Under Secretary  to the Govt. of  India
Download Ministry of Health  and Family Welfare OM No.S.14025/10/2002/MS dated 26.05.2015