Central Government Health Scheme

The Central Govt. Health Scheme in India is comprehensive health care scheme applicable to the following categories of people residing in CGHS covered cities:

All Central Govt. Servants paid from Civil Estimates (other than those employed in Railway Services and those employed under Delhi Administration except members of Delhi Police Force).
Pensioners drawing pension from Civil Estimates and their family members –(Pensioner residing in non- CGHS areas also may obtain CGHS Card from nearest CGHS covered City)
Hon’ble Members of Parliament
Hon’ble Judges of Supreme Court of India
Ex- Members of Parliament
Employees & Pensioners of Autonomous Bodies covered under CGHS (Delhi)
Ex- Governors and Ex-Vice Presidents
Former Prime Ministers
Former Judges of Hon’ble Supreme Court of India and Hon’ble High Courts
Freedom Fighters
It provides service through following categories of systems:-
- Allopathic
- Homeopathic
- Indian System of Medicines e.g.
- Ayurveda
- Unani
- Yoga
- Sidha System

CGHS Covered Cities:

The CGHS covered cities are DELHI, AHMEDABAD, ALLAHABAD, BENGALURU, BHOPAL, BHUBANESHWAR, CHANDIGARH, CHENNAI, DEHRADUN, GUWAHATI, HYDERABAD, JAIPUR, JABALPUR, KANPUR, KOLKATA, LUCKNOW, MEERUT, MUMBAI, NAGPUR, PATNA, PUNE, RANCHI, SHILLONG, and THIRUVANANTHAPURAM.

The main components of the Scheme are:

The dispensary services including domiciliary care.
F. W. & M.C.H. Services
Specialists consultation facilities both at dispensary, polyclinic and hospital
level including X-Ray, ECG and Laboratory Examinations.
Hospitalization.
Organization for the purchase, storage, distribution and supply of medicines
and other requirements.
Health Education to beneficiaries.

The dispensary is the backbone of the Scheme. Instructions on these various matters have been issued from. time to time for the guidance of the specialists and medical Officers. With the rapid and continuous expansion of the Scheme, however, not only situation has changed and problems arisen but also. the rapidly expanding staff have not approved practices, procedures and instructions in regard to their various duties and responsibilities. In the following paragraphs is set out the gist of provisions of the Scheme, various instructions and order issued from time to time to serve as a Compendium for the guidance of the CGHS staff.

DEFINITION OF FAMILY

In accordance with the initial instructions, the term of Family for the purposes of the Scheme shall consist of the Government servant’s wife or husband, as the case may be children and stepchildren and parents who are mainly dependent on and residing with the Government servant concerned. Subsequently in pursuance of the recommendations of the Sixth Central Pay Commission, it has been decided that for availing the medical facilities under the scheme, parents, sisters,. widowed sisters, widowed daughters, minor brothers and children will be deemed dependent on the Government employee if they are residing- with him and their income from all sources including pension and pension equivalent of DCRG benefit is less than Rs. 3500 +DA per month.

ENTITLEMENT OF THE SCHEME:

All Central Govt. Servants paid from Civil Estimates (other than those employed in Railway Services and those employed under Delhi Administration except members of Delhi Police Force) having their head quarters in cities where the Scheme is functioning and members of their families, are entitled for the CGHS medical facilities.

TRANSFER

In case the. Central Govt. Employees is transferred to uncovered city leaving behind his family, the Government Employee is not entitled for the medical benefits either for himself or for his family under the Scheme but will be governed under CS(MA) Rule. In the event of the posting of the Central Govt.Employee to North Eastern Region Andaman and Nicobar Is-lands & Lakshadweep and his family members continue to stay in an area covered by the Scheme temporary family permit for availing CGHS benefits will be issued to the family members by depositing advance usual contribution. But in such cases the Central Govt. Employee himself will be governed under CS(MA) Rule.

TEMPORARV VISIT IN COVERED CITY

Central Govt. employees and dependent family members who are beneficiaries of the CGHS. and who may be visiting other cities where the scheme is operating and stay in the areas covered by the Scheme are entitled for free medical attendance / treatment under the said scheme. (Necessary authority/ temporary cards for medical treatment in any of those cities, should be issued by the respective departments in case of serving employees.) Medical facilities should be restricted to period not exceeding six months after which fresh authorities may be issued, if necessary. Similar facilities are also available to pensioners and the dependent family members if holding. CGHS Cards and permission shall be granted by CGHS of the city visiting.

PRODUCTION OF CGHS CARD

The production of CGHS Card is obligatory at every visit to enable correct identification of the patient and to prevent misuse of card.The misuse of card is a cognizable offence. However, in view of humanitarian service, essential and immediate treatment should not be denied to the patient but the beneficiary should be advised to bring the CGHS Card at the time of subsequent Visits and if considered necessary, a note may be made in OPD ticket of the patient. The production of CGHS Index Card in the dispensary will enroll the card holder as a member of the said dispensary. The renewal of Pensioners’ card shall be done in the dispensary. The Indian Postal Order should be sent to Pensioner Cell, Nirma,n Bhavan/DDO Office outside Delhi, regularly on Or before 6th day of the following month. Before accepting the I.P.Os the Chief Medical Office!r Incharge must see the date of issue of I.P.O/ DDS which should be within one month of issue from the Post Office. The Chief Medical Officer incharge will obtain a certificate from each pensioner for any rise of pay/pension due to incremente rise after every two years for calculation of rate of pension or the fact may he verified from his pension payment order before revalidation of card.The Chief Medical Officer Incharge may therefore re-fix the rate of contribution accordingly. In case of Pensioner the transfer of card from one dispensary to another shall be) done by the Chief Medical Incharge of the dispensary.

REGISTRATION OF CGHS CARD IN DISPENSARY

Card Holder must deposit the Index Card in the dispensary and obtain receipt from the receiving clerk. The receiving clerk, will initial the token card in confirmation. Until he deposits the Index Card. he is not entitled for treatment in the said dispensary. On transfer to another dispensary the Card Holder must collect the index card from the dispensarv and deposit the same along with necessary forms (in duplicate) to the new dispensary which has been allotted to him. It is only after the deposition of Index Card in the dispensary that the members mentioned in the token card are entitled to obtain CGHS facilities.

SURRENDER OF CGHS CARD

The CGHS Identity Card held by the beneficiary other than Pensioner, General Public, Ex- MPs etc. must be surrendered to the issuing authority in the following events:-

(a) Retirement /Resignation

(b) Death of Government Servant.

(c) Transfer of Govt. Servant to another office. The Govt. servant if transferred to another office where he/ she is again entitled far CGHS benefits must apply and obtain a new Identity Card.

Pensioners, EX-M.Ps Member of General Public etc. are also required to surrender their Identity Cards to the issuing authority on its expiry in case they no longer desire to avail CGHS facilities.

MISUSE OF CGHS CARD

If the Medical Officer detects a case of misuse of CGHS Token Card by unauthorized person, he will bring to the notice of Chief Medical Officer Incharge and / or the matter reported to the Zonal HQ/ ete. for further necessary action.

LOSS OF IDENTITY CARD

As a lost card is likely to be misused the card holder must inform immediately to the

Police and inform the following with a, copy of F.I.R.

(i) Issuing authority.

(ii) M.O. Incharge of the concerned dispensary.

(iii) Headquarters of CGHS in the cities other than Delhi. A duplicate card can be issued after realising penalty of Rs. 5!- for 1st instance. 2nd… instance Rs. 7/-, 3rd and subsequent instance Rs. 10/- . In case of individual Plastic Cards in Delhi – the procedure is same but , the penalty is Rs.50/-

DEPENDENCE CERTIFICATE

Every Card Holder must certify that the parents /Dependents whose names have been included in the token card, normally reside with him. Such a certificate must be furnished at the time of issue of Token Card and renewed every January. Otherwise the parents shall be treated as non entitled persons. The certificate must also state that the income from all sources does not exceed Rs. 3500 + DA p.m.