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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  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                       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)  Copy of CGHS  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

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