Hospitalization in emergency
CGHS beneficiaries may be admitted to any government or private hospital in an emergency, but compensation will be based on CGHS rates. On the advice of the Technical Standing Committee (see OM No. 4-18/2005- C&P-[Vol1 (Pt 1)] dated 20/2/2009), full compensation may be permitted in some situations.
If payment is required in such circumstances, the private hospital must submit an emergency certificate detailing the patient’s condition at the time of admission that necessitated the emergency admission.
CGHS-empanelled hospitals are prohibited from refusing admission to CGHS beneficiaries in an emergency and must offer treatment on credit to pensioner beneficiaries and other eligible categories (even if the beneficiary is from outside CGHS city/other CGHS city).
Important points regarding indoor treatment in CGHS empanelled hospital
- When a treatment procedure is performed in an empanelled hospital, it comprises all pre-operative investigations, two pre-operative and two post-operative consultations, room charges as per entitlement, medicines, and any other services provided during the admission period. In addition to package rates, the cost of implants, grafts, and stents is reimbursable at CGHS ceiling rates (or actual, whichever is lower).
- In the case of indoor treatment, the hospital will provide a credit facility to the pensioner (and other eligible categories of beneficiary), while service employees will be charged only at the CGHS rates.
- The hospital will not charge the beneficiary any additional fees over and above the package rate/rate agreed, unless the beneficiary chooses a more expensive implant/device than the one approved by the CGHS, in which case the hospital will need written authorization from the beneficiary. The beneficiary will not be repaid for the additional funds.