Cashless Medical Treatment in CGHS empanelled private hospitals

GOVERNMENT OF INDIA

MINISTRY OF HEALTH AND FAMILY WELFARE

LOK SABHA

ANSWERED ON 07.02.2014

(a) the medical assistance and other facilities provided by the Government to retired Central Government pensioners under the Central Government Health Scheme (CGHS) through empanelled hospitals;

(b) whether the empanelled hospitals under CGHS provide cashless facility to the pensioners only for the diseases for which they are empanelled even during the emergencies and if so, the details thereof along with the regulations in this regard;

(c) whether the Government plans to instruct all empanelled hospitals to provide cashless facilities to pensioners and other CGHS beneficiaries irrespective of diseases for which they are empanelled during emergencies and shift the patients to other authorised hospitals after first aid;

(d) if so, the details thereof and if not,the reasons therefor; and

(e) the steps taken/proposed to check exploitation of patients in emergencies by empanelled hospitals?

THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI GHULAM NABI AZAD)

(a) to (e): Central Government Health Scheme (CGHS) empanels private hospitals for providing inpatient medical treatment to its beneficiaries. They may avail the requisite treatment with prior permission for procedures advised by CGHS and other government specialists / CMO–in-charge. CGHS pensioner beneficiaries are entitled for cashless medical treatment in the CGHS empanelled private hospitals. The empanelled private hospitals under CGHS provide treatment to the pensioners on credit /cashless basis for the procedures for which they are empanelled.

However, in case of emergency conditions empanelled hospitals are expected to provide treatment to pensioners on credit basis, even for conditions for which they are not empanelled and they are expected to shift the patient to another empanelled hospital after stabilization as per the Memorandum of Agreement (MoA) signed with government.

In case of violation of the terms of the Memorandum of Agreement, suitable action, including depanelment can be initiated against errant hospitals.