Central Government Health Scheme – CGHS Frequently asked questions

35. How to get a drug if same is not available in WC & also not supplied by
Chemist(ALC)?

Beneficiary, after authorization by CMO i/c can purchase such drugs from open market & claim reimbursement from ALC.

36. What should  beneficiary do,  if  he/  she notice some  deterioration  in  the quality of drugs?

He /she should return the medicine to WC & get replacement. Samples can be sent for testing through CMOI/C.

37. My father is a cancer patient and after operation is bed ridden. Doctors have advised Protein powder. Can I get from CGHS?

Dietary supplements are not permissible under CGHS

38. Govt. Specialist advised a new treatment procedure and a new implant. Are they permitted under CGHS?

New  Guidelines  were  issued  under  CGHS  vide  Office  Memorandum  dated 25.08.2014

( http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File739.pdf)

a)         CGHS shall hereinafter allow only the listed investigations / treatment procedures for which there are   prescribed  CGHS rates, to be under taken in CGHS empanelled diagnostic centers and hospitals.

b)         Similarly, only listed implants / medical devices with a CGHS prescribed ceiling  rate  shall  be  permitted  for  treatment  /  reimbursement  under CGHS.

c)         In those cases where any unlisted investigation / treatment procedure is undertaken the reimbursement   shall be limited to the rate of   nearest similar investigation / treatment procedure under CGHS. Addl. Director of the city /zone shall take a decision based on justification in such cases , in consultation with experts in the field, if necessary.

d)         In   those   cases   where   any  unlisted   implant   /  device  is   installed reimbursement   shall be limited to the CGHS rate of   nearest   similar implant / device. Addl. Director of the city /zone shall take a decision based on justification in such cases in consultation with experts in the field, if necessary.

e)         In order to provide a mechanism to update the investigations /treatment procedures / implants , etc., as an ongoing process , a Technical Committee is constituted to consider    inclusion / exclusion of investigations /treatment procedures / implants , etc., under CGHS.

( http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File744.pdf )

.

39. Is Penfill Injection provided under CGHS?

Insulin pen is not supplied under CGHS. But, Insulin pen cartridges are supplied under CGHS

40. What do I do if I am unwell at odd hours, say late in night?

CGHS beneficiaries have the option to go to any of the 24 hr functional dispensaries in Delhi, a nearby govt. hospital / empanelled private hospital or even any private hospital, in case of emergency.

41. Whom should I contact if the doctors are not present in the Wellness Centre
/ Dispensary?

Contact CMO i/c of the concerned Wellness Centre or Addl. Director, CGHS of concerned city or Director, CGHS.

42. In  emergency  who  are  all  entitled  to  get  treatment  at  Pvt  Empanelled
Hospital ?

Any beneficiary holding a Valid CGHS card.

43. What should I do in case of emergency?

CGHS beneficiaries have the option to go to any of the 24 hr functional dispensaries in Delhi, a nearby govt. hospital / empanelled private hospital or even any private hospital

44. What are the papers to be submitted for any investigation by an empanelled diagnostic centre?

Original or self attested copy of prescription of CGHS Doctor / Government specialist. Copy of CGHS Card of the patient and main card holder (head of family).

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