Central Government Health Scheme – CGHS Frequently asked questions
45. What are the criteria for Entitlement of Treatment endorsed on CGHS Card like General ward / Semi-Pvt ward or Pvt. Ward in CGHS Empanelled Hospitals?
Endorsement of entitlement for general/semi- private/private ward facility is done according to their basic pay / basic pension as under :
|Basic Pay / Basic Pension||Entitlement|
|Upto Rs. 13,950/- per month||General Ward|
|Rs. 13,960/- to 9,530/- per month||Semi-private Ward|
|Rs. 19,540/- and above – per month||Private Ward|
46. Which are the categories eligible for cashless treatment?
Hospitals shall provide credit facility to the following categories of CGHS beneficiaries (including dependant family members, whose names are entered on CGHS Card):
- Members of Parliament;
- Pensioners of Central Government drawing pension from central estimates;
- Former Vice-presidents, Former Governors and former Prime Ministers; Ex-Members of Parliament;Freedom Fighters;
- Serving employees of Ministry of Health & Family Welfare (including attached / subordinate offices under the Ministry of Health & Family Welfare)
47. What should I do if the empanelled hospital refuses to entertain or give a step-motherly treatment?
Contact CMO i/c of the concerned Wellness Centre or Addl. Director, CGHS of concerned city or the nodal officer for grievances.
48. I am a serving employee of an autonomous body, holding CGHS card. Who will give me permission for treatment on the recommendation of Govt. specialist?
Permission for specific treatment procedure as advised by a Govt. Specialist at private empanelled hospitals shall be granted by the Head of Autonomous body in respect of serving employees as well as pensioners of Autonomous bodies covered under CGHS.
49. What is the time within which my medical claim is to be reimbursed?
If all documentation is complete medical claims of pensioners are cleared in 45 days.
50. What can I do if my claim is unnecessarily delayed?
Pensioner beneficiaries can contact the Additional Directors of concerned city / zone on any Wednesday between 11 A.M. and 1 P.M.
51. I am a CGHS Pensioner. My wife was admitted in pvt hospital in emergency state. How to get reimbursement of money spent on her treatment?
Apply to CMO I/c of WC with :
- MRC forms duly filled in as per Check list
- Copy of Discharge summary Hospital bills with break-up Receipts in original
- Copy of the valid CGHS Card
- Copies of other documents issued by hospital
- MRC forms are available with CMO I/c and can also be downloaded from CGHS Website http://msotransparent.nic.in/cghsnew/index.asp
- Serving employee in similar cases shall submit the medical claim to his department.