Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi
Dated the 22nd May, 2018
Subject: – Constitution of High Powered Committee for Grievance redressal of CGHS beneficiaries pertaining to medical claims
With reference to the above mentioned subject the undersigned is directed to convey the approval of competent authority for Constitution of a High Powered Committee for Grievance redressal of CGHS beneficiaries pertaining to their medical claims in compliance of the directions of Hon’ble Supreme Court of India in their Judgement in the WP (Civil) No. 694 of 2015 filed by Sh. Shiva Kant Jha Vs UoI delivered on 13th April 2018 as per the details given under:
i. Special Director General … … Chairperson
ii. Directorate General, CGHS or his nominee. . . . . Member
iii. Additional Director , CGHS(HQ)/Addl. DDG(HQ),CGHS … … Member
iv. Addl. Director, CGHS(R&H) … … Member Secretary
v. One Government Specialist (of concemed Speciality) … … Member
2. The High Powered Committee shall however, consider the representations of only those CGHS beneficiaries having a valid CGHS Card.
3. High Powered Committee shall meet once in a month and action on the decisions taken shall be completed within seven days of meeting, with the concurrence of the IF D, wherever, it is deemed necessary.
4. The High Powered Committee shall consider the grievances pertaining to the settlement of medical claims of CGHS beneficiaries holding a valid CGHS card at the time of treatment and to examine the requests pertaining to approval of reimbursement under the following conditions:
a) Settlement of medical claims in relaxation of rules
b) Approval for air-fare with or without attendant on the advice of treating doctor for treatment in another city even though he/she is not eligible for air travel treatment facilities are available in city of residence.
c) Representations from CGHS beneficiaries seeking full reimbursements under special Circumstances, which are not notified.