Question : EMPANELLED PRIVATE HOSPITALS

(a) whether the Government has empanelled private hospitals for Central Government Health Scheme (CGHS) beneficiaries for taking treatment therefrom;

(b) if so, the details thereof;

(c) whether the amount spent on taking treatment in CGHS empanelled private hospitals is fully reimbursed and if not, the reasons therefor;

(d) whether the Government reimburses full expenses incurred by CGHS beneficiaries including Ministers and Ex-Ministers on taking treatment from private hospitals as well as for taking treatment in abroad;

(e) if so, the reasons for not reimbursing full amount incurred by CGHS beneficiary on his/her treatment from CGHS recognized private hospitals; and

(f) the details of medical claims of pensioners which are pending for reimbursement with CGHS, Delhi, zonewise alongwith reasons therefor and the steps taken by the Government to settle the claims expeditiously?

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

(a) & (b): Yes, Central Government Health Scheme (CGHS) has empanelled 469 private hospitals and 129 diagnostic centres in different CGHS cities across the country.The list of such private hospitals and diagnostic centres is available on the website of the CGHS www.msotransparent.nic.in/cghs/index.asp

(c): The private empanelled hospitals are under a contractual obligation to provide the medical treatment to the CGHS beneficiaries at the pre determined mutually agreed package rates. However, in certain deserving cases full reimbursement is also allowed as per the laid down norms with the approval of a Standing Technical Committee which examines each case on its merits.

(d): Government reimburses medical expenses incurred by CGHS beneficiaries including Ministers and Ex-Ministers as per the laid down rules. However, expenses incurred on medical treatment taken abroad are considered only in case of the sitting MPs, current Ministers and serving Central Government employees under the Central Services (Medical Attendance) Rules, 1944 subject to the fulfillment of prescribed conditions and with the approval of the Standing Committee headed by the Director General of Health Services.

(e): CGHS beneficiaries are entitled to full reimbursement of medical expenses incurred in a CGHS empanelled private hospital which raises the bill as per the approved package rates only. However, in certain deserving cases full reimbursement is also allowed as per the laid down norms with the approval of a Standing Technical Committee which examines each case on its merits.

(f): The details of pending cases of medical reimbursement claims, zone-wise are as follows ; East zone –115, Central Zone –86, North Zone – 237, South Zone – 221.

The steps taken by the Government to settle the claims –

1) Detailed instructions and guidelines have been issued to further streamline the processes to ensure speedy disposal of claims.

2) Holding of Claims Adalats and Claims days regularly,

3) Regular monitoring of the pendency position at higher levels,

4) Fresh budget re-allocation to provide requisite funds to pass the bills.

5) Deployment of increased manpower for expeditious settlement of pending medical reimbursement claims; and

6) Enhanced delegation of financial power to CGHS officers.