Question : TREATMENT FROM CGHS EMPANELLED HOSPITALS

(a) whether Central Government Health Scheme (CGHS) beneficiary can avail treatment at the nearest CGHS empanelled private hospital without permission from the appropriate authority;

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

(c) whether the Government has received any representations/requests from various quarters to permit CGHS beneficiaries for treatment in CGHS empanelled hospitals without permission from appropriate authority for speedily treatment and also provide cashless facilities in these empanelled hospitals in this regard;

(d) if so, the details thereof and the action taken by the Government thereon; and

(e) the steps proposed by the Government to provide comprehensive and hassle free healthcare services to the CGHS beneficiaries?

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

(a) & (b): As per the existing guidelines, a CGHS beneficiary is required to obtain permission from his administrative Department / Office or CMO in charge (in case of pensioner beneficiary) to avail medical treatment in a CGHS empanelled private hospital. However, in case of emergency he can go to any hospital whether empanelled or not, to avail medical treatment. This provision is necessary to ensure proper medical treatment of a CGHS beneficiary in consultation with the Government specialists. This is also a measure of ‘checks and balances’ to ensure financial propriety and optimum utilization of public money.

(c) & (d): This Ministry has been receiving representations from the individuals, Pensioners Associations etc. to allow the CGHS beneficiaries to take treatment from the CGHS empanelled private hospitals without obtaining the requisite permission. However, their requests have not been acceded to as the present referral system is considered necessary in the interest of the beneficiaries and it is also necessary as a check and balance measure to ensure financial propriety.

(e): CGHS is already providing comprehensive and hassle free healthcare services to its beneficiaries through its large network of Wellness Centres and empanelled private hospitals and diagnostic /imaging centres. With a view to further simplify and liberalize the procedures in CGHS to make its services more hassle free, the requirement of mandatory permission for undertaking diagnostic tests and investigations has been done away with w.e.f. 1st January, 2013. In addition, ‘Continuous Empanelment Scheme’ has also been revived at all CGHS locations to empanel more number of eligible private hospitals to enhance accessibility and availability of medical services to the beneficiaries in a hassle free manner.