THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI GHULAM NABI AZAD)
(a): Yes.
(b): Cases falling under the following categories are considered by the Technical Standing Committee for making recommendations for full reimbursement of claims:-
(i) Treatment taken in private non-empanelled hospital in an emergency and patient was admitted by others when the beneficiary was unconscious or severely incapacitated and was hospitalized for a prolonged period.
(ii) When the patient was admitted for a prolonged period of treatment of head injury, Coma, Septicemia, Multi organ failure etc.
(iii) In case of emergency treatment of advanced malignancy.
(iv) In case of treatment under emergency in higher type of accommodation as room as per his/her entitlement was not available during that period.
(v) In case the treatment was taken in a higher type of accommodation under specific condition for isolation of patients to avoid contacting infections.
(vi) Treatment taken at private non-empanelled hospital under emergency when there was a strike in Govt. Hospitals.
(vii) Treatment taken in a private non-empanelled hospital in an emergency while on official tour to non CGHS covered area.
(viii) Approval for air fares with or without attendant on the advice of a treating doctor for treatment in another city even though he is not eligible for air travel.
(ix) Any other special circumstances.
24 cases of Delhi & NCR and 26 cases of other CGHS cities were considered by the Standing Technical Committee during thefinancial year 2011-12 for full reimbursement /technical approval.
(c) & (d): As per the terms and conditions of empanelment and MOA, private hospitals empanelled under CGHS are expected to charge as per CGHS rates only. In case of any violation of terms and conditions there is provision for recovery of the excess amount and penal action against the erring hospitals.
