Streamlining CGHS Reimbursement Claims

In response to a series of questions raised in the Lok Sabha, the Minister of State in the Ministry of Health and Family Welfare provided information on the reimbursement claims of CGHS (Central Government Health Scheme) beneficiaries. The questions addressed the difficulties faced by CGHS beneficiaries in making upfront payments to medical institutes and seeking individual reimbursement claims and follow-ups from CGHS.

Reimbursement claims of CGHS beneficiaries

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA
UNSTARRED QUESTION NO. 257
TO BE ANSWERED ON 21ST JULY, 2023

‚ÄúREIMBURSEMENT CLAIMS OF CGHS BENEFICIARIES‚ÄĚ

  1. SHRI UNMESH BHAIYYASAHEB PATIL:
    DR. HEENA VIJAYKUMAR GAVIT:
    SHRI NATARAJAN P. R.:
    DR. SUJAY RADHAKRISHNA VIKHE PATIL:
    PROF. RITA BAHUGUNA JOSHI:
    DR. KRISHNA PAL SINGH YADAV:
    DR. SHRIKANT EKNATH SHINDE:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) whether the Government has taken note of the difficulties being faced by CGHS beneficiaries due to making upfront payments to the medical institutes and seeking individual reimbursement claims and follow ups from the CGHS;

(b) if so, the details thereof along with steps taken by the Government for eliminating the need to submit individual reimbursement claims and follow ups for approvals;

(c) whether the Government has recognized any specific institutes which would provide such relief of cashless treatment to the beneficiaries, if so, the details thereof;

(d) the details of the criteria for determining the eligibility of CGHS beneficiaries for such relief at such recognized institutes, if any; and

(e) whether the Government plans to expand this facility to other medical institutes in the near future and if so, the details thereof?

ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE
(DR. BHARATI PRAVIN PAWAR)

(a) to (e) As per Memorandum of Association (MoA) signed between CGHS and empanelled Health Care Organizations (HCOs), in respect of the following categories of beneficiaries, treatment / procedures/services shall be provided on credit.

  • Pensioners,
  • Ex-Members of Parliament,
  • Sitting Members of Parliament
  • Freedom Fighters,
  • Serving CGHS/DGHS/Ministry of H&FW employees,
  • Such other categories of CGHS cardholders as notified by the Government.

No payment shall be sought from them and the bills should be submitted to the Bill Clearing Agency / Office of the Additional / Joint Additional Director, CGHS of the concerned city.

Further, the Government has also signed MoA with All India Institute of Medical Sciences, New Delhi, Post Graduate Institute of Medical Education and Research, Chandigarh, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry and All India Institute of Medical Sciences located in Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh to provide treatment on Cashless basis to CGHS pensioners and other entitled class of beneficiaries like ex-MPs. ex-Governors, former Judges of Supreme Court of India, former Judges of High Courts, Freedom Fighters, etc. No referral from CGHS is mandatory for availing treatment at these Medical Institutions.

Source :Loksabha

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