75 Years and above CGHS Beneficiaries getting more relaxation on referral rules

New CGHS Referral Rule: Annual Health Check-up in Private Hospitals for Beneficiaries above 75

The Central Government Health Scheme (CGHS) has recently announced that beneficiaries who are 75 years and above will be given additional relaxation on referral rules. Under this new rule, these beneficiaries can easily seek consultation from specialists at CGHS empaneled hospitals without having to go through the referral process. This is a great relief for elderly individuals who require specialized medical attention and care. This new rule aims to make healthcare more accessible and convenient for the elderly population, ensuring they receive the medical attention they need to lead healthy and fulfilling lives.

A new policy has been put in place for beneficiaries of the Central Government Health Scheme (CGHS) who are aged 75 years and above. Under this policy, these beneficiaries are now allowed to seek direct outpatient department (OPD) consultation from specialists of private hospitals that are empanelled under CGHS. This means that they no longer need a referral from a CGHS Wellness Centre to receive this specialized care. The policy is aimed at making it easier for elderly beneficiaries to access the care they need, and to ensure that they receive it in a timely and efficient manner.

Central Government Health Scheme (CGHS): Beneficiaries above 75 can avail health check-up in private hospitals

Z.15025/35/2019/DIR/CGHS/ CGHS(P)
Government of India Ministry of Health & Family Welfare
Department of Health & Family Welfare

Nirman Bhawan, New Delhi
Dated the 29th May, 2019.

OFFICE MEMORANDUM

Sub: Consultation from Specialists at CGHS empanelled hospitals in respect of CGHS beneficiaries aged 75 years and above -regarding

With reference to the above mentioned subject the undersigned is directed to state that the matter related to relaxation of consultation norms in respect of elderly CGHS beneficiaries was under consideration of this Ministry and it has now been decided that hereinafter, CGHS beneficiaries aged 75 years and above shall be permitted to seek direct OPD Consultation from Specialists of private hospitals empanelled under CGHS without referral from CGHS Wellness Centre.

2.If any investigations / procedures are advised and are required in emergency, no other authorization is required and the same may be undertaken. However, in non-emergency conditions approval of competent authority is required if any non-listed investigations/procedures are advised. Medicines prescribed are to be procured from CGHS Wellness Centre.

3.Private hospitals empanelled under CGHS shall provide such facilities on cashless basis at CGHS rates to pensioners, ex-MPs , Members of Parliament and such other Categories of CGHS beneficiaries, who are eligible for treatment /investigations on credit basis. More than 75 year old dependents of serving CGHS beneficiaries, who are otherwise not eligible for Cashless treatment shall claim the reimbursement from concerned Ministry /Department. Beneficiaries of Autonomous Bodies /Statutory Bodies covered under CGHS shall claim reimbursement from the respective organization.

4.These orders are in supersession of the earlier guidelines on the subject.

sd/-
Dr.Manoj Jain
Addl.DDG(HQ)CGHS

View Order