Clarification on Grant of Medical Advance for all treatment (OPD and IPD) under CGHS / CS(MS) Rules
Government of India
Ministry of Health & Family Welfare
Department of Health
Nirman Bhawan, New Delhi
Dated the September 2021
Sub: Grant of Medical Advance for all treatment (OPD and IPD) under CGHS / CS(MS) Rules – clarification regarding
The undersigned is directed to refer to this Ministry’s O.M. No 14025/18/2015-MS/EHSS dated 17.10.2016 on the subject mentioned above and to say that a numbers of references seeking clarification on grant of medical advance to CGHS/CS(MA) beneficiaries in respect of treatment procedures for which there are no prescribed CGHS package Dates, are being received in this ministry.
2. In view of the difficulties being faced by CGHS / CS(MA) beneficiaries, the matter has been examined in this Ministry and it has been decided that in case of treatment procedures without Package rates, the admissible amount is calculated item-wise at CGHS rate. Item(s) for which there are no CGHS rates, AIIMS rates shall be considered. If there is no CGHS/AIIMS rate, actual estimate for the procedure shall be considered.
3. The Hospital seeking advance shall provide item-wise break-up of the estimate to facilitate processing of the requests for medical advance, 90% of the admissible rates arrived at, as per para (2) above, would be considered for grant of Medical advance.
4. The other terms and conditions mentioned in the OM No 14025/18/2015-MS/EHSS dated 17th October 2016 shall remain unchanged.
Signed by Rajender Kumar
Date: 22-09-2021 11:37:15
Under Secretary to Government of India