Medical Emergency Conditions Included Under The Purview of CGHS Act

CGHS Emergency Treatment

List of Emergency Conditions
The medical emergency conditions included under the purview of CGHS Act are enlisted below:

a) Acute Coronary Syndromes viz. (Coronary Artery By-pass Graft or Percutaneous Trans-Luminal Coronary Angioplasty) including Myocardial Infarction, Unstable Angina, Ventricular Arrhythmias, Paroxysmal Supra- Ventricular Tachycardia, Cardiac Tamponade, Acute Left-Ventricular Failure, Severe Congestive Cardiac Failure, Accelerated Hypertension, Complete Heart Block and Stokes-Adams Attack, Acute Aortic dissection.

b) Acute Limb Ischemia, Rupture of Aneurism, Medical and surgical shock and peripheral circulatory failure.

c) Cerebro-Vascular Attack, Strokes, sudden Unconsciousness, Head Injury, Respiratory failure, De-compensated Lung Disease, Cerebro-Meningeal Infection, Convulsions, Acute Paralysis, Acute Visual Loss.

d) Acute Abdomen

e) RTA (Road Traffic Accident) with injuries including fall

f) Acute Poisoning

g) Acute Renal Failure

h) Acute Abdomen in females including Acute Obstetrical and Gynecological Emergencies.

i) Heat Stroke

O.P.D. (Outdoor Patient Department) treatment and subsequent follow-up after hospitalization is not permitted in Private Hospitals and Diagnostic Centres recognized under CGHS. Exceptions for follow-up treatment are permissible in following conditions for a period of 3 to 6 months after conducting the surgical procedure, are as follows:

a. Neuro-surgery

b. Cardiac Surgery including Angioplasty

c. Cancer Surgery, Radiotherapy and Chemotherapy

d. Organ transplant viz. Kidney

e. Knee replacement.

f. RTA (Road Traffic Accident)

Revision of rates for reimbursement of medical expenses incurred in emergency conditions under CS (MA) Rules, 1944.

The undersigned is directed to state that the issue of revision of rates for reimbursement of medical expenses incurred on availing medical treatment in
emergency conditions under CS (MA) Rules, 1944, when treatment is taken in a non empanelled private hospital, has been under consideration of the Government for some time.

2. It has now been decided that, reimbursement of medical expenses incurred by a Central Government employee covered under CS (MA) Rules, 1944 on availing medical treatment for himself and his dependent family members in emergency conditions, would be allowed as per the prevailing non-NABH CGHS rates as applicable to a CGHS covered city and non-NABH rates applicable to the nearest CGHS covered city in case of non-CGHS city, as the case may be, or the actuals, whichever is less.

3. For the medical treatment in such cases where package rates are prescribed under CGHS, the non-NABH rates of the CGHS covered city and non-NABH rates of the nearest CGHS city (in case of non-CGHS covered city) or the actuals. whichever is less, will be applicable.

4. This OM supersedes all earlier orders issued from time to time under CS(MA)Rules, 1944 on this subject for allowing reimbursement of medical expenses in emergency conditions when treatment is taken in a non-empanelled private hospital.

5. This OM will come into effect from the date of issue.

6. This issues with the concurrence of the Integrated Finance Division vide their Dy.No.C-282 dated 22.05.2013.