Central Government Health Scheme: CGHS referral rules changed for these beneficiaries : 23-10-2019

CGHS referral new rules 2019: The Central Government Health Scheme (CGHS) beneficiaries who are above 75 years of age have been given some relief when it comes to availing health services such as CGHS OPD consultations, annual health check-ups and CGHS treatments in empanelled hospitals. The CGHS centres are set up to provide basic medical services and if required depending on the treatment, they can refer the medical case to government hospitals or even private hospitals. If it is an emergency situation, the beneficiary need not wait for any permission or endorsement from the CGHS centre, however, for a non-emergency situation, an endorsement from the CGHS centre is required.

CGHS 75 year age rule

As per the new CGHS rules, the CGHS pensioners who are aged 75 years and above have been permitted to undergo annual health check-up at CGHS empanelled hospitals. The CGHS circular for 75-year-old states that the permission to the primary cardholder who is aged 75 years and above will be granted by CMO in charge of the CGHS wellness centre.

The beneficiary can undergo the check-up from a private hospital empanelled under CGHS as per CGHS rate list and will also get the cashless facility for the treatments.

The government had also allowed elderly CGHS beneficiaries who are 75 years and above to seek consultations from Specialists without any endorsement from the CGHS centres. The beneficiary is also permitted to consult up to 3 Specialists if required in a single visit to the hospital.

Also, investigations advised by Specialist of the private empanelled hospitals may be undertaken if they are required in an emergency as certified by Specialist without endorsement by CGHS. They can, therefore, now undergo treatment or investigations without any prior CGHS referral letter.

However, permission will be required only for any unlisted treatment procedure or tests in non-emergency conditions.

CGHS referral rules – For OPD consultations

As per the CGHS OPD rules, there is no requirement of referral for beneficiaries to avail OPD consultation from specialists in any Government Hospital.

In the case of OPD consultation from Specialists in any of the CGHS empanelled hospitals, beneficiaries in all CGHS Cities below the age of 75 years need a referral from the Medical Officer or CMO In-charge of the Wellness Centre. The referral shall be valid for consultations up to 3 times in the same hospital within 30 days.

Beneficiaries who are aged above 75 years can directly avail the OPD facilities at the empanelled CGHS hospitals without any referral from the Medical Officer of CGHS but only by showing CGHS card. If any investigations or procedures are advised and required in an emergency, no additional permission or endorsement is required from the Medical Officer of CGHS.

Source : PTI