GUIDELINES FOR CGHS BENEFICIARIES – DAPWA

GUIDELINES FOR CGHS BENEFICIARIES – DAPWA

Central Govt. Health Scheme is a boon for Central Govt. pensioners in the twilight year of their lives since the cost of Medical care has reached the seventh haven and affording treatment for diseases and other ailments has gone out of reach of the pensioners.

In order to dispel some doubts prevalent amongst beneficiaries of the scheme an effort has been made to provide some guidelines for the benefit of the members.

ELIGIBILITY
Central Govt. pensioners their spouses, dependent sons. below 25 years of age, daughters till the date of marriage or the date from which they start earning and dependent parents are eligible. Disabled Sons with 40% or more disability are also eligible even beyond the age of 25 years.

RATES OF CONTRIBUTION AND ENTITLEMENT FOR WARD/PRIVATE ROOM
Rate of contribution to the scheme is based on the grade pay appropriate to the scale of
pay prescribed by 6th CPC whereas the entitlement for hospital accommodation for Indoor
treatment is determined with reference to Basic Pay/Pension.

Rates for medical procedures, tests/investigations carried Out by NABL, Non-NABL hospitals and diagnostic laboratories are prescribed by Govt. from time to time.

ISSUE OF CGHS CARDS
Persons retiring from offices/establishments, located in CGHS covered areas, will be issued CGHS cards on the day of retirement, if they opt for CGHS coverage after retirement. Pensioner residing in Non-CGHS covered areas can also enroll themselves and eligible family members in the Weliness Centers nearest to their place of residence or any Wellness Centre by submitting application along with necessary documents to Addl/Jt. Director of the area. CGHS cards can also be issued to pensioners for indoor treatment only while they can continue to draw F.M.A.

VALIDITY
Plastic Card and CGHS token cards are valid for obtaining treatment at Wellness Centers throughout India.

INDOOR TREATMENT
Indoor treatment is provided to the beneficiaries in any of the empanelled hospitals on the recommendation of CMO Incharge. Depending upon the nature of treatment required the patient is referred to the hospital registered for the specific treatment viz. cardio, ortho, eye, general purpose etc.

EMERGENCY TREATMENT
In case of medical emergency beneficiaries and eligible members may obtain indoor treatment from any Govt./Recognized, Private Hospital approved under CSMA rules besides empanelled hospitals without recommendation of the CMO Incharge. Reimbursement for treatment in Private/Govt. Hospitals will be subject to CGHS approved rates.

DIAGNOSTIC TEST
Patients referred to Govt. Hospitals/Institutes for OPD Treatment can undertake diagnostic tests/investigations at the empanelled laboratories/centers, if recommended by the hospital, directly without reverting to Wellness centre for permission. It may be ensured in such cases that the hospital prescription slip is signed by the assistant professor / specialist of the hospital.

NOTE :- Please do carry your token card / plastic card while attending Wellness Centre, Collecting indented medicines, attending empanelled hospitals / labs / diagnostic centers.

R.P. Sharma
Legal Secretary
DAPWA(Regd.)

Source : www.dapwa.org
[http://dapwa.org/pdfdocs/Guidelines_for_CGHS_Beneficiaries.pdf]