GUIDELINES / CRITERIA FOR REIMBURSEMENT OF EXPENSES FOR IN-VITRO FERTILISATION (IVF) TREATMENT TO CGHS BENEFICIARIES AND BENEFICIARIES UNDER CENTRAL SERVICES (MEDICAL ATTENDANCE) RULES. 1944 Government of India

Government of India

Ministry of Health and Family Welfare

Department of Health & Family Welfare

Nirman Bhawan, New Delhi 110 108

No: Z.15025/5/201 1-CGHS III/CGHS (P)  Dated, 2 November, 2011

OFFICE MEMORANDUM

Subject: Guidelines / Criteria for reimbursement of expenses for In-Vitro Fertilisation (IVF) treatment to CGHS beneficiaries and beneficiaries under Central Services (Medical Attendance) Rules. 1944.

            The undersigned is directed to say that the Ministry of Health & Family Welfare has been receiving requests for providing clarifications as to whether the expenditure incurred on In-Vitro Fertilisation ((IVF) treatment is admissible under CGHS, and if so. whether any guidelines have been laid down for reimbursement of the expenses incurred on IVF treatment.

            (2) The matter has been examined by a Technical Committee of the Heads of Department of Gynaecology & Obstetrics of Government Medical institutions, and based on the recommendations of the Committee, the following guidelines are laid down for considering cases for reimbursement of expenses incurred on IVF treatment by CGHS beneficiaries and beneficiaries under Central Services (Medical Attendance) Rules, 1944:-

(I) Requests for IVF treatment will be considered only on the basis of advice tendered by the Head of Department of Gynaecology & Obstetrics of a Government Medical institution;

            (ii) Permission for IVF treatment to be undertaken may be given by the Head of Department in the Ministries / Departments on the recommendations of the Head of Department of Gynaecology & Obstetrics of a Government Medical institution;

            (iii) IVF procedure will be allowed in a Government Medical institution on the recommendations of the Head of Department of Gynaecology & Obstetrics of a Government Medical institution;

(iv)      IVF procedure may be allowed, on a case to case basis, in a private medical institution if the Institution is registered with the State / Central Government and has the necessary facilities including equipment and trained man power for carrying out the procedure. It is, however, mandatory to obtain the recommendations of the Head of Department of Gynaecology & Obstetrics of a Government Medical institution for permitting the procedure to be undertaken in a private institution;

(V)       There should be clear evidence of failure of conventional treatment before permitting IVF treatment procedure;

(vi)      The age of women undergoing IVF treatment procedure should be between 21 and 39 years

(vii)     The woman has to be married and living with her husband;

(viii)    The IVF treatment procedure will be allowed only in cases of infertility where the couple has no living issue

(ix)      Reimbursement of expenditure incurred on IVF procedure will be allowed upto a maximum of 3 (three) fresh cycles;

(X)       An amount not exceeding Rs.65,000/- (Rupees sixty five thousand only) per cycle or the actual cost, whichever is lower, will be allowed for reimbursement. This amount will be inclusive of the cost of drugs and disposables and monitoring cost during IVF procedures;

(x         i) As IVF treatment is a planned procedure, reimbursement cases can be considered by the Ministries / Departments only if prior approval was obtained by the beneficiary for undergoing the IVF treatment.

(xii)     There will be a onetime permission for availing IVF treatment consisting of three cycles in total, which would be admissible to the beneficiary. The concerned Ministry / Department shall obtain an undertaking from the applicant that he / she has not claimed the reimbursement earlier from the Government of India in the past and will not claim it in the future.

            These guidelines come into force from the date of issue of the Office Memorandum and reimbursement cases of IVF treatment undertaken after the issue of the Office Memorandum only can be considered by the Ministries / Departments.

4. This issues with the concurrence of Integrated Finance Division in the Ministry of Health & Family Welfare, vide Dy. No.C.1747/IFD (Health)/2011 dated the 21stNovember,October, 2011

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[V.P. Singh]

Deputy Secretary to the Government of India

EXPANSION OF PREVENTIVE HEALTH CHECK UP PROJECT IN CGHS DELHI

Government of India

Ministry of Health and Family Welfare

Department of Health and Family Welfare

Nirman Bhawan, New Delhi-110108

No. 11-25/2009-CGHS/SZ/CGHS(P)

Date: 22nd December, 2011

OFFICE MEMORANDUM

Sub: Expansion of Preventive Health Check up Project in CGHS Delhi.

            A Pilot Project was initiated for Preventive Health Checkup at CGHS Wellness Centre R. K. Puram-V, New Delhi in the year 2010-11. On the basis of the feedback received and also keeping in view of the importance of Diagnosis of Chronic Non-communicable Health Problems at the preventive level, it has been decided to expand the project to other dispensaries of CGHS Delhi-NCR. 8 Wellness Centres have been identified in order to initiate the project activity which will cover the whole of CGHS Delhi as referral centres on zonal basis. The dispensaries are as follows-

1. CGHS Wellness Centre, R.K. Puram-V(South Zone)

2. CGHS Wellness Centre, Sadiq Nagar (South Zone)

3. CGHS Wellness Center, Chanakya Puri (Central Zone)

4. CGHS Wellness Centre. Pandara Road (Central Zone)

5. CGHS Wellness Centre. Janakpuri-I(North Zone)

6. CGHS Wellness Centre. Shalimar Bagh(North Zone)

7. CGHS Wellness Centre, Kingsway Camp (East Zone)

8. CGHS Wellness Centre, Ghaziabad (East Zone)

      The beneficiaries of the same zone may be referred to the two project centres for Preventive Health Checkup depending upon the laid down criteria.

      The beneficiaries above the age of 40 years are to be covered under this project. The beneficiaries' referral has to be done on-line through the In-charge module. The service beneficiaries should be issued a referral slip for further reimbursement at their own offices Serving beneficiaries will not require any permission from their respective offices/departments for this purpose once they are referred by their respective CMO I/c to undergo Preventive Health Check up. Reimbursement would be done as per the package rate of Rs. 790/- for man and Rs.875/- for woman beneficiary. Pensioner beneficiaries would be provided cashless facilities M/s Hindlabs (a unit of HLL Lifecare Ltd.). the service provider, would raise bills in respect of the preventive health check up scheme, directly to the Additional Director CGHS of the concerned zone.

      Initially the project will operate on two days a week at every project centre (dispensary) which may be extended depending on the response received. It is decided to conduct Preventive Health Check up on 50 beneficiaries in a day at every project centre M/s Hindlabs will conduct laboratory and E.C.G. investigation as per package for this Preventive Health Checkup. It will setup collection centres at 8 earmarked dispensaries along with facility for E.C.G.

      There will be arrangement for proper health education by means of Audio Visual and IEC materials at these project centres which will be supplementary to the clinical and laboratory investigations under this project.

CMO I/c of the Wellness Centres along with the In-charge of the project centres will maintain proper record of the activities for further evaluation of the project in future.

      This project will start functioning w.e.f. 1st January, 2012.

      All the CMO I/c of Wellness Centres are requested to take note of the new facility that has become available and to give wide publicity to the same in their Wellness Centres for the benefit of CGHS beneficiaries registered with them and refer the interested beneficiaries to the Preventive Health Checkup centres.

      All Ministries/Departments are also requested to publicize this facility among their staff members and note that the expenditure incurred by the serving beneficiaries is to be reimbursed as per the package rate of Rs. 790/- and 875/- for man and woman beneficiary respectively for the purpose of Preventive Health Checkup. Any further information if required may be obtained from CMO Project at Office of the Additional Director, CGHS (HO), New Delhi.

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(V.P.SINGH)

Deputy Secretary to the Government of India

 Source: www.msotransparent.nic.in/

RENEWAL OF CGHS CARDS

1986 Shri TUFANI SAROJ

QUESTION

(a)    the process of renewal and issuance of CGHS cards to the beneficiaries;

(b)     whether the CGHS beneficiaries have to stand in queue for several days for obtaining the CGHS cards;

(c)     if so, the reasons for not adopting any centralised system for distribution of the CGHS cards;

(d)     whether there is any proposal to adopt any new convenient procedure for renewal of the said cards; and

(e)     if so, the details thereof and the time by which it is likely to be implemented? 

ANSWER

MINISTER OF THE STATE IN THE MINISTRY OF HEALTH & FAMILY WELFARE (SHRI GHULAM NABI AZAD)

(a)     The eligible persons are required to make an application in the prescribed proforma for issue of Central Government Health Scheme (CGHS) card for self and dependent family members. Serving employees are supposed to submit these forms after getting the entries verified and forwarded through their departments. Pensioners submit the application form with the requisite fee through Demand Draft as per their entitlements and period of validity. On receipt of the application and after due verification, a paper print out of the index card is issued to the applicant. This printout is valid for availing CGHS facilities till a plastic card is issued to the beneficiary.

(b) & (c)     The process now is a centralized one. All card related activities like submission of forms, distribution of cards, on line uploading of data and photographs, correction in database, addition and deletion to data base, receipt of subscription from departments and individuals etc. are managed by Card & Programme Section of Delhi CGHS (HQ). However, because of some manpower, logistic and infrastructure constraints, initial inconveniences have taken place. The situation has improved significantly.

(d) & (e)     Action has been initiated to further streamline the entire process of CGHS card making in order to make it hassle free and more convenient to the beneficiaries. Different systems for serving employees and pensioners beneficiaries are contemplated in which the CGHS cards are proposed to be delivered at the residence of the pensioners and at office of the serving employees.

Fresh empanelment of Private Hospitals and revision of package rates applicable under CGHS, Mumbai – Clarification regarding.

Department of Health & Family Welfare issued here a corrected list of package rates applicable for empanelled hospitals under CGHS, Mumbai. The list of hospitals, which are already empanelled / being empanelled under continuous empanelment scheme under CGHS, Mumbai are hereby requested to take note of the corrected rates (the bills already will not be opened). The other hospitals shortlisted for consideration of empanelment are also requested to accept the corrected rates and come forward to sign MOAs with Addl. Director, CGHS, Mumbai. We have reproduced the content of the order here for your information…

Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi 110 108

No:S.110011/23/2009-CGHS D.II/Hospital Cell (Part I)

Dated 28/08/2011

OFFICE MEMORANDUM

Subject: Fresh empanelment of private hospitals and revision of package rates applicable under CGHS, Mumbai – Clarification regarding.

The undersigned is directed to invite reference to the Office Memorandum of even number dated 1st September, 2011 on the above subject, vide which inter alia revised package rates applicable under CGHS, Mumbai were notified and to state that that in response to several representations received by this Ministry with requests for correction of typographical and other anomalies in the notified rates, the rates earlier notified for empanelment for empanelled hospitals under CGHS, Mumbai have now been reviewed.

2. Accordingly, a corrected list of package rates applicable for empanelled hospitals under CGHS, Mumbai is enclosed.

3.The hospitals, which are already empanelled / being empanelled under continuous empanelment scheme under CGHS, Mumbai are hereby requested to take note of the corrected rates (The bills already cleared will not be reopened.)

4. The other hospitals shortlisted for consideration of empanelment are also requested to accept the corrected rates and come forward to sign MOAs with Addl. Director, CGHS, Mumbai.

5. This issues with the concurrence of Finance Division vide Dy. No.561 dated 8th June 2011 of the Office of SS & FA, Min. of Health & Family Welfare.

A copy of this Office Memorandum along with the corrected rate list and a copy of MOA are placed on the internet at http://msotransparent.nic.in/cghsnew/index.asp

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(Jai Prakash)
Under Secretary to Government of India

Source : www.msotransparent.nic.in

Click here to download the above order

The salient features of the CGHS Scheme are enlisted below

Dispensary services including domiciliary care.

IPD (Indoor Patient) and OPD (Outdoor Patient) Services

F. W. (Family Welfare) & M.C.H. (Maternal and Child Healthcare) Services

Consultation facilities by Specialist and Super-Specialist Doctors provided at dispensaries, polyclinics and hospitals

Various Diagnostic tests including X-Ray, ECG and Laboratory (or Pathology) Examinations

Hospitalization

Organization for the purchase, storage, distribution and supply of medicines and other requirements pertaining to healthcare

Health Education and updating on related toCGHSbeneficiaries.

The dispensary is the backbone of the CGHS Scheme. Instructions on various matters and inter-related aspects are issued from time to time for the guidance of the Medical Officers and the Specialists and updating them with the latest issues pertaining to healthcare and its comprehensive management. With continuous and rapid expansion of this healthcare scheme, the situation has drastically improved especially related to the health issues concerning Governmental Employees included under this scheme. But, at the same time, a number of problems have arisen on account of it. On account of the rapidly expanding staff and manpower, various practices, procedures and instructions to be implemented in regard to the duties and responsibilities of hospital employees are not adhered to in a stringent manner. As a result, there is some laxity in the entire process and deficiency in the healthcare services under the CGHS. Various instructions and orders issued from time to time serve as a Compendium for the guidance of the CGHS staff.

Courtesy: CGHS