Reimbursement for Treatment in Non Empanelled Hospitals for CGHS Beneficiaries

RAJYA SABHA UNSTARRED QUESTION NO-2344

ANSWERED ON-07.08.2018

Shri Ram Kumar Kashyap

(a) whether Supreme Court while disposing off Writ Petition (Civil) No. 694 of 2015 has ordered that reimbursement cannot be denied to CGHS beneficiaries even if they received treatment in a hospital not empanelled under the plan;

(b) if so, whether CGHS beneficiaries can take treatment in any hospital not empanelled under CGHS in view of the recent Supreme Court Judgement;

(d) the details of medical claims pending in CGHS Delhi South Zone, R. K. Puram, Sector-8 Dispensary for more than three years and by which date the said claims will be settled?

ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE
(SHRI ASHWINI KUMAR CHOUBEY)

(a) to (c): Hon’ble Supreme Court of India vide its Judgement dated 13th April, 2018 in the WP (Civil) No. 694 of 2015 between Shri Shiva Kant Jha Vs UoI has given directions to frame guidelines for settlement of medical claims of pensioners within 1 month and for constitution of a High Powered Committee for settlement of grievances of medical claims of pensioners. Accordingly, Office Memoranda No. Z.15025/38/2018/DIR/CGHS, dated 14.05.2018 and No. Z.15025/38/2018/DIR/CGHS/EHS, dated 22.05.2018 have been issued for fixation of timelines for settlement of medical claims of pensioners and constitution of High Powered Committee respectively.

There is already a provision under CGHS for consideration of medical expenditure incurred for treatment under emergency in non-empanelled hospitals at CGHS rates and to undergo treatment in non-empanelled hospitals at CGHS approved rates after obtaining permission from Competent Authority.

(d): No claim with proper supporting documents is pending for more than three years.

Authority: https://rajyasabha.nic.in/