The government has issued an important clarification for Central Government Health Scheme (CGHS) beneficiaries regarding follow-up consultations, medical tests and minor procedures.
The clarification comes after several medical reimbursement claims faced problems because of confusion over existing CGHS rules.
The government has now explained where beneficiaries need to go for follow-up treatment and when a referral from a CGHS Wellness Centre is required.
Where Should You Get Follow-Up Treatment?
Under the clarified guidelines, follow-up consultations, investigations and minor procedures should generally be done at the same CGHS-empanelled hospital where the initial consultation took place.
There are also specific rules for medical tests.
If a specialist at an empanelled hospital prescribes a test costing up to ₹3,000 per test, the beneficiary must get it done at the same hospital or healthcare organisation where the initial consultation was conducted.
However, if the beneficiary wants to get the test done at another CGHS-empanelled hospital, healthcare organisation or diagnostic centre, they must first obtain a referral or endorsement from a CGHS Wellness Centre.
Referral Needed for Expensive Tests
For costly and specialised investigations, a CGHS referral or endorsement is required.
This includes tests such as:
CT scans
MRI scans
PET scans
Other investigations costing more than ₹3,000
This means beneficiaries should check the referral requirement before getting an expensive test done at another facility.
Consultation Remains Valid for 7 Days
The government has also clarified that each consultation will remain valid for seven days, provided the follow-up relates to the same medical specialty.
For eye-related consultations, the consultation fee will include refraction, tonometry and fundus examination.
If a specialist at a CGHS-empanelled hospital recommends an investigation or procedure that is not listed under the existing CGHS package, prior permission from the concerned department or office is mandatory.
CGHS Pensioner Card Process Gets Easier
There is also good news for retiring government employees and pensioners.
The Health Ministry has integrated the CGHS web portal with the Bhavishya portal to make the process of getting a CGHS Pensioner Card easier.
The new system is designed to reduce paperwork and avoid unnecessary delays during retirement.
Under the integrated system, approved pension-related information available on the Bhavishya portal will be automatically used to pre-fill the CGHS Pensioner Card application.
What Does This Mean for Retiring Employees?
The integration is aimed at making the transition from government service to retirement healthcare smoother.
The Department of Health & Family Welfare and the Department of Pension & Pensioners’ Welfare have worked together to connect the two portals.
With the new technology-based process, retiring employees and pensioners can expect a simpler and more paperless application process for CGHS healthcare benefits after retirement.
The move is expected to reduce manual work and help eligible retirees receive their healthcare benefits more efficiently.
