16. If during a spell of treatment of a disease another disease occurs, then consultation made for it will be fresh first consultation and a separate new spell.
17. Medical
claim should be preferred within six months of completion of the treatment. However, the Departments may
condone delay beyond 6 months. The three months have been raised under OM No.S 14025/19/2015-MSdated 27.05.2015.
18. Family means for
availing medical treatment
(i) Husband/wife
(ii) Parents &Step
mother
3
Note: In case
of adoption, only the adoptive and not the real parents. If the adoptive father
has more than one wife, his first wife only. A female employee can choose to
include either her parents or her parents in
law. Option exercised can be changed only once during one's
service. Resident condition is not
applicable for parents.
(iii) Children
Unmarried
Son- Till he starts earning or attaining the age of 25, whichever is earlier.
Daughter -
Till she starts earning or gets married, whichever is earlier (irrespective of age limit).
Son
suffering from permanent disability or mentally - no age limit.
(iv) Widowed daughter and dependent divorced/separated
daughters, irrespective of age limit.
(v) Sisters including widowed, divorced/separated sisters
irrespective of age limit.
(vi) Minor brothers and dependent brothers' up to the age of
becoming major.
(vii) Minor children of
widowed/separated daughters.
(viii) Permanently disabled dependent brother. (No age limit)
provided he is unmarried, not having his own family, wholly dependent on and
residing with the principal CGHS card holder or beneficiary.
19. Advance may be paid irrespective of pay limit for inpatient
hospital treatment. The advance may be paid in one or more instalments for
the same illness or injury. There is no
limit for the number of advances payable to an official with reference to
himself and to each member of the family
and in each case of illness.
20. When advance is paid direct to the hospital, the official
should submit the bills for final settlement within one month from the date of
discharge from hospital. The Head of the office will correspond directly with the hospital for a refund of the
unutilized balance, if any.
21. For Major illness of Bypass surgery, kidney transplant etc,
90% of the package deal wherever it exists, or the amount demanded by the hospital concerned in other cases.
22. In case
of serious illness/accidents, the wife or other legal heir may apply for
advance on behalf of the Government servant.
23. Reimbursement of ambulance
charges:
i) The ambulance should be
used within the same city and also belong to Govt./Local Fund or Social service
organization.
ii) It should
be certified that the conveyance of the patient by any other means would definitely endanger his life or
aggravate his health condition. iii) It should be used between one hospital to
another for certain medical
examinations.
24. Expenses incurred on the surgery and post-operative care of
the donor of the Kidney to the employees
or to a member of their family for
transplantation will be reimbursed. TA is also admissible.
25. In case
of emergency treatment, reimbursement shall be allowed in non - NABH rates under CGHS for the city or nearest CGHS City.
26. Requests for relaxation of procedures in considering the
claims shall be referred along with specified documents (OM No. S.11024/1/2015
CGHS (P) dated 01.01.2016)
Very good presentation. Sir I enjoyed to read rulings 🙏
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