Rules, Rights & Rites -24 Advisory to CGHS Pensioner Beneficiaries regarding the migration to TMS 2.0
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Advisory to CGHS Pensioner Beneficiaries regarding the migration to TMS 2.0 and implementation of Revised CGHS Rates, effective 00:00 hrs, October 13, 2025:
• CGHS is migrating to NHA platforms (TMS 2.0/UMP/HEM 2.0) and implementing Revised CGHS Rates. Which are effective from 00:00 hrs (midnight) of October 13, 2025.
• The instructions are aimed at CGHS Pensioner beneficiaries who are eligible for credit.
• Care will not be denied due to the referral issue date. Empanelled Health-Care Organisations (HCOs) must provide treatment even for valid referrals issued before 13/10/2025.
• OTP verification on the beneficiary's registered mobile number is mandatory in TMS 2.0 for claim submission. Beneficiaries must share the OTP with the HCO upon request.
• Beneficiaries must ensure their mobile number is updated in the CGHS database. To update, contact the nearest CGHS Wellness Centre (WC).
• If the TMS portal shows a missing photograph or ward entitlement, the beneficiary must contact the Office of the concerned Additional Director (AD) City where the card is registered for updates.
• Under exceptional circumstances, the attendant's mobile number may be used for OTP verification, which the HCO must record in TMS 2.0 along with the attendant's relation.
• Beneficiaries are requested to cooperate when the HCO captures a geotagged photograph at the point of care.
• A CGHS feedback form must be filled out at discharge as part of quality monitoring.
• The Beneficiary/Patient's Attendant must clearly state on the form if any amount was collected during admission.
• Services on or after 13.10.2025 (00:00 hrs) are covered by the Revised CGHS Rates. Services up to 12.10.2025 (23:59 hrs) are covered by the Old CGHS Rates.
• If the HCO charges for inadmissible items (those not payable under CGHS rules), the HCO must issue a separate bill/receipt to the beneficiary. These inadmissible items must not be included in the final bill claimed from CGHS. Beneficiaries should collect and retain proper bills/receipts for any payments made.
• Every empanelled HCO must maintain a grievance redressal mechanism, and beneficiaries should approach the Nodal Officer if needed.
• If a beneficiary receives an SMS/intimation for a service not availed, they must immediately inform the office of the respective AD City where the card is registered.
• Any misuse of the CGHS card by a beneficiary or HCO constitutes an offence and will attract action under applicable rules and law.
• The HCO can collect payment from the beneficiary for these items, but they must issue a separate bill.
• Toiletries and Personal Use Items (e.g., soap, hand sanitizers, diapers) , Cosmetics , Non-Medical Services/Overheads (e.g., patient's attendant food, internet fees, carry bags) , Attendant Charges (for an ayah/ward boy) , and Mortuary/Cremation charges.
• These are considered part of standard charges and must not be billed separately to CGHS or the beneficiary.
• Examples include: Glucometer strips (if used for bedside monitoring) , ECG leads/electrodes, Ventilator circuits/consumables, Ward facilities like airbed/infusion pumps , and charges for issuance of medical records/films. Items Included Under Package Rates (Not Billed Separately) services are integral to inpatient treatment or ward charges.
• Examples include: Registration/Admission charges , Special beds for bed sore prevention (Alpha bed, etc.) , Biomedical waste management fee, laundry charges, Patient's diet and dietician consultation, and Preparation of discharge summary/medical record copying.
(MOH & FW OM dated 12.10.2025 Advisory to CGHS Beneficiaries)
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