Reimbursement Of Medical Claim For Emergency Treatment In Non Empanelled Hospital

REIMBURSEMENT OF MEDICAL CLAIM FOR EMERGENCY TREATMENT IN NON EMPANELLED HOSPITAL

1. A Clarification was sought from the Chief Medical Officer (SAG), CGHS Mumbai on the rates at which the claims are settled of CGHS beneficiaries. The CGHS authorities have clarified vide their letter No. 3(xiv)3/13 Gen1/1958/13 dt 30 Aug 13 that reimbursement at 25% higher rate that the 2002 CGHS rates is applicable to those who have taken treatment in private non empanelled hospital through CGHS in Mumbai.

2. Based on the above provision provided by CGHS reimbursement at 25% higher rates that 2002 CGHS rates will also be applicable to those ECHS members who have taken any emergency treatment in a non empanelled hospital for or for those undergoing any planned listed procedure in a non empanelled hospital after taking prior sanction of Central Org ECHS.

3. The above orders are applicable till further instructions.