Stay Informed about New CGHS Referral Process – Positive Insights from the Latest Order Dated 28.6.2024

The Ministry of Health and Family Welfare has released updated guidelines for the CGHS Referral Process. It is important for all CGHS beneficiaries to familiarize themselves with these revised guidelines in order to access treatment without any complications.

Key factors in Revised Guidelines

1. Government hospital” shall also include all AIIMSs, Institutions of National Importance (INIS), North East Institutions, Tata Memorial Hospital and all other medical institutions under central government. No referral ‘‘permission/endorsement shall be required for undergoing consultation investigation/ treatment procedure including unlisted investigations/ procedures
2. A maximum 6 consultations shall be allowed during this validity period of 3 months.
3. Unlisted investigation(s) and treatment procedures advised by the Specialist of CGHS empaneled hospital can be considered
4. In partial modification of O.M. No. Z 215025/35/2019/DIR/CGHS/CGHS(P) dated 29.05.2019, the special provision for CGHS beneficiaries to avail Consultation/ investigations/ treatment procedures shall hereinafter apply to CGHS beneficiaries aged 70 years and above. as against 75 years

Revised guidelines for CGHS Referral Process

File No: 215025/19/2024/DIR/CGHS/EHS(Comp No. 8281286)
I/3687286/2024
Government of India
Ministry of Health & Family Welfare
(EHS Section)

Nirman Bhawan. New Delhi
Dated the 28-06-2024

OFFICE MEMORANDUM

Subject: Revised guidelines for Referral Process in CGHS-reg.

In partial modification of MoHFW OM No. Z.15025/117/DIR/CGHS/EHSS dated 15.01.2018 and 10.12.2018. the undersigned is directed to convey approval of the Competent Authority for issue of revised guidelines for referral procedures for Consultation, Investigations and Treatment in Government and Private hospitals (empanelled with CGHS), as per details given below:

A. In continuation of OM No Z.15025/18/2020 dated the 09.10.2020 the term “Government hospital” shall also include all AIIMSs, Institutions of National Importance (INIS), North East Institutions, Tata Memorial Hospital and all other medical institutions under central government. No referral ‘‘permission/endorsement shall be required for undergoing consultation investigation/ treatment procedure including unlisted investigations/ procedures.

Treatment and Investigation process at Private empanelled hospital

B. Treatment at Private empanelled hospital(s):

i) Single referral for Specialist Consultation: A referral issued by any Medical Officer of a CGHS Wellness Centre will be valid for three months. During this period. the beneficiary may consult two more specialists i.e. up to total of three specialists, if recommended by the primary specialist. A maximum 6 consultations shall be allowed during this validity period of 3 months.

ii) Investigation and treatment Procedures advised by specialist of empanelled private hospital after referral by CGHS: No further endorsement from CGHS shall be required for undergoing routine listed investigations and minor procedures, not requiring admission in the hospital. as advised by the specialist, within the validity period of 3 months from the date of issue of the initial referral. However, Referral/endorsement from CGHS shall be required for special investigations like CT Scan, MRI Scan. PET Scan and any other investigation costing over Rs. 3.000/- and the referral will be valid tor 3 months.

iii) Correspondingly, referral’ endorsement would be required from Medical Officer of CGHS for any procedure requiring admission in the hospital. which would be valid for 3 month.

iv) Unlisted investigation(s) and treatment procedures advised by the Specialist of CGHS empaneled hospital: Permission for undergoing such investigations and treatment procedures shall be considered as per the delegated powers vide OM Z.15025/14/2023/ DIR/CGHS dated 27.12.2023 in case of pensioners and OM No. S 12020/4/97-CGHS(P) dated 07.04.1999 in case of serving employees. i.e.

• CGHS (Additional Director/ Director) in case of Pensioner beneficiaries.
• Head of the Department/ Office (HOD/HOO) in case of serving employee(s)

v) In partial modification of O.M. No. Z 215025/35/2019/DIR/CGHS/CGHS(P) dated 29.05.2019, the special provision for CGHS beneficiaries to avail Consultation/ investigations/ treatment procedures shall hereinafter apply to CGHS beneficiaries aged 70 years and above. as against 75 years prescribed in OM as mentioned above dated 29.05.2019. The other conditions shall remain unchanged. The beneficiaries can also avail of the services through tele-consultation facility available through e-Sanjeevani 2.0 (https ://esanjeevani.mohfw.gov.in/).

vi) In case of treatment under emergency and post-operative follow-up treatment, the instructions shall remain as per extant rules. Reference Instructions:

• O.M. No. S.11011/29/2019-EHS dated 13.09.2019.
• O.M. No. Z 215025/35/2019/DIR/CGHS/CGHS(P) dated 29.05.2019 (regarding post-operative follow-up treatment).

Signed by
Hemlata Singh
Under Secretary to the Govt of India

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