CGHS New Rules: There is big news for the CGHS cardholders of the Central Government. The government has made the emergency service of the hospital easier than before for the CGHS cardholders. So that, treatment can start immediately without any hassle
CGHS New Rules: There is big news for the CGHS cardholders of the Central Government. The government has made the emergency service of the hospital easier than before for the CGHS cardholders. So that, treatment can start immediately without any hassle. The Ministry of Health has issued new guidelines for the cardholders of the Central Government Health Scheme (CGHS). The purpose of these guidelines is to make health services even easier. So that people can get better service for consultation, investigation and treatment in government and listed private hospitals. In the Office Memorandum (OM) issued on 24 September 2024, the Ministry of Health has changed the old rules related to referral and has issued a Standard Operating Process (SOP) regarding the new rules.
New CGHS rules for emergency cases
If there is an emergency situation, now the Healthcare Organization (HCOs) will not need to get referral or endorsement from CGHS. They can directly do cashless treatment. Provided that the patient gets an emergency certificate from the expert of the treating hospital. With this certificate, the hospital will upload the treatment claim on the BCA portal.
Even if any test or treatment is not in the list of CGHS for emergency treatment, referral will not be required. The hospital can get permission for this through the NHA portal, and there will be no need to take any permission from the local CGHS office.
Change in referral rules
Now the consultation memos received through CGHS will be valid for three months. If a CGHS medical officer refers you to an expert, then you can take consultation from that expert a maximum of six times within three months. If the primary consultant advises, then you can also take advice from two additional experts. These rules apply only to referrals given by CGHS medical officers. These rules will not apply to referrals from government hospitals.
Exemption for beneficiaries above 70 years of age
Beneficiaries who are 70 years or older will no longer need a referral to get consultation from any expert. These beneficiaries will be allowed to get direct treatment for any registered investigation or process in listed hospitals. However, if any test or procedure is not in the CGHS list, then permission has to be taken from the CGHS authorities.
Follow-up rules for special cases
Beneficiaries suffering from certain special diseases will be allowed to get follow-up consultation and investigations without any time limit on the basis of primary referral. These diseases include:
Post-cardiac surgery cases
Post-organ transplant cases
Post-neurosurgery cases
End-stage renal disease
Cancer Treatment
Autoimmune disorders
Neurological disorders
People suffering from these diseases will not need to seek repeated referrals for treatment or investigations.
