Lok Sabha Question No. 2282 (UNSTARRED), answered on 2015-12-11
Subject: CGHS
Ministry: HEALTH AND FAMILY WELFARE
Asked by: RAMESWAR TELI, SUBHASH RAMRAO BHAMRE

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 2282 TO BE ANSWERED ON 11 TH DECEMBER, 2015

## CGHS

## 2282. SHRI RAMESWAR TELI: DR. SUBHASH BHAMRE:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) the number of beneficiaries enrolled under the Central Government Health Scheme (CGHS) along with the details of facilities and medical equipment admissible to them;
- (b)  whether  instances  of  denial  of  ce rtainfacilities  and  medical  equipment  to  the CGHS beneficiaries despite doctor's advice have come to the notice of the Government, if so, the details thereof during the last three years and the reasons therefor along with the action taken by the Governmen t in this regard;
- (c) whether many CGHS empanelled hospitals have refused to treat the patients for non - payment of the outstanding dues causing serious problems to the CGHS beneficiaries, if so, the details thereof and the action taken by the Government i n this regard; and
- (d) whether the Government has taken note of inconvenience caused to the beneficiaries due to frequent break down/ deficient Internet services in CGHS dispensaries, if so, the details thereof alongwith the corrective action taken by theGovernment in this regard ?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE

## (SHRI JAGAT PRAKASH NADDA)

- (a) : The Central Government Health Scheme (CGHS) is providing comprehensive healthcare facilities  to  the  central  Government  employees  and  pensioners  and  some  other  sele categories of persons in 26 cities across the country.  At present there are 29,65,940 b eneficiaries enrolled under CGHS.

The facilities and medical equipments available to CGHS beneficiaries include:

- (i) OPD treatment and medicines from CGHS Wellness Centres .
- (ii) Specialist Consultation at Govt. Hospitals .
- (iii) Hospitalization at Govt. and CGHS empan elled hospitals .
- (iv) Investigations at Govt. and  empanelled Diagnostic centres .
- (v) Medical consultation and dispensing of medicines in Ayurveda, Homeopathy,    Unan and Siddha systems of medicine (AYUSH).
- (vi) In case of emergency, CGHS beneficiaries can go to any hospital, empanelled or n -empanelled and avail medical treatment.
- (vii) Reimbursement of expenses for treatment in Private unrecognized hospitals in case emergency.
- (viii) The beneficiary can go to any CGH S Wellness Centre in the country.
- (ix) Reimbursement of expenses incurred for purchase of medical equipments such as hearing aid, hip/knee joint implants, artificial limbs, pace makers, ICD/ Combo device, C Bi- PAP, Oxygen Concentrator, Neuro implants  etc. , as per the CGHS ceiling rates and guidelines.

(b): No instance of denial has come to the notice of the Government. At times, request received for issue of medical equipments / facilities which are not approved under CGHS. requests for such unapproved medical equipments and facilities are considered in consultati with the specialists in the field and are decided on a case to case basis.  In case the c experts  does  not  find  justification  for  the  requested  appliances/facilities,  th e  same  are  not provided.

(c): As per reports received from the field, at present, Ruby Hall Clinic, Pune has re the cashless facilities to serious/emergency cases, and cardiology and oncology cases on to pendency of hospital bills.

CGHS has cleared part of the outstanding dues of the hospital and process of cleara rest of the dues has been started by the Pay and Accounts Office.

(d): In order to deal with the situation of breakdown of internet connectivity due to t reasons, Chief Medical Officers -in charge (CMO i/c) of Wellness Centres have been provided user Data cards.  They also take up the matter with the officers of MTNL/BSNL and NIC early restoration of the same.  Instructions are also in place for issue of medic ines manually in case of breakdown in connectivity.