The Central Government Health Scheme (CGHS) has introduced new rules aimed at making healthcare services easier and quicker for central employees and pensioners. The updated guidelines, released by the Ministry of Health, focus on streamlining emergency care and simplifying the referral process for consultation and treatment in both government and empanelled private hospitals. With these new regulations, CGHS cardholders can now receive timely treatment in emergencies without the previous hurdles.
Emergency Treatment Now Available Without Referral
In a significant move to improve healthcare for CGHS beneficiaries, the new rules state that hospitals will no longer need referrals or endorsements from CGHS for emergency cases. This allows for immediate cashless treatment, provided the hospital obtains an emergency certificate from a specialist treating the patient. Hospitals are then required to upload the treatment claim to the BCA portal, ensuring a smooth and quick process.
Furthermore, if a test or treatment not listed under CGHS is required during an emergency, hospitals can request approval via the NHA portal. This removes the need for permission from the local CGHS office, ensuring faster care for patients in urgent situations.
Simplified Referral Rules for Consultations
Under the revised rules, the referral process for consultations has been made more convenient. The consultation memo from CGHS will now be valid for three months. If referred to a specialist by a CGHS medical officer, beneficiaries can consult the specialist up to six times within this three-month period. Additionally, two more specialists can be consulted if needed based on the primary specialist’s advice.
These updated rules only apply to referrals given by CGHS medical officers and do not extend to referrals from government hospitals. This change is designed to give beneficiaries more flexibility and better access to necessary consultations.
Special Exemptions for Beneficiaries Over 70 Years Old
For beneficiaries aged 70 years and above, the rules have been relaxed further. They no longer require a referral to seek consultation from specialists. These senior beneficiaries can directly access treatment for any registered tests or procedures in empanelled hospitals. However, if a particular test or procedure is not included in the CGHS list, they will still need permission from CGHS officials to proceed.
This exemption is expected to make healthcare services more accessible for older beneficiaries, reducing the paperwork and time involved in getting the necessary treatment.
Follow-Up Consultation Rules for Special Cases
Patients with certain chronic or severe conditions have also been given additional flexibility. Beneficiaries suffering from specific ailments, such as post-cardiac surgery, organ transplant, cancer, end-stage renal disease, neurological disorders, autoimmune disorders, or post-neurosurgery cases, will not need repeated referrals for consultations and tests.
Once a primary referral is given, these patients can continue with their treatment and required testing without the hassle of acquiring multiple referrals. This is a much-needed relief for those undergoing long-term treatment for serious health issues, ensuring continuous care without unnecessary delays.
With these updates, CGHS is aiming to make healthcare more accessible and less complicated for its cardholders, especially in emergency situations and for the elderly. The new rules are a step forward in improving healthcare services for central government employees and pensioners across India.
