The Central Government has provided significant relief to lakhs of beneficiaries under the CGHS (Central Government Health Scheme). The Ministry of Health has enhanced the financial powers of officials regarding approvals for medical reimbursements and treatments; an official memorandum has been issued to this effect. The objective of this decision is to expedite the settlement of medical claims and ensure timely relief for beneficiaries.
**Significant Hike in Medical Claim Limits**
The government has substantially raised the approval limits for hospital bills and medical claims. Additional Directors (CGHS City/Zone) can now approve claims up to ₹15 lakh, up from the previous limit of ₹7 lakh. Similarly, the limit for the CGHS Director has been increased from ₹15 lakh to ₹25 lakh. Meanwhile, the Additional Secretary and Director General (DG) of CGHS can now approve claims up to ₹50 lakh. Cases exceeding ₹50 lakh will still require approval from the Ministry of Health and the Department of Finance.
**Relief on Tests, Surgeries, and Implants**
Approval limits have also been raised for medical tests, surgeries, or implants for which no specific CGHS package rate exists. Additional Directors can now approve up to ₹2 lakh, Directors up to ₹5 lakh, and the DG CGHS up to ₹10 lakh. This will reduce delays in patient treatment.
**Easier Treatment at Non-Empanelled Hospitals**
Under the new system, pensioners, former MPs, freedom fighters, and CGHS employees can undergo treatment at non-empanelled hospitals or laboratories. Additional Directors have been authorized to approve in such cases. However, reimbursement will be based on either the CGHS package rate or the actual expenditure incurred, whichever is lower.
**Relief for Procedural Lapses**
Relief will now be available even if a patient failed to obtain the necessary prior permission or recommendation during treatment. Additional Directors can grant approval in such instances, though payment will be made strictly in accordance with established rules.
**What are the benefits?**
This decision will accelerate the settlement of medical claims and eliminate the need to repeatedly send files to the Ministry. This will ensure that pensioners and other beneficiaries receive payments on time. At the same time, the entire process will become more transparent and simplified, leading to a reduction in pending cases.
Disclaimer: This content has been sourced and edited from NDTV India. While we have made modifications for clarity and presentation, the original content belongs to its respective authors and website. We do not claim ownership of the content.
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