REF: BPMS / MH&FW / Advance / 156 (8/1/L)
Govt. of India, Min. of Health & Family Welfare,
156 – A, Nirman Bhawan,
New Delhi 110001.
Subject: Grant of Advance for Cancer treatment in Non-Empanelled Private Hospitals / Private Nursing Home under CGHS / CS (MA) Rules.
Considering the hardships being faced by cancer patient, vide O.M. No.1967/2013/DEL/CGHS/SZ/D52/CGHS(P) , Dated 30.12.2014 Department of Health & Family Welfare, CGHS (Policy) Division delegated the powers to HOD’s for permission / ex-post facto approval for cancer treatment taken in non-empanelled hospitals subject to reimbursement being restricted to CGHS rates or actual expenditure, whichever is less.
Further, as per O.M. No. s.12020/4/97-CGHS (P), Dated 07.03.2000 of Ministry of Health & Family Welfare (Department of Health) the Heads of Departments (HODs) may decide the cases of reimbursement of medical claims in respect of treatment obtained in emergency at private hospitals/private nursing home/private clinic, subject to item-wise ceiling as per rates prescribed for CGHS beneficiaries without financial limit on the total amount to be reimbursed.
Now, it has been experienced that a government employee covered under CGHS / CS(MA) Rules and resides in Kanpur, obtains the permission of Head of Department for treatment in Non-Empanelled Private Nursing Home/Hospital (for example Rajiv Gandhi Cancer Institute & Research Centre, New Delhi). After surgical treatment of Cancer, he needs post operative treatment (Chemotherapy) and he wants to continue his treatment from the same non-empanelled private nursing home/hospital. But the HOD refuses to grant advance for post operative treatment on the plea that advance may be granted in emergency for treatment in non-empanelled private nursing home and post operative treatment of cancer (Chemotherapy) does not fall under the category of emergency. In absence of advance, such employee finds himself unable to get treated and cured and that add insult to injury.
In such circumstances, you are requested to issue necessary orders so that the beneficiaries covered under CGHS / CS (MA) Rules may be granted medical advance being restricted to CGHS rates for post operative treatment of Cancer obtained from nonempanelled private nursing home/hospital.
Enclosed: As mentioned
1. The DHS, OFB, Kolkata Secretary/BPMS &
2. The US D(Civ-I), MoD, New Delhi Member, JCM-II Level Council (MOD)
-With request to take appropriate action.