A Landmark Judgment for Pensioners' Right to Life and Medical Reimbursement

 

                    CGHS AT A GLANCE.BLOGSPOT.COM /006/E                         Date 11/05/25

🏥 Clarification on Admissible & Non-Admissible Items under CGHS

Issued by: Government of India, Ministry of Health & Family Welfare

Date: 1st August, 2013

Reference No.: 2-1/2012/CGHS/VC/CGHS(P)

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📄 About the Office Memorandum

In compliance with the directions of the Hon’ble High Court of Delhi (W.P. (C) 9044/2011 – Sh. Kanhiya Singh Vs. UOI & Others), this Office Memorandum provides detailed clarification regarding which medical items and services are reimbursable under the Central Government Health Scheme (CGHS), and which are not.

This clarification is a reiteration and expansion of the earlier memorandum issued on 1st October 2012, meant for wider circulation and better understanding among CGHS beneficiaries.

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✅ What Does CGHS Package Rate Include?

The CGHS Package Rate is a lump-sum charge for in-patient, day-care, or diagnostic procedures. It includes, but is not limited to, the following:

• Registration, admission, and accommodation charges (including patient’s diet)
• Operation, injection, dressing, and anesthesia charges
• ICU/ICCU and monitoring charges
• Blood transfusion and operation theatre charges
• Surgeon’s/procedural fees
• Surgical disposables and other sundries
• Cost of medicines and essential investigations
• Physiotherapy charges
• Nursing care and service charges

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💉 What Else is Reimbursable?

Implants, stents, and grafts are reimbursable in addition to the package rate, as per CGHS ceiling rates or actual cost (whichever is lower).

In case of conservative treatment or where no package rate exists, item-wise reimbursement is allowed as per CGHS rates, AIIMS rates (if CGHS rate is not available), or actual cost.

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🚫 What Is Not Reimbursable?

Certain non-medical or personal use items are not reimbursable under CGHS, such as:

• Telephone charges     
  
• Toiletries
• Sanitary napkins
• Talcum powder
• Mouth fresheners 

🏥 Responsibilities of Empanelled Hospitals

• Hospitals are not allowed to ask beneficiaries or attendants to purchase medicines, disposables, or equipment separately during in-patient care.
• Treatment should be strictly within CGHS package rates, covering all required items and services.
• If a beneficiary is asked to purchase any items (excluding non-admissible ones) with specific doctor authorization, the cost is reimbursable and will be recovered from the hospital's pending bills.

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🕒 Extended Hospital Stay

Package rates include hospitalization duration as follows:

• Super-specialty treatment: 12 days
• Major surgeries: 7 days
• Laparoscopic surgery/Normal delivery: 3 days
• Day care/minor OPD procedures: 1 day

If a longer stay is medically justified, only room rent, tests (at approved rates), medicines, and doctor visit charges (max. 2/day) will be reimbursed.

No reimbursement will be allowed for extensions due to post-operative infections or procedural errors.

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⚖️ Legal Compliance

This memorandum is issued in strict compliance with the judgment of the Hon’ble Delhi High Court in W.P. (C) 9044/2011 and aims to ensure transparency and fairness in CGHS reimbursements.

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Issued by:

🖋️ [V.P. Singh]

Deputy Secretary to the Government of India

Quick Reference

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   CBWAI (Central Government Health Scheme Beneficiaries Welfare Association of India) is a registered, all-India welfare association. All are requested to join by clicking on link https://tinyurl.com/bde9r8vb

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Regards,

Chandra Kant Bapat

National Coordinator, CBWAI