The Union health ministry has simplified the referral system under Central Government Health Scheme (CGHS), permitting all beneficiaries to seek OPD consultations from specialists at empanelled private hospitals after due referral.
The referral will be mentioned on prescription slips, which will be computer-generated.
As per the new guidelines issued by the ministry, after the consultation at the empanelled hospital, a beneficiary shall report back to wellness centre concerned, where the medical officer or chief medical officer (CMO) would endorse listed investigation and issue medicines.
For unlisted treatment/ investigation procedure, CMO in-charge shall submit the prescription to the competent authority for consideration in case of pensioner beneficiaries.
The serving employees require taking permission for unlisted investigation/ treatment procedure from their department as per existing guidelines.
The medicines prescribed by specialists at empanelled private hospitals will be supplied by CGHS according to available generic names at the CGHS wellness centres.
As per the guidelines, if only an alternative brand name of a prescribed medicine having the same composition is available, it shall be supplied by the available brand name.
If the prescribed medicine is not available at the CGHS wellness centre either by generic name or alternative brand name, it shall be indented by the same brand name through authorised local chemist.
The validity of the advice of the central/state government specialist/CGHS medical officer shall be valid for 3-months for listed treatment.
In case of Haemo Dialysis, the advice for treatment can be made up to six months. However, in case of radiotherapy, chemotherapy, advised by a government specialist, the advice shall be valid for all cycles of radiotherapy/chemotherapy.
No other referral letter is required for treatment at any of the empanelled hospitals.
The specialist has to specify the procedure and self-attested (by the beneficiary) photocopies of the permission letter are required to be submitted, the order stated.
Central Government Health Scheme is providing comprehensive medical care to the Central Government employees and pensioners enrolled under the scheme. In fact, CGHS caters to the healthcare needs of eligible beneficiaries covering all four pillars of democratic set up in India namely Legislature, Judiciary, Executive and Press.
CGHS is the model Healthcare facility provider for Central Government employees & Pensioners and is unique of its kind due to the large volume of the beneficiary base, and open-ended generous approach of providing health care.