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May 16, 2010

CGHS – CS(MA) Rules


27.1    The  CentralGovernment  servants  are  entitled  to medical  facilities  under the  Central  Services  (Medical  Attendance)  Rules,  1944,  the  salient  features  of which are given hereunder:  

27.2    These Rules are applicable to all government servants other  than  (i) those in Railway Service, and  (ii)  those of     non-gazetted  rank  stationed  in or passing through  Kolkata,  whose  conditions  of  service  are  prescribed  by  rules made  or deemed  to have been made by  the Central Government, when  they are on duty, leave  or  foreign  service  in  India  or when under  suspension.    Following medical facilities are available under these rules:  
In India only -
1.  Avitaminosis and Hypovitaminosis.

2.  Correction  of  squint  (eye).   Testing  of  eye  sight  for  glasses  of  the employees once in three years.

3.  Disease(s) causing general debility and secondary anaemia.

4.  Treatment  for  immunizing and prophylactic purposes  in the case of communicable diseases only. 

5.  Venereal diseases andDelirium Tremens.

6.  Treatment of  sterility and operation for sterilization.

7. Medical  termination  of  pregnancy  performed  at  government hospital/recognised institutions etc.   

8.  Confinement including at residence if attended by Child Welfare and Maternity Centres staff ; prenatal and post – natal treatment.

9.  Blood and blood transfusion charges.

10.  Dental  treatment  (only  in  government  hospitals,  private  recognised hospitals)  -  Surgical 
operations  needed  for  removal  of  Odontomes and  impacted wisdom  -  tooth,  Treatment  of  gum  boils, Extraction, Scaling  and  gum  treatment  including  pyorrhoea  and  Gingivitis, Filling of teeth ,Root canal treatment etc.

11.  Anti-rabic treatment.

12.  Cost of Hepatitis Vaccine B & C.

Following treatment can be availed outside India also -

a)  Cardio vascular Surgery.

b)  Kidney  and other organ Transplant.

c)  Joint replacement and surgery. 

d)  Bone-marrow transplant.

e)  Certain  types  of  medical  and  oncological  disorder,  such  as Leukaemia and neoplastic

f)  Micro vascular and neuro surgery.

g)  Treatment with laser which obviates the need of open surgery.

h)  Treatment with  Argon, Krypton and Yag Laser in  Ophthalmic cases.

i)  Extra corporeal stone disintegration by ultrasonic shock waves.

27.3    A government servant desirous of availing medical  treatment outside India may make an application in the prescribed form through his Department/Ministry to  the    Standing  Committee  established  under  this  rule.    On  receipt  of  such application, the Standing Committee, if after due consideration it is satisfied that the  patient  can  be  treated  only outside  India,  may  issue  a  certificate  to  the concerned Department/Ministry conveying its approval of the application and the concerned  Department / Ministry  shall,  on  the  strength  of  that  certificate  incur necessary  expenditure  in  getting  the  government 
servant  concerned  or  the member of his  family treated  in accordance with the procedure  laid down by the Committee (Rules 8 & 11).

27.4    For getting medical  treatment by  the Central Government servant and his family members in India, the following Hospitals/Institutions are recognised:

1. All  State  Government  hospitals  including  those  maintained  by Local Bodies.

2.  All hospitals,   primary health centres, maternity and child welfare centres and dispensaries  recognised by State Governments  for    treatment of their employees and/or members of their families.

3.  All  hospitals/dispensaries  attached  to  Public  Sector Undertakings/Projects/Port Trusts.

4. Cantonment  hospitals  in  cantonment  areas  where  there  are  no government  hospitals,  for  treatment  of  government  servants  and  their family members  residing  in  those  areas  and  also  in  the  adjoining  areas outside cantonment limits.

5. All railway hospitals.

6. Pay  Clinics  in  Bihar,  Punjab,  Haryana,  Uttar  Pradesh,  Madhya Pradesh, Rajasthan and Chandigarh.

7. Private hospitals  in particular stations notified by the Government of India from time to time (Rule 2).

 27.5    In addition  to    the above, Head of Department as specified  in SR 2(10)  is empowered  to  appoint  Medical  Officers  under  the  employment  of  the Central/State Governments and Union Territories, as also Medical Officers not in government  employment  i.e.  Private  Registered  Medical 
Practitioners  as Authorised Medical Attendants. 

27.6    Private  Medical  Practitioners  are  appointed  as  AMAs  where    adequate number of government doctors in various systems of medicines are not  available or when  their  services  are  not  available within  a  radius  of    five  kilometres    or because of  the  remoteness of  the area  (Rule 2).   The AMA  so appointed, will be bound  by  the  terms  and  conditions  prescribed  by  the  government  from  time  to time under  these  rules.  If  the condition of  the patient so  requires,  the AMA can send the patient to the nearest specialist or other medical officer or summon them to attend the patient (Rule 5).

27.7    The  treatment  at  the  consulting  room  of  the AMA    is  limited  to  ten  days with a maximum of four consultations and normally ten injections.   The limit of four  consultations  within  10  days  is  applicable  for  attendance  with  a Specialist/other Medical  Officer  and  will  count  from    the  date  from  which  the Specialist/other Medical Officer    is consulted.     Consultation on  the 10th day of treatment is permissible, if no medicine is prescribed on that consultation. 

27.8    Cases  of  medical  treatment  requiring  hospitalization  are  referred  to government/  recognised hospital.    If hospitalization  is not  considered necessary but treatment is expected to be prolonged, the patient should be referred to OPD of government / recognised hospital.

27.9    When a patient consults the same AMA in regard to the super imposition of another disease during the course of treatment of one disease, it is regarded as a fresh  consultation  and  will  be  charged  at  full  rates  as  prescribed  by  the government from time to time.   To justify a fresh claim for the recurrence of the same  disease  for  a  second  time,  there  should  be  a  reasonable  gap  between  the closing of the first spell and the recurrence of the second spell.  A separate claim is to be preferred in respect of each spell of illness and or an entirely new disease (GID (21) in Rule 2).

27.10    The claim for reimbursement should be received within 3 months from the date  of 
last  treatment.   However,  subject  to  certain  conditions,  the Department may condone the delay. (GIDs (9) and (10) Section-1).

27.11    The government  servant and  their  family members may  receive  treatment for  all  diseases  for  which  treatment  is  provided  under  the  rules  in  a  government/recognised  hospital  outside  the district/state  but  within  India, provided :

  (i)  Necessary and suitable facilities for treatment are not available in a government or recognised
hospital at  the district or state headquarters or within  the district or state where one falls ill and

(ii)  The  treatment  outside  the  district/state  is  recommended  by  the  Authorised Medical Attendant and
countersigned by the Chief Medical Officer of the district if the  treatment  is  undertaken  outside  the  district  or  by  the Chief  Administrative Medical Officer of  the  state  if  it  is  to be undertaken outside  the state.  (G.I.D.(4) under Rule 6).

27.12    Travelling Allowance for medical treatment and attendance. The  government  employees 
and  their  family  members  are  entitled  to undertake journeys to take appropriate medical attendance and treatment, if it is certified by the AMA/Specialist/Medical Officer attached to the hospital to whom the patient was referred, that the journey was unavoidably necessary to obtain the treatment. The patient ( government servant or his family member ) and attendant also (wherever  recommended)  will  be  entitled  to  TA  plus  DA  for  the  period  of journey   undertaken by rail, road, sea and air.  No DA will be admissible for halt.  The government servant is eligible for reimbursement of the travelling  expenses of the donor of a kidney to him or to a  member of his family for the journeys made  in connection with the

27.13   Central Government Health Scheme(CGHS)
   The medical  facilities  under  the  Central  Government  Health  Scheme  are available  to  all  the  employees  paid  from  the  civil  estimates  and  their    family members residing in the area covered by the scheme.  An employee can opt out of the  scheme  and  avail  of  the medical  facilities  provided  by  the  employer  of  his spouse.  If an employee or a member of his family covered under the Scheme falls ill at a place not covered under CGHS,  the  treatment shall be admissible under

CS(MA) Rules1[1]

27.14    The  medical  facilities  to  the  Central  Government  employees  and  their dependent  family members  are provided under  the Central Government Health Scheme in the following cities:
















21.Delhi/New Delhi 




Definition of Family:‘ Family’ means employee’s

(i)  Husband/Wife  including  more  than  one  wife  and  also  judicially separated wife.

(ii)  Parents and Stepmother.  In  the case of adoption, only  the adoptive and not  the  real parents.  If  the adoptive  father has more  than one wife, the first wife only. A  female  employee  has  a  choice  to  include  either  her  parents  or  her parents-in-law; option exercised can be changed only once during service.

(iii)  Children  including  legally  adopted  children,  stepchildren  and children taken as wards subject to the following conditions :

 Son  -Till he starts earning, irrespective of age limit.

Daughter  -Till she starts earning or gets married, whichever is  earlier, irrespective of age-limit.

 Son suffering from      -No age -limit.

 Permanent disability of any kind (physical or mental)

(iv)  Widowed daughters and dependent  divorced/separated daughters.

 (v)  Sisters including widowed sisters.

 (vi)  Minor borthers and dependent brothers.

27.15.1  But  the  above  persons  should  reside  with  the  government  servants  and their income from all sources should not be more than Rs.1500/- per month.

27.16    Contribution  
    A compulsory monthly contribution is charged from all the entitled classes of government servants on the basis of rates fixed by the government from time to time. The present rates of contribution are as under:

Grade Pay

Rate of monthly contribution (Rs.)

Up to Rs.1,650 per month


Rs.1,800; Rs.1,900; Rs.2,000; Rs.2,400 per month


Rs.4,200 per month


Rs.4,600; Rs.4,800; Rs.5,400; Rs.6,600 per month


Rs.7,600 per month

27.16.1  When both husband and wife are Central Government servants covered by the scheme, the
contribution  will be recovered from only one of them whose pay
is higher.

27.16.2  An employee transferred to another CGHS station  or one who goes to serve abroad leaving  his family at the old station may continue to pay  the contribution and his family can avail the facilities at the old station for that duration.

27.17  Facilities available under the Scheme 

i)  Medical attendance including consultaon with the AMA at a CGHS Dispensary.

ii)  X-Ray,  Laboratory  and  other  diagnostic  facilities  at  CGHS Laboratories  or  other  laboratories  of  CGHS  wing  of    Hospitals/Private Hospitals recognised by CGHS.

iii) Hospital  services  in  the CGHS wing  of Hospitals/Referral/Private Hospitals recognised by the CGHS.

iv) Nursing  Home  facilities  for  those  having  a  basic  pay  above  Rs. 12000/-.

v) Special  treatment  for diseases  like TB, Cancer, Kidney Transplant and By-pass Surgery and facilities for Dental treatment  (for few diseases).

vi)   Ante natal/confinement/post natal care facilities.

vii) Specialist  consultation  in  selected  centres/poly  clinics/hospitals etc.

viii)  Intra  -  ocular  lens  implantation/treatment  and  cost  of  spectacles after cataract operation.

ix) Post-operative  treatment  relating  to    Neurosurgery,  Cardiac Diseases,  Cancer,  Kidney  transplantation  and  hip/knee  replacement surgery  in  the  same  institutions/hospitals where  the  surgery was  earlier carried out with prior permission of CGHS.

x)  Medicines  prescribed  during  OPD  treatment  are  provided  by  the CGHS  dispensary  concerned.    No    reimbursement  is  allowed  for  such medicines purchased from outside.

xi)  The scale of hospital accommodation is prescribed as under: 

Pay drawn in Pay Band

Ward Entitlement

Pension / Family Pension drawn

Upto Rs.13,950

General Ward

Upto Rs.19,530

Rs.13,960 to Rs.19,530

Semi-Private Ward

Rs.19,540 and above

Private Ward

From Rs.19,540 to Rs.25,110

Deluxe Ward

Rs.25,110 and above

27.18    Procedure for reference to Referral/Recognised Hospitals under CGHS:  The  beneficiaries  will  have  the  option  to  avail  specialised  treatment  at CGHS    recognised  hospitals  of  his/her  choice  if  the  specialist  of  the  CGHS dispensary or  government hospital  recommends  the patient  for  such  specialised treatment.

27.18.1  After  the specialist advises a procedure in writing, the permission letter for taking  such treatment    in  a  CGHS  recognised  private/referral  hospital  of    the choice  of  the  employee  in  the  same  city,  would  be  given  by  the  parent department/office.

27.18.2  In case the beneficiary, inspite of the facility being available in the city still chooses  to  get  treatment  in another city, permission of  the CGHS authorities of the city would have to be obtained.  In such cases, no TA/DA will be paid by the government.

27.18.3  The  government  servant  is  allowed  to  take  treatment  from referral/recognised  hospitals  under  CGHS  in  emergency.  However,  the  term ‘emergency’ will be decided by  the Additional Director, CGHS concerned whether the case  is/was of real  ‘Emergency’ before reimbursement  is made by the parent department on the basis of rates fixed by the CGHS from time to time.

27.18.4  Ex post facto permission for treatment in government referral hospitals like PGI Chandigarh etc. can be given by the parent department.

Medical Advance

    The medical advance  to  the serving government servant  for self  treatment or treatment of the
dependents on receipt of estimate from the treating doctor of a
government/recognised hospital is available subject to the following conditions:

i)  Rs.10,000/- or  the amount  recommended by  the doctor, whichever is  less  for  indoor  treatment  in  hospital  and  for  OPD  treatment  in case of TB/Cancer.

 ii)  In case of major  illness  like by-pass urgery, kidney  transplant etc., the  advance may be limited to 90%  of the package deal wherever it exists or the amount demanded by the hospital concerned.

iii)  The advance is paid directly to the hospital concerned on receipt of an estimate.

iv) For settlement of advance, the employee concerned may be required to submit the adjustment bills within a period of one month from the date of his discharge  from  the hospital.    In case  the entire advance has  not  been utilised  for  the  treatment  of  the  patient,  the head  of office  concerned will  correspond with  the hospital  for  refund of  the unutilised balance of medical advance.

27.20   Settlement of Claim -  The  government  servant  is  required  to prefer  claim/bill within 3
from  the  date  of  discharge  from  the  hospital.  If  the  claim  gets  time  barred, relaxation of delay is allowed by the department depending on the circumstances of delay.

27.20.1  The claim should have the following documents completed:

a)  Claim  Form  Med.  ‘97′  and  Essentiality  Certificate  ‘A’  for  Outdoor treatment and ‘B’ for Indoor treatment.  

b)  All original bills verified by the treating doctor with his stamp.

c)  Photocopy of CGHS Token Card.

d)  Discharge Slip of the Hospital in case of  Indoor Treatment.

e)  A  detailed  list  of  all  medicines,  laboratory  tests,  investigations, number of doctors visits etc. 

f)  Self explanatory letter from the beneficiary explaining the emergency circumstances  in case of emergency.

g)  Legal heir certificate in case of death of the card holder.

27.20.2  Based on the  rates  fixed by  the CGHS,  the  admissible  amount  is worked out  by 
the  department.  If  the  rates  claimed  by  the  concerned  are  less  than  the rates  fixed by  the  government,  the  actual  amount  is  reimbursed.  In  case CGHS rates are not available for a particular item, the reimbursement is allowed on the basis of rate  list of AIIMS.  Incidentally, where AIIMS rates are also not available, the actual amount paid by the patient is reimbursed.  Items  mentioned in the list of 
inadmissible  items under CS(MA) Rules are not reimbursable. Special Nursing Charges  are  to  be  reimbursed  as  fixed  by  the Ministry  of  Health  from  time  to time.

27.20.3 In normal cases, AO(A)/AO(E)/SsP upto  the amount of Rs. 1000/-DIsG upto  the amount
of Rs. 5000/- and JDs upto the amount of Rs. 10000/- are empowered to accord sanction for reimbursement.    In  other  cases  claims  are  submitted  to DCBI  through  JDs  concerned  for consideration.

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