Hearing Aids: Revision of rate and guidelines for reimbursement under CGHS & CSMA Rules

Revision of rate and guideline for reimbursement of expenses on purchase of Hearing AIDS Under CSMA Rules,1944 and CGHS

No.S.14025/10/2002/MS

Government of India

Ministry of Health and Family Welfare

Department of Health and Family Welfare

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Nirman Bhawan, New Delhi

Dated the 26th May, 2015

OFFICE MEMORANDUM

With reference to the above mentioned subject the undersigned is directed to refer to the Office Memorandum of even no dated 21.03.2012 , 17.11.2006 and 28.10.2002 and OM No S.14025/36/93/MS dated 26.03.94 and 17.08.99 and to state that on the basis of recommendation of an Expert Committee, it has been decided to revise the rates and guidelines for hearing aids to be reimbursed under CS(MA) Rules, 1944 and CGHS.

2. The revised ceiling rates fixed for various types of hearing-aids (for one ear) are as under:-

Body worn/Pocket type Rs.3000/-

Analogue BTE Digital – Rs. 7000/-

BTE Digital Rs. 15000/-

ITC/CIC Rs. 20000/-

The cost of hearing aids shall include all taxes in including VAT and Shall carry 3 year warranty. The cost of analogue BTE/Digital BTE/ITC/CIC type hearing aid. shall also include the cost of hearing mould.

3. Beneficiaries covered under CS (MA) Rules /CGHS shall be eligible to obtain hearing aid as per the following guidelines:

(i). Patients/Beneficiaries should be properly referred to CGHS/Government hospital ENT specialist from the parent CGHS wellness centre (A computerized referral printout should be made wherever computerization has been done).

(ii). It would be mandatory to carry CGHS Beneficiary’s ID card (in original) whenever the CGHS beneficiaries visit the CGHS/Government ENT specialist for consultation and Audiometric test.

(iii). The ENT specialist of CGHS /Government hospital shall then recommend a hearing aid on basis of Audiometric and Audiological assessment, specifying the type of hearing aid most suited for the Beneficiary. The ‘Audiogram report’ shall be authenticated by the ENT specialist/Consultant of the CGHS/Government hospital.

4. The permission to procure hearing aid shall be granted by the ADDITIONAL DIRECTOR(Zonal) of CGI IS-ZONAL OFFICE in case of CGHS pensioner beneficiaries, and by the HEAD OF DEPARTMENT/OFFICE in case of serving employees and CGHS beneficiaries of Autonomous bodies on the basis of Recommendation of a CGHS/Government ENT specialist, and an ‘undertaking’ that the beneficiary has not been reimbursed the cost of hearing – aid in the preceding five years.

5. Reimbursement claim shall be submitted to CGI IS ZONAL OFFICE through the CMO – Incharge of the Concerned dispensary by CGHS Pensioner beneficiaries in the prescribed medical reimbursement claim for-along with the following documents :-

a) Referral letter from parent CGHS Wellness Centre (computerized Slip where computerization is done already).

b) Copy of ‘prescription’ of ENT consultant (CGIIS/Govt.Hospital) with the ‘Audiogram’ report duly authenticated by the treating ENT consultant (CGI IS/Govt).

c) Copy of CGHS Card.

d) Bill/Receipt (in original) carrying details of the hearing – aid seller i.e. NAME, QUALIFICATION AND RCI/MCI REGISTRATION NUMBER of the hearing – aid seller.

e) The ‘permission letter’ to purchase hearing – aid (in original).

f) Empty Box/boxes or the Carton(s) with the label showing details of the hearing aid supplied.

In case of the other beneficiaries, the medical claim shall be submitted to the concerned Ministry/ Department /Office. Reimbursement shall be limited to the ceiling rate or actual cost of the hearing – aid, whichever is less.

6. Records of permissions granted for procurement of hearing-aids shall be maintained by CGHS in respect of pensioner CGHS beneficiaries and by the concerned Ministry/Department/ Office in respect of other beneficiaries.

7. Replacement of hearing-aid may be permitted after 5 years on the basis of condemnation certificate issued by a technical expert and on approval of CGHS/Government ENT Surgeon. Maintenance and repair will be the responsibility of the beneficiary.

8. These orders shall supercede all the earlier orders issued on the subject.

9. The revised rates and guidelines shall come into force from the date of issue and shall be valid for a period of two year or till further revision, whichever is earlier.

l0. This issues with the approval of Integrated Finance Division of Ministry of Health & Family Welfare

(Sunil Kumar Gupta)

Under Secretary to the Govt. of India

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