Settlement of reimbursement claims / Permissions /ex-post facto approval in respect of Pensioner CGHS beneficiaries – O.M. dated 27-12-2023

Settlement of reimbursement claims / Permissions /ex-post facto approval in respect of Pensioner CGHS beneficiaries – Revision in delegation of financial powers vide CGHS O.M. dated 27-12-2023

No: Z.15025/14/2023/ DIR/CGHS
Government of India-
Ministry of Health and Family Welfare
Directorate of CGHS

CGHS Bhawan,
RK Puram Sector-13,New Delhi
Dated the 27th December, 2023.

OFFICE MEMORANDUM

Subject:- Delegation of Financial powers for settlement of reimbursement claims / Permissions /ex-post facto approval in respect of Pensioner CGHS beneficiaries, etc..,

With reference to the above subject the undersigned is directed to draw attention to the OM No Z 15025/79/2/DIR/CGHS dated 5th October 2016 vide which powers had been delegated for settlement of reimbursement claims/ Permissions/ex-post facto approvals in respect of Pensioner CGHS beneficiaries. It has now been decided by the Competent Authority to further delegate financial powers to the Addl. Secretary & DG, CGHS and Director, CGHS in respect of approvals related to unlisted treatment procedures/ investigations/ implants, in partial modification of para (v) of the above referred OM as per the details given under:

a) Revised Delegation of Financial Powers for Permission / ex-post facto Approval/ Settlement of Medical Reimbursement Claims of Individual Beneficiaries / Hospital Bills in respect of Unlisted treatment procedures / investigations / Implants are as per the details given below:

b) If there is no CGHS package rate for treatment procedures / investigations/ Implants approval shall be granted as per AIIMS rate (if any) and if there is no CGHS/AIIMS rate approval shall be granted as per actual rate.

c) In respect of unlisted treatment procedures / investigations / Implants, which cost more than Rs. 1,50,000/- the cases shall continue to be placed before Standard Technical Committee (STC) for justification, before considering the approval.

2 The revised financial delegations mentioned above will be subject to the conditions that they will not include any case involving relaxation of rules, irrespective of the amount involved. Further, cases where the amounts exceed the monetary limits prescribed above will be considered by the Ministry of Health & Family Welfare with the concurrence of Integrated Finance Division.

3. The above mentioned delegations of financial powers are in supersession of all the earlier OM in this regard.

4. The other terms and conditions mentioned in the Office Memorandum No. Z15025/79/2/DIR/CGHS dated 5th October 2016 shall remain unchanged.

5. This issues with the concurrence of Integrated Finance Division, Ministry of Health and Family Welfare.

(Dr. Manoj Jain )
Director, CGHS

To

1. Addl. DDG(HQ), CGHS/ AD(HQ), CGHS/ All Addl. Directors of CGHS
2. Addl. CEO, NHA
3. PPS to Secretary, Ministry of Health & Family Welfare
4. PPS to AS&DG (CGHS), Ministry of Health & Family Welfare
5. PPS to JS, Ministry of Health & Family Welfare, looking after CGHS
6. N.O., CGHS(MCTC) with the request to upload this OM on the CGHS website.
7. Guard file

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