Latest news with #CentralGovernmentHealthScheme
Hindustan Times
a day ago
- Health
- Hindustan Times
Reimburse cost of surgery to retd employee: HC to centre
MUMBAI: The Bombay high court on Friday directed the central government to fully reimburse the medical expense of a pensioner who underwent heart transplant in a private hospital in 2019 as hospitals empanelled under Central Government Health Scheme (CGHS) could not provide him the required treatment. The court has granted four weeks to the central government to reimburse the full expenses. CGHS empanelled hospitals provide healthcare services to central government employees, pensioners and their dependents at affordable rates. The pensioner, Anirudh Prataprai Nansi, voluntarily stepped down from central government services in 2008. In 2009, Nansi was diagnosed with Cardiomyopathy which aggravated in 2019 when the functioning of his heart's left ventricle significantly deteriorated to 15%, restricting smooth blood flow. Doctors advised Nansi for immediate heart transplant but as CGHS-empanelled government hospitals did not have the necessary license, approvals and expertise,he sought treatment at the privately owned Sir H. N. Reliance Foundation Hospital. Prior to the surgery, he notified CGHS authorities regarding the estimated cost. After multiple follow ups, CGHS authorities responded to Nansi's reimbursement request in March 2021, stating that they could only provide an amount of ₹69,000 out of the total expense of ₹22 lakh, as per CGHS's Mumbai rate list. Nansi approached the Bombay high court in 2021. The court appointed committee heard the case in November 2021 and opined that the full expense could not be reimbursed as it did not match CGHS rates. The committee noted that since the heart transplantation was a planned surgery and not an emergency, the reimbursement should be done as per CGHS rules and guidelines. Nansi again approached the high court in 2022, citing violation of his fundamental right to life and pleading that the full expense be reimbursed to him as government hospitals lacked the required facilities. On Friday, the division bench of justices G S Kulkarni and Advait Sethna observed that Nansi cannot be deprived of full reimbursement when he had to undergo treatment at a private hospital as the surgery had to be done immediately. In such cases of necessary treatment, the central government is obliged to grant reimbursement on a case to case basis, the court said. 'Not granting full reimbursement is not only violative of the fundamental rights but strikes at the very root, purpose and essence of these basic human rights as guaranteed by the Constitution, i.e., Right to Life under Article 21. Any employee, merely because he has retired, ought not be differently treated when it comes to genuine and realistic health expenditure,' the bench said.
New Indian Express
29-05-2025
- Health
- New Indian Express
Delays and disruptions in CGHS new portal leave patients without medicines
NEW DELHI: A transition to a new e-interface by the Central Government Health Scheme (CGHS) of its Health Management Information System (HMIS) portal has led to delays and disruptions in accessing medicines to thousands of beneficiaries in Delhi NCR. Patients complained facing delay of over 10 days in getting essential medicines for their health conditions, which is attributed to server issues and incomplete patient data uploads. The issue has severely impacted beneficiaries who rely on government dispensaries for treatment. Out of 151 CGHS dispensary units in the Delhi NCR region, around 139 are located in the national capital. While Ayurvedic and homeopathic medicines are available in a few centres, most dispensaries primarily distribute allopathic medicines. However, with the new digital interface facing technical glitches, most of these facilities have been unable to provide even basic allopathic drugs on time. Patients across multiple locations have reported being turned away daily. Vineet Raje, a resident of RK Puram, said she has been unable to collect his prescribed medicines for several days.
Hindustan Times
24-05-2025
- Health
- Hindustan Times
Won't tolerate discrimination against DGEHS patients: Delhi govt to hospitals
The Delhi government's health department has issued a stern directive to private hospitals empanelled under schemes such as the Delhi Government Employees Health Scheme (DGEHS), warning them against discriminatory practices in treating scheme beneficiaries, according to an order seen by HT. The order, issued on May 22, follows a string of complaints about delayed admissions, restricted consultations, and refusals to treat critically ill patients referred by government departments to private hospitals, officials aware of the matter said. Calling these practices a violation of agreed terms, the order noted that some hospitals were assigning specific doctors exclusively to DGEHS cardholders and limiting consultation timings—restrictions not imposed on other patients. 'Several health care organisations empanelled under DGEHS are not complying with the terms and conditions… Certain hospitals are reportedly assigning specific doctors exclusively for DGEHS card holders. This practice is discriminatory and undermines the intent of equitable healthcare access,' it stated. Additionally, the order said, that instances have been reported where empanelled hospitals have refused to admit seriously ill patients referred by government departments. The health department has asked all private hospitals on the empanelled list to confirm their compliance. The government, officials said, is likely to take strong action against hospitals that fail to honour the terms of the MoUs signed under the schemes. Under DGEHS and the Central Government Health Scheme (CGHS), beneficiaries are entitled to cashless treatment at empanelled private hospitals, in accordance with guidelines issued by the Directorate General of Health Services (DGHS). However, officials who asked not to be identified, said many hospitals have routinely failed to comply, forcing patients to pay out-of-pocket despite being eligible for government-funded care. The order directs all empanelled hospitals to stop assigning limited time slots or restricted doctors to DGEHS patients. 'Refrain from imposing consultation or hospital visit timings not applicable to other patients,' the order said, warning of 'appropriate action' in case of non-compliance. Beneficiaries said such practices are common. Chaitali Mitra, a 34-year-old CGHS cardholder, said she experienced severe pain and rushed to a well-known private hospital empanelled under the scheme. 'They told me treatment was only available at certain times for CGHS patients. I had to proceed without using my card and pay the full amount,' she said. Another CGHS beneficiary said hospitals often discourage admissions for cardholders. 'They deny cashless treatment, saying it can only be reimbursed later, which makes the process extremely difficult,' he said. Some also claim hospitals cite unavailability of beds for CGHS patients while admitting others who pay out of pocket. Rajeev Sharma, also a CGHS beneficiary, said, 'It's become routine for hospitals to say no beds are available for cardholders. They prefer patients who aren't part of these schemes because they can charge more.' The health department has asked all private hospitals on the empanelled list to confirm their compliance. The government, officials said, is likely to take strong action against hospitals that fail to honour the terms of the MoUs signed under the schemes.
Time of India
19-05-2025
- Health
- Time of India
Reimagining CGHS: Reforming a lifeline for India's retired public servants
In India's smaller towns and cities, a growing number of retired government employees are quietly grappling with the Central Government Health Scheme (CGHS), that was meant to support them in their later years. In the absence of CGHS dispensaries and empanelled hospitals in these regions, retirees are left with few options. Most are forced to seek care at private healthcare facilities, pay out of pocket, and then navigate a tedious and outdated reimbursement process that tests both patience and resilience. The reimbursement system, far from being a support mechanism, often becomes a source of stress and frustration. Pensioners must compile large volumes of paperwork—sometimes dozens of pages—that need to be certified by hospitals and physically mailed to Delhi. This laborious process is followed by long periods of silence, as reimbursements are delayed for months and frequently cover only a partial payment of the actual medical expenses. The financial strain this causes is considerable, particularly for elderly individuals with chronic conditions who rely solely on their pension for income and have no external support system. This experience is very common and reveals deeper structural issues within the CGHS that make it particularly inadequate for those living in tier-2 and tier-3 cities. As more government retirees choose to settle in these smaller, often more affordable towns, the urban-centric design of the CGHS is becoming a critical flaw. The vast majority of CGHS wellness centers, empanelled hospitals, and administrative offices remain concentrated in a handful of large cities, making access to basic medical care more aspirational than assured for those outside these hubs. Communication and support systems within CGHS offer little relief. Emails go unanswered, helplines are often unresponsive, and in-person visits to CGHS offices are impractical for those living far from Delhi. For a scheme intended to deliver dignity and security in retirement, such inefficiencies result in the opposite—an experience marked by confusion, delay, and disappointment. Another significant shortcoming is the scheme's limited coverage. While hospitalization costs are reimbursed to some extent, outpatient services such as doctor consultations, diagnostic tests, and routine medication are excluded. These day-to-day health needs form the bulk of medical expenses for older adults, particularly those managing chronic illnesses like diabetes, hypertension, or heart disease. The result is a healthcare model that leaves pensioners to bear the cost of regular treatment entirely on their own—undermining CGHS's intended role as a safety net. To make CGHS truly effective and equitable, a set of targeted, practical reforms is urgently needed. First and foremost, the government should implement a nationwide cashless treatment model for beneficiaries, much like the one used in the Ayushman Bharat scheme. Retired public servants deserve the same ease of access and respect when it comes to medical care. In parallel, there must be a focused push to empanel private hospitals and clinics in smaller towns and cities—not only for hospitalization but also for outpatient services, diagnostics, and medicines. This would eliminate the need for long-distance travel and make essential care more locally accessible. Modernizing the reimbursement process is equally crucial. Healthcare providers should be allowed to submit documents directly through a secure digital platform, and pensioners should be able to track claims in real time. Automated alerts for missing documents or errors would reduce delays and the likelihood of claims being indefinitely stalled due to minor issues. By digitizing the system, the CGHS could significantly reduce the reliance on postal submissions and lower the administrative burden on elderly patients. To support pensioners at the local level, CGHS facilitation centers should be established in every district, offering assistance with documentation, digital submissions, claim tracking, and grievance redressal. For those unfamiliar with online systems, in-person help would make the difference between accessible healthcare and bureaucratic exclusion. Furthermore, the scope of CGHS coverage must be broadened to include outpatient and preventive care. Chronic conditions require consistent monitoring and long-term treatment plans. By covering these areas, the scheme would not only enhance health outcomes but also reduce the overall financial burden on both retirees and the public health system. Equally important is the creation of a centralized CGHS helpline and virtual grievance redressal portal, staffed by trained professionals who can offer real-time, empathetic, and accurate guidance to beneficiaries and their caregivers. CGHS is not merely a health insurance program—it is a reflection of the state's responsibility to those who have spent their working lives in public service. Yet in its current form, it fails to meet the needs of its most vulnerable members. If India aspires to become a developed nation by 2047, the care and treatment of its senior citizens—especially those who have served the nation—must be treated as a foundational concern. Reforming CGHS into a decentralized, digitally-enabled, and people-centered system is not just about policy—it is a matter of national honor. It is time to reaffirm that those who served the public are not forgotten once they retire, but are cared for with the dignity and respect they rightfully deserve. 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Business Standard
15-05-2025
- Health
- Business Standard
CGHS got a digital makeover: How it helps beneficiaries in health care
The Central Government Health Scheme (CGHS) has launched a new Health Management Information System (HMIS) to improve digital services for its beneficiaries. According to the statement issued by CGHS, the new HMIS replaces a two-decade-old system and was developed by the Centre for Development of Advanced Computing (C-DAC). Key Features of the New HMIS Notable features of HMIS include: PAN-based unique identification: Beneficiaries above 18 years are now required to link their Permanent Account Number (PAN) with their CGHS ID, ensuring accurate identification and reducing duplication. Integrated Payment System: The manual payment process via the Bharat Kosh portal has been discontinued. All contributions must now be made through the official CGHS portal, with payments auto-verified to minimise errors and refund issues. Real-time tracking: Beneficiaries can monitor the status of their applications and services in real-time, enhancing transparency and reducing delays. Mobile application: A new 'myCGHS' mobile app is out, allowing users to access services, track applications, and receive updates on the go According to the CGHS to facilitate the transition to the new system: All CGHS Wellness Centres were closed to the public on April 26, 2025, to prepare for the system upgrade. The previous CGHS websites ( and have been deactivated. All services are now accessible through the unified portal: Beneficiaries are required to reset their passwords upon first login to the new system Applications pending payment as of April 27, 2025, have lapsed. Fresh applications must be submitted through the new portal Support and assistance To ensure a smooth transition Master trainers have been deployed across CGHS offices and Wellness Centres to assist beneficiaries. User manuals and helpdesk facilities are available on the CGHS website and the 'myCGHS' app.
