The Ministry of Health and Family Welfare has issued new guidelines to address complaints of overcharging and denial of services to Central Government Health Scheme (CGHS) beneficiaries. The directives aim to ensure fair, affordable, and transparent healthcare for all eligible beneficiaries.

Key highlights of the guidelines

Mandatory treatment

CGHS-empanelled hospitals cannot refuse treatment to eligible beneficiaries.

The ministry emphasised that services must be provided without discrimination.

Transparency in costs and services

Hospitals must prominently display:

• CGHS-approved rates for services.
• Availability of beds in wards and ICUs.
• Beneficiaries’ entitled ward categories. Allocating a lower category is strictly prohibited.
• Details such as the CGHS city the hospital is empanelled under, credit eligibility, and Nodal Officer contact information.

Reporting obligations
Hospitals must report:

• Non-referral cases, emergency admissions, and consultations within 24 hours to the respective CGHS Additional Director’s office via email.
• Details of direct visits and admissions for beneficiaries aged 70 and above, including inpatient card information.
• Unreported cases will not be processed for approval.

Accountability in critical cases

In cases of patient death or coma, hospitals must obtain the signatures and contact details of the beneficiaries’ attendants on the final bills for all services, including daycare and laboratory procedures.

Standardised prescriptions

Prescriptions must use generic names and be written in capital letters.

Hospitals are not allowed to insist on specific brands, ensuring affordability for beneficiaries.

Pre-approval for costly procedures

Hospitals must obtain prior approval for expensive procedures, preventing unnecessary or overpriced treatments.

Penalties for non-compliance

Hospitals failing to adhere to these guidelines may face penalties, including removal from the CGHS network.