CGHS Enhances Financial Powers of Officials to Expedite Treatment

Subject: Polity & Governance

Context

The Union Ministry of Health and Family Welfare has significantly enhanced the financial approval powers of senior officials under the Central Government Health Scheme (CGHS).

Objective

The decision aims to:

• Reduce delays in approving cashless treatment.
• Speed up settlement of medical reimbursement claims.
• Expedite approval of unlisted medical investigations, procedures, and implants.
• Improve administrative efficiency and ensure timely access to healthcare for beneficiaries.

Revised Financial Approval Powers

The revised delegation of financial powers enables senior CGHS officials to approve higher-value claims without referring them to higher authorities.

Cases Above ₹50 Lakh

• Claims exceeding ₹50 lakh will continue to require approval from the Union Ministry of Health and Family Welfare with the concurrence of the Integrated Finance Division (IFD).

Approval Limits for Unlisted Medical Procedures

The revised limits for sanctioning unlisted investigations, procedures, and implants are:

Significance of the Reforms

The revised financial powers apply to medical reimbursement claims submitted after treatment, particularly for:

• High-cost medical procedures.
• Emergency treatment.
• Unlisted investigations and implants.

Expected Benefits

• Faster approval of reimbursement claims.
• Reduced administrative delays.
• Fewer cases requiring referral to higher authorities.
• Quicker access to cashless treatment.
• Greater convenience for beneficiaries requiring expensive tertiary healthcare.

The reforms are expected to particularly benefit pensioners and senior citizens, who constitute a large proportion of CGHS beneficiaries and often require specialized and high-cost medical care.

About the Central Government Health Scheme (CGHS)

Established

• 1954

Nodal Ministry

• Ministry of Health and Family Welfare

Objective

To provide comprehensive healthcare services to:

• Central Government employees.
• Central Government pensioners.
• Eligible dependent family members.
• Other notified categories of beneficiaries.

Services Provided under CGHS

Outpatient Care

• Consultation and treatment at CGHS Wellness Centres.
• Supply of prescribed medicines.

Specialist Services

• Consultation at CGHS Polyclinics, Government hospitals, and empanelled private hospitals through referral.

Hospitalisation

• Cashless outpatient (OPD) and inpatient (IPD) treatment at Government and empanelled hospitals for eligible beneficiaries, including pensioners.

Medical Reimbursement

• Reimbursement of treatment expenses incurred in Government or private hospitals during emergencies.

Medical Appliances

• Reimbursement for approved purchases of:
  • Hearing aids.
  • Artificial limbs.
  • Other medical appliances, subject to prescribed conditions.

Maternal and Family Health

• Maternity care.
• Child healthcare services.
• Family welfare services.
• Medical consultation.

AYUSH Services

CGHS also provides medicines and consultations under:

• Ayurveda
• Yoga & Naturopathy
• Unani
• Siddha
• Homeopathy (AYUSH)

Coverage

• Covers approximately 42 lakh beneficiaries.
• Operates through CGHS Wellness Centres across 79 cities in India.
• The Government aims to expand CGHS coverage to additional cities to improve accessibility.

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