After SC rap, timeline fixed for settling CGHS claims

Vijay Mohan

Tribune News Service

Chandigarh, May 26

Following the Supreme Court’s rap over the tardy pace of disposal of medical claims by aged beneficiaries of the Central Government Health Scheme (CGHS), the health ministry has prescribed a timeline for settling claims by pensioners. The apex court had held that claims cannot be rejected on technical grounds.

Under new rules issued by the CGHS Directorate General last week, payment for claims submitted to the chief medical officer of the wellness centre concerned will be completed within 30 days. Claims requiring opinion of specialists are to be finalised in 45 days, while those requiring approval of higher authorities shall be finalised within 45 days in Delhi and 60 days in other cities. 

The order also states that care shall be taken not to regret medical claims of pensioners on minor technical issues if they fall under procedural lapses, which can be condoned. Further, if approval of the directorate or ministry is involved, only e-file with self-contained notes, recommendations and scanned documents are to be submitted. Established in 1954, CGHS provides comprehensive medical care facilities to lakhs of Central government employees, pensioners and their dependents residing in specified cities through a network of dispensaries and empanelled hospitals. Treatment is on concessional rates that are reimbursed to the member.

Disposing of a plea by a CGHS member, whose claims worth several lakh rupees for emergency treatment in non-empanelled private hospitals were rejected without hearing him or communicating any speaking order, a SC Division Bench had opined that a timeframe for finalization and disbursement of claims of pensioners was necessary.