Revision of Consultation / Visiting / injection fee of AMA under CS(MA), Rules

Revision of rates and guidelines for reimbursement of expenses on purchase of Hearing Aids under CS(MA) Rules, 1944 and CGHS

No: S..14025/10/2002/MS
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare

Nirman Bhawan, New Delhi 110 108
Dated the 21st March, 2012.

OFFICE MEMORANDUM

Subject: Revision of rates and guidelines for reimbursement of expenses on purchase of Hearing Aids under CS(MA) Rules, 1944 and CGHS- regarding.

With reference to the above mentioned subject the undersigned is directed to refer to the Office memoranda of even No. dated 17.11.2006 and 28.10.2002 and OM Nos.S.14025/36/93/MS dated 26.03.94 and 17.08.1999 and to state that on the basis of recommendations of an Expert Committee, it has been decided to revise he rates and guidelines for hearing aids to be reimbursed under CS (MA) Rules, 1944 and CGHS.

2. The revised ceiling rates fixed for various types of Hearing Aids (for one ear) are as under:

Body worn / Pocket type	Rs 2,500/-
Analogue BTE	Rs. 7.000/-
Digital BTE	Rs. 20,000/-
ITC/CIC	Rs. 25,000/-

The cost of hearing aid shall include all Taxes including VAT and shall carry ’3′  year Warranty.

The cost of Analogue BTE / Digital BTE / ITC / CIC type hearing aid shall also include the cost of ear mould.

3. Beneficiaries covered under CS(MA) Rules, 1944 / CGHS shall be eligible to obtain hearing aid after the same has been recommended by a Government E.N.T. Specialist on the basis of audiometric and audiological assessment. ENT Specialist shall specify the type of hearing aid most suited for the beneficiary.

4. The permission to procure hearing aid shall be granted by Chief Medical Officer in-charge of CGHS Wellness Centre in case of CGHS pensioner beneficiaries and by the Head of Department /Office in case of serving employees and CGHS beneficiaries of Autonomous Bodies on the basis of recommendation of a Government Specialist and an undertaking that the beneficiary has not been reimbursed the cost of bearing aid in the preceding Five years.

5. Reimbursement claim shall be submitted to CGHS through CMO i/c of concerned dispensary by CGHS Pensioner beneficiary in the prescribed medical reimbursement claim form along with a photo copy of CGHS card, original bill of the Hearing aid and original copy of the permission letter. In case of other beneficiaries, the medical claim shall be submitted to the concerned Ministry/ Department / Office. Reimbursement shall be limited to the ceiling rate or actual cost of the hearing aid, whichever is less.

6. Record of permissions granted for procurement of hearing aids shall be maintained by CGHS in respect of pensioner CGHS beneficiaries and by concerned Ministry / Department Office in respect of other beneficiaries.

7. Replacement of hearing aid may be permitted after 5 years on the basis of condemnation certificate issued by a technical expert and on approval of a Government ENT Surgeon. Maintenance and repair will be the responsibility of the beneficiary.

8. These orders shall supercede all the earlier orders issued on the subject.

9. The revised rates and guidelines shall come into force from the date of issue and shall be valid for a period of two years or till further revision, whichever is earlier.

10. This issues with the concurrence of Integrated Finance Division vide Dy.No. 5894 dated 19.03.2012 of the office of AS&FA, Min. of Health &Family Welfare.

sd/-
(V.P. Singh)
Deputy Secretary to the Government of India

reimbursement of expenses for In-Vitro Fertilisation (IVF) treatment to CGHS beneficiaries and beneficiaries under CS, (MA) Rules. 1944.

Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi 110 108

No: Z. 15025/5/2011-CGHS III/CGHS (P)

Dated, the 22nd November, 2011

OFFICE MEMORANDUM

Subject: Guidelines / Criteria for reimbursement of expenses for In-Vitro Fertilisation (IVF) treatment to CGHS beneficiaries and beneficiaries under Central Services (Medical Attendance) Rules. 1944.

The undersigned is directed to say that the Ministry of Health & Family Welfare has been receiving requests for providing clarifications as to whether the expenditure incurred on In-Vitro Fertilisation ((IVF) treatment is admissible under CGHS, and if so. whether any guidelines have been laid down for reimbursement of the expenses incurred on IVF treatment.

(2) The matter has been examined by a Technical Committee of the Heads of Department of Gynaecology & Obstetrics of Government Medical institutions, and based on the recommendations of the Committee, the following guidelines are laid down for considering cases for reimbursement of expenses incurred on IVF treatment by CGHS beneficiaries and beneficiaries under Central Services (Medical Attendance) Rules, 1944:-

(I) Requests for IVF treatment will be considered only on the basis of advice tendered by the Head of Department of Gynaecology & Obstetrics of a Government Medical institution;

(ii) Permission for IVF treatment to be undertaken may be given by the Head of Department in the Ministries / Departments on the recommendations of the Head of Department of Gynaecology & Obstetrics of a Government Medical institution;

(iii) IVF procedure will be allowed in a Government Medical institution on the recommendations of the Head of Department of Gynaecology & Obstetrics of a Government Medical institution;

(iv) IVF procedure may be allowed, on a case to case basis, in a private medical institution if the Institution is registered with the State / Central Government and has the necessary facilities including equipment and trained man power for carrying out the procedure. It is, however, mandatory to obtain the recommendations of the Head of Department of Gynaecology & Obstetrics of a Government Medical institution for permitting the procedure to be undertaken in a private institution;

(V) There should be clear evidence of failure of conventional treatment before permitting IVF treatment procedure;

(vi) The age of women undergoing IVF treatment procedure should be between 21 and 39 years

(vii) The woman has to be married and living with her husband;

(viii) The IVF treatment procedure will be allowed only in cases of infertility where the couple has no living issue

(ix) Reimbursement of expenditure incurred on IVF procedure will be allowed upto a maximum of 3 (three) fresh cycles;

(X) An amount not exceeding Rs.65,000/- (Rupees sixty five thousand only) per cycle or the actual cost, whichever is lower, will be allowed for reimbursement. This amount will be inclusive of the cost of drugs and disposables and monitoring cost during IVF procedures;

(xi) As IVF treatment is a planned procedure, reimbursement cases can be considered by the Ministries / Departments only if prior approval was obtained by the beneficiary for undergoing the IVF treatment.

(xii) There will be a onetime permission for availing IVF treatment consisting of three cycles in total, which would be admissible to the beneficiary. The concerned Ministry / Department shall obtain an undertaking from the applicant that he / she has not claimed the reimbursement earlier from the Government of India in the past and will not claim it in the future.

These guidelines come into force from the date of issue of the Office Memorandum and reimbursement cases of IVF treatment undertaken after the issue of the Office Memorandum only can be considered by the Ministries / Departments.

4. This issues with the concurrence of Integrated Finance Division in the Ministry of Health & Family Welfare, vide Dy. No.C.1747/IFD (Health)/2011 dated the 21st November,October, 2011

sd/-
[V.P. Singh]
Deputy Secretary to the Government of India