DELHI GOVERNMENT  EMPLOYEES HEALTH SCHEME
Delhi Government Employees Health Scheme (DGEHS)  was launched in April 1997 with a view to provide comprehensive medical  facilities to Delhi Government employees and pensioners and their dependants on  the pattern of Central Government Health Scheme. All health facilities  (hospitals / dispensaries) run by the Govt. of NCT of Delhi and autonomous  bodies under Delhi Government, local bodies viz. MCD, NDMC, Delhi Cantonment  Board, Central Government and other Government bodies [such as AIIMS, Patel  Chest Institute (University of Delhi) etc.] are recognized under the scheme. In  addition, some Private Hospitals/Diagnostic centers notified from time to time  are also recognized/ empanelled as referral health facilities. The scheme has  been modified for the benefit of beneficiaries vide Office Memorandums dated  06.10.2003, dated 21.2.2005, dated 25.10.2007, dated 28.07.2010 and dated  31/01/2012. 
1. Salient features

 
• Comprehensive  health care services to the beneficiaries through network of Delhi Government Dispensaries,  Hospitals and recognized private hospitals and diagnostic centers in Delhi and NCR.
 
• Provisions  of Central Government Employees Health Scheme are included in the scheme  including rates approved under CGHS.
 
• Membership  is compulsory for serving employees and is optional for pensioners.
 
• Cash  less facility is available for all beneficiaries in emergent conditions however  it is available to pensioners in routine cases as well.
 
• All  facilities are available at CGHS approved rates.

2. Eligibility
  The scheme is available for all employees, Retired employees  of Government of NCT of Delhi. The schcme is also available for Ministers,  MLAs, Ex. MLAs and Ex. Metropolitan Councilors of Government of NCT of Delhi,  Judges and Ex. Judges of Hon’ble High court of Delhi, Employees of fully funded  autonomous bodies of Govt. of NCT of Delhi and IAS (AGMUT) & DANICS officers of GNCT of Delhi who  are on deputation / transfer posting outside Delhi. It is compulsory for Delhi  Government employees and Mandatory monthly contribution is deducted from the  salaries as per salary slabs. Pensioners have the option of becoming member of  the scheme by depositing contribution equal to 10 year’s installments as a lump  some amount or in annual installments for 10 years at the rates prevalent at  the time of submission of contribution (lump some or annual installments).
  3. Dependent family members
  For availing medical facilities under DGEH Scheme spouse  (wife / husband), children, parents, sisters, widowed/ divorced / separated  daughters, brothers, stepmother shall be deemed to be dependent on the  government servant if they are normally residing with him/her and their income  from all sources including pension and pension equivalent to DCRG  benefit/family pension, does not exceed Rs. 3500 plus amount of dearness relief  thereon drawn as on the date of consideration (w.e.f. 1.1.2009), as per  provisions contained in CS(MA) and CGHS rules issued from time to time. Any  addition / deletion in family must be informed immediately by the beneficiary  to his / her office, Authorized Medical Attendant (AMA) and SPO of DGEHS.
  4. Facilities under D.G.E.H. scheme
  1. Out  patient care facilities in all systems (i.e. Allopathy, Homeopathy, Ayurvedic, Unani, Yoga and  Sidha) can be availed at government dispensaries, government hospitals and empanelled  hospitals with the permission of AMA as per provisions of the scheme.
  2. Indoor  services in  non-emergent conditions – Indoor treatment as per entitlement shall be  available in private recognized hospitals of the choice of beneficiary during  non-emergent conditions on the advice of the concerned AMA or on the advice of  doctors of other recognized health facility duly endorsed by the concerned AMA.  The concerned AMA shall issue a referral / authorization to the opted Hospital  / Diagnostic center for treatment. Follow up treatment subsequent to any  specialized procedure or for illness shall ordinarily be valid for six months.  No claim form non-recognized / non- empanelled private hospital / diagnostic  centers shall be entertained. Treatment in any central government, state  government, autonomous hospital under government and any government body can be  availed without referral from AMA.
  3. Treatment  in emergent conditions by the beneficiary can be availed in any recognized institution of his /  her choice directly with out being formally referred by AMA. Cashless treatment  facility in emergent conditions will be available to all working beneficiaries  in recognized empanelled private hospitals / diagnostic center of Delhi on production of  valid DGEHS card. Follow up subsequent to any emergent treatment / procedure or  for the illness shall be on authorization of concerned AMA.
  Treatment in private not recognized / not empanelled under the  scheme in medically emergent conditions will also be admissible when treatment  is necessitated in such hospitals being situated near the place of illness /  trauma and when no other recognized facility is available nearby or due to  circumstances beyond the control of the beneficiary. However reimbursement  shall be made by concerned department within the ceiling of DGEHS rates,
  4. Specialized  consultation and treatment specialized  treatment in private empanelled hospitals of choice of the beneficiary shall be  available on the advice of the concerned AMA for a period not exceeding six  months in each instance. Any OPD treatment in private hospitals not recognized  / empanelled under the scheme shall not be admissible for reimbursement.
  5. Free  supply of drugs prescribed by doctors of Government dispensaries and hospitals and recognized  hospitals. In case of chronic illnesses requiring prolonged treatment,  medicines may be supplied for one month at a time. However, in case of senior  citizen beneficiaries with chronic conditions, requiring prolonged treatment,  the same may be dispensed up to three months also on the decision of the in-charge  of the attached dispensary / hospital. The medicines to the serving beneficiaries  shall be provided by the concerned attached dispensary / hospital and in case  this is not possible, the beneficiary would be allowed reimbursement of such  medicines. In case of pensioners if any medicine is not available in hospital /  dispensary, the same dispensary / hospital authorities shall arrange it for the  eligible beneficiary and in case this is not possible, the beneficiary would be  allowed reimbursement of such medicines.
  6. Special  treatment for diseases like TB, Cancer, Kidney Transplant, Liver  Transplant and by-pass surgery etc. are provided in specialized centers.
  7. Cashless  treatment facility to  self and dependent family members as per entitlement in recognized empanelled  private hospitals / diagnostic centers will be available to serving employees  in emergent conditions on production of DGEHS health card in original. Cashless  treatment is also available to self and dependent family members of Ministers,  MLAs, Ex. MLAs, Ex. Metropolitan Councilors and pensioners for routine &  emergent treatments and investigations on production of valid DGEHS card in  original. Credit / Cashless facility is also available to dependents of IAS  (AGMUT) & DANICS officers posted on deputation / transfer to outside Delhi.  These hospitals will be sending the bills to GAD in case of Ministers, Delhi  Legislative Assembly in case of MLAs and Metropolitan Councilors, concerned  departments in case of serving employees and DGEHS cell in case of pensioners  and IAS (AGMUT) & DANICS officer on deputation / transfer for making  payments as per terms and conditions of the agreement entered into with these  hospitals / diagnostic centers. The itemized bills will have to be accompanied by  the following documents (in duplicate)-

 
• Photocopy  of valid DGEHS card of the beneficiary
 
• Referral  / authorization from AMA or emergency certificate issued by the hospitals  concerned, as the case may be.
 
• Essentiality  certificate as per CS(MA) rules.
 
• Certificate  by the hospital to the effect that
 
• The  treatment given by the hospital has been as per entitlement of the beneficiary  and the rates charged have been as per DGEHS approved rates.
 
• The  treatment given was absolutely essential and in accordance with CS(MA) rules  and was not cosmetic in nature.
 
• Stickers  / invoices indicating serial number / manufacturer etc. of implants etc. as per  practice being followed under CGHS.

The bills should be item-wise and should be authenticated /  verified by the beneficiary or in case of inability / death of patient, the  bills should be authenticated / verified by the next of kin / legal heir of the  beneficiary or attendant of the beneficiary.
    8. Reimbursement of specialized tests and treatments
  DGEHS beneficiaries on production of a valid DGEHS card can  avail of treatment facilities at AIIMS and Institute  of Liver and Biliary sciences Delhi. No prior permission  / approval is necessary from concerned Authorized Medical Attendant (AMA) for  this facility. The expenditure on treatment is reimbursed as per entitlement of  the beneficiary, as per DGEHS/CGHS/AIIMS rates or actual, whichever is less.  Where ceiling has been prescribed, reimbursement will be limited to the ceiling  rates or actual expenditure, whichever is less, as per provisions contained in  Office Memorandum dated 25/10/2007.
  Entitlement  of ward in the Institute of Liver and Biliary sciences, New Delhi

5. Treatment in Government / Referral / Private Empanelled  Hospitals
  In addition to treatment and provision of prescribed medicines  from the Delhi Government Dispensaries, all categories of the beneficiaries  under the Scheme, including their eligible family members, are entitled to  treatment in Government/Referral/Private Empanelled hospitals with the  permission of AMA. The expenditure incurred on this account is reimbursable by  the respective Departments. Such reimbursement is restricted to the limits  prescribed by the Government from time to time. The expenditure incurred in  excess of the limits prescribed has to be borne by the beneficiary himself. Cashless treatment facility is available to  Ministers of Government of NCT of Delhi, MLAs, Ex. MLAs, Ex. Metropolitan  Councilors and pensioners and their dependants in all recognized hospitals.  Cashless facility is also available to dependents of IAS (AGMUT) & DANICS  officers posted on deputation / transfer to outside Delhi. The concerned  department shall verify the validity of the card and dependent members of beneficiaries.
  Package rates for reimbursement of indoor treatment  expenses for various treatment / tests under package deals have been specified.  Reimbursement shall be made as per provisions of the scheme.

Entitlement  of ward for indoor treatment in private empanelled / government hospitals

Package  rates for empanelled AYUSH   Hospitals / Centers for  Ayurvedic, Unani, Yoga and Naturopathy treatment
            Package rate  means rates for a package of treatment of standard set of procedures that are  administered to the patient while undergoing treatment for a pre-diagnosed  disease condition for the specified time period. This includes all charges  pertaining to the particular treatment.
Admissible room rent for indoor treatment
            The maximum  room rent to be charged by Private Empanelled Hospitals for different  categories is as under
                               General  ward                   Rs. 1000  Per day
                               Semi  Private ward           Rs. 2000  Per day
                               Private  ward                             Rs. 3000  Per  day
            Room rent is  applicable only for treatment procedures for which there are no prescribed  package rates.
  6. Contribution
  Rates of  contribution for serving Delhi  Government employees

          Contribution  shall be recovered from the monthly salary bills of the employees.
Contribution by pensioners
Pensioners/Family pensioners have an option to get their  DGEHS Pensioner card made by paying a lump sum amount equivalent to 10 years  contribution as due on the date of becoming member of the scheme. Pensioners /  Family pensioners who are making contribution on an annual basis and wish to  continue to avail benefits will have to contribute at the revised rates upto  the time of contribution needed to cover a period of a total to ten years from  the time pensioner was issued pensioner’s card for the first time. The  beneficiary is not covered under the scheme during the period for which  contribution has not been paid. The scheme has been made open ended for the  pensioners i.e. the Pensioners who are not members of the scheme can opt for  scheme at any stage by paying it’s contribution.
7. Fixed Medical Allowance
Pensioners who do not opt for DGEH Scheme or who are not  staying in areas covered by the DGEHS shall be paid Fixed Medical Allowance at  the rate of Rs. 300.00 per month.
8. Identity cards
The DGEHS cards are issued to the employee / pensioners by  the concerned administrative department.
Guideline For Offices For Issuing The Health Card
1. Blank health cards [Index Cards (3 copies) and Medical  Facility Card(1) for each beneficiary] are being supplied by Directorate of  Health Services to respective departments for issue to their  employees/pensioners who have opted for the health scheme. In case of  pensioners, the issuing authority will be concerned department from where the  pensioner has retired.
2. After being filled up, the first copy of the of  the index slip is to be retained by issuing authority and kept in the services  book/personal file of the employee. The second copy of the card is to be sent  to the Medical Officer In-charge of the dispensary/ hospital, to which the  employee wants to be attached. The third copy is sent to State Program Officer  (DGEHS), Directorate of Health Services (HQ) F-17, Karkardooma, Delhi- 110032.
 
  3. Duly properly filled in Medical facility Card, clearly showing validity, entitlement of  ward and list of dependants, is to be issued to the beneficiary attached to  the particular department. This card shall be used by the beneficiary for  availing medical facilities. The beneficiary has the option to opt for hospital  / diagnostic center of his / her choice.
  4. The dispensary to which the beneficiary wants  to be attached should be clearly mentioned on the index card as well as on the  medical facility card. In case of pensioners the validity of cards and  eligibility of ward for indoor treatment should clearly be mentioned. The administrative department must clearly  indicate the validity of the card in case of pensioners on the basis of the  subscription paid by the pensioner.
  5. Photograph of the employee /  pensioner must be affixed on the health card.
  6. In case of loss of health card the  issuing department shall issue duplicate health card on receiving an  application, a copy of FIR / Complaint lodged with police regarding loss of  health card, payment of Rs. 10 for issue of duplicate card and two latest  family photographs of the beneficiary.
  7. An account of blank index cards and medical  facilities cards received from Directorate of Health Services and details of  cards issued to employees/pensioners have to be maintained in every office. 
 
  #In case of EDUCATION DEPARTMENT, the cards are  issued by Directorate of Health Services to DDEs/RDEs only, from where  concerned/subordinate schools can indent their requirement of DGEHS Cards. 
 
  # In case of PWD, the cards are supplied to the  Chief Engineer’s Offices/Engineer in Chief Office, from where the individual  subordinate offices may get required number of DGEHS Cards.
  9. Traveling allowance for medical treatment
  Beneficiary permitted for treatment in another city, if such  treatment is not available in the same city, on the advice of the Government  specialist, shall be entitled for traveling allowance restricted to the  distance up to the Referral Hospital available in the nearest city by the  shortest route. In case of any deviation, prior permission of the department /  DHS must be obtained.
  Attendant or escort who is required to travel along with  patient, if the Medical Authority attending the patient has certified in  writing that it is unsafe for the patient to travel alone and an attendant /  escort is necessary to accompany him.
10. Medical Advance
The heads of the departments of Delhi Government are  competent to sanction medical advance to the extent of 90% of the estimated  cost of treatment for major / serious illnesses in accordance with the provisions  of CS(MA) Rules 1944. Medical advance shall be issued by the Director Health  Services in case of pensioners on production of copies of valid Medical card,  Estimate provided by Government / Private empanelled Hospital, OPD card and an  application for the same.
11. Settlement of Medical Claims
A beneficiary should submit an application to the concerned  authority for claiming reimbursement of medical expenditure and settlement of  any advance. The claim should be filed within 3 months of treatment taken. The  application should be submitted along with the following documents-
  1. Modified checklist for reimbursement of medical claim,  Form Medical 2004
  2. All original bills
  3. Photocopy of Valid DGEHS Medical card
  4. Discharge Summary
  5. A detailed list of all medicines, Laboratory tests,  investigations, No. of doctor visits etc. with dates.
  6. In case treatment is taken in emergency, a self  explanatory letter from the beneficiary, explaining the emergency   circumstances. Emergency treatment certificate from the concerned hospital must  also be submitted.
  7. Photocopies of claim papers and an affidavit on stamp  paper, in case original papers have been lost.
  8. Affidavit on stamp paper by claimant, no abjection from  any other legal heirs on stamp paper and the copy of death certificate, in case  of death f the card holder.
  9. Prescription slip and diagnostic reports.

12. Referral system
1. The attached dispensary /hospital shall be the single  window for taking care of health requirement of the beneficiary (Primary health  care, referrals, supply of medicines etc.). The Authorized Medical Attendant  (AMA) at the attached dispensary / hospital will be competent to accord  permission / authorization for treatment / tests in DGEHS recognized private hospitals  / diagnostic centers. There will not be any need of permission of the concerned  department from where the beneficiary is working in such cases.
  2. The AMA for referral purposes will be the CMO/ MO  In-charge of the dispensary / hospital where the beneficiary is attached. For  this purpose all hospitals shall designate a staff physician who will function  as AMA for beneficiaries attached to the hospital.
  3. The beneficiary will have the option of availing facility  of treatment / diagnostic procedures etc. in recognized institutions of his/  her choice.
  4. It has now been decided and Referral system has been  simplified by dispensing away with the requirement of authorization for  investigations, before actually undergoing these tests, which are necessary to  arrive at diagnosis provided the tests have been advised by the specialist of  the empanelled hospital to which the patient has been referred to by Authorized  Medical Attendant (AMA) or the doctors of Government hospitals / dispensaries.  The investigations must be undertaken from an empanelled diagnostic center  approved for particular tests under DGEHS. Authorization for undergoing  Specific operative / IPD procedure shall continue to be obtained from AMA  before actually undergoing the same.
  5. In emergent conditions beneficiary can go to any of the empanelled  institution of his / her choice directly without being formally referred by  AMA. Cashless treatment facility in emergent conditions will be available to  all working beneficiaries in recognized empanelled private hospitals /  diagnostic centers on production of valid DGEHS card. Follow up treatment  subsequent to any emergent treatment / procedure or the illness shall be on  authorization of concerned AMA.
  6. Treatment in private hospitals not empanelled under the  scheme in medically emergent conditions will also be admissible, subject to  ceiling DGEHS rates applicable as per entitlement, when treatment is  necessitated in such hospitals being situated near the place of illness /  trauma and when no other recognized facility is available nearby or due to  circumstances beyond control of the beneficiary. The genuineness of the  emergent condition shall be evaluated on case to case basis. Merely getting  admitted through emergency, without any justifiable emergent condition, shall  not make beneficiary entitled for the benefit.
  7. Beneficiaries residing in NCR  areas outside Delhi are allowed to get treatment even during non-emergent  conditions from Government Institutions and Government / CGHS recognized  centers after referral from Government institutions in concerned areas or in  Delhi as per provisions of the scheme.
13. Special  Provisions for Ministers / MLAs / Ex. Metropolitan Councilors / Retired Judges  of Hon’ble High court of Delhi / DANICS officers and Head of Departments
  Ministers of Govt. of NCT of Delhi, MLAs, Ex. MLAs, Ex.  Metropolitan Councilors, Retired judges of Hon’ble High Court of Delhi / DANICS  officers in the grade pay of Rs. 7600 or above and Heads of the Departments of  GNCT of Delhi are allowed to avail direct treatment from private empanelled  hospitals under DGEHS with out the permission of Authorized Medical Attendants  in the specialties for which the empanelled hospital is recognized for and as  per entitlement.
  Cashless facility is available to self and dependent family  members of Ministers, MLAs, Ex. MLAs,  Ex. Metropolitan Councilors of GNCT of Delhi and  to dependents of IAS (AGMUT) & DANICS officers posted on deputation /  transfer to outside Delhi in all empanelled hospitals in the specialties the  hospitals are recognized for and as per entitlement.
  Note – The above description is brief and general information about  the scheme. For further details refer various office orders issued from time to  time about the scheme.
  In case of  any further queries may contact -
            Dr. Virender  Kumar, M.O. I/C (DGEHS)
            Dr. P.K. Malik,  State Program Officer (DGEHS)
            Phone no.  22391435

FREQUENTLY ASKED QUESTIONS

  1.  What is this ‘Delhi  Government Employees Health Scheme’ all about? 
  Delhi Government Employees Health Scheme is a welfare scheme  of Delhi Government to provide medical facilities to Delhi Government employees  and pensioners on the pattern of Central Government Health Scheme on the basis  of contribution by the beneficiaries. 
  2.  Who can become the member and how?
  1. Ministers, MLAs, Ex. MLAs, Ex. Metropolitan Councilors of GNCT of  Delhi.
  2. The membership of scheme is  compulsory for all employees. 
  3. The membership of the scheme for pensioners is  optional. Employee at the time of retirement can opt for the scheme by  depositing the contribution in lump sum or in installments. A lump sum  deposition of contribution shall make the pensioner and dependents beneficiary  for the life term. The pensioner who opt to pay in installments shall be  covered under the scheme for the period the subscription is deposited. Once ten  years contribution is paid the pensioner and his dependent shall be covered for  rest of their life. 
  4. Retiring officers of Indian Administrative  Service/Indian Forest Service of AGMUT cadre, officers of DANICS/UTCS cadres  including their family pensioners can also opt for the scheme. 
  5. Autonomous/statutory bodies fully funded by  Delhi Govt. may opt for Delhi Government Employee Health Scheme. IAS & DANICS officers on deputation  outside Delhi can also opt for the scheme as per provisions of the scheme.
  6. In case of expiry of the pensioner beneficiary  who has deposited contribution for lifelong benefits, the family pensioners of  such expired pensioners will continue to get benefits of the scheme. 
  7. The membership of the scheme is prospective in  nature i.e. from the date of becoming the member. By contributing the  stipulated contribution/subscription at rates applicable on the date a  pensioner become the member of the scheme.
  8. The pensioners who do not opt for the scheme  are eligible to get fixed medical allowance at Rs. 300/- per month. 
  3.  What is the subscription of the scheme ?
  Subscription to the scheme is as per OM dated 28.07.2010 as  per following list: 
  The rates of  contribution for serving Delhi  Government employees :

          Contribution  shall be recovered from the monthly salary bills of the employees.
    4. I am a pensioner (Family pensioner),  whether I can become Life member for the scheme?
    A pensioner or a family pensioner can become member of the  scheme with prospective effect by paying in the contribution, as applicable on  the date, as lump sum or in installments at time of retirement or any time  thereafter. 
    5.  I have deposited a lump-sum of 60 months contribution in 1997 before the  modified scheme was notified in 2003. Will I be getting the medical benefits?
  For those pensioners who have deposited 60 months contribution as per scheme  orders in 1997, the medical facilities will be provided to such pensioners  under the scheme on life long basis. 
  6.  From where the Medical Facility card will be issued to me?
  The medical facility card is issued from the office where the employee is  working or from the office where from he retired, in case of pensioners. In  case of eligible pensioners who have not retired from Government of NCT of  Delhi, the DGEHS cards shall be issued by Directorate of Health Services. 
  7.  What are the hospitals recognized empanelled under the scheme ?
  1. All health facilities (hospitals/dispensaries) run by the  Govt. of NCT of Delhi and autonomous bodies under Delhi Government, local  bodies viz. MCD, NDMC, Delhi Cantonment Board, Central Government and other  Government bodies [such as AIIMS, Patel Chest Institute (University of Delhi)  etc.] are recognized under the scheme. In addition, some Private  Hospitals/Diagnostic centers notified from time to time are also recognized/  empanelled as referral health facilities.
  2.  Beneficiaries residing in NCR areas outside Delhi are allowed to get treatment  even during non-emergent conditions from Government Institutions, DGEHS  Empanelled hospitals and Government / CGHS recognized centers after referral  from Government institutions in concerned areas or in Delhi as per provisions  of the scheme.
  3.  Private recognized hospitals/diagnostic centers in NCR region outside Delhi for beneficiaries  residing in these areas will be same as for CGHS beneficiaries as notified by  CGHS from time to time.
  8.  Do I need a referral to avail treatment facilities in these hospitals?
  1. All  beneficiaries are supposed to get attachment to one of the Delhi Government Allopathy  Dispensary / Hospital, the Medical Officer In-charge / staff physician will be  the Authorized Medical Attendant for the respective beneficiaries. In  non-emergent / routine cases for getting treatment / diagnostic facility from  the recognized private hospitals / diagnostic centers, prior permission of Authorized  Medical Attendant (AMA) is required. However, during emergency the patient can  directly approach the private recognized hospitals. 
  2. No permission is needed for getting treatment from  health facilities / institutions under Delhi Government, its autonomous bodies  and those under local bodies (viz. MCD, NDMC and Delhi Cantonment Board) as per  CS(MA) rules 
  9.  Are there any credit facilities for the beneficiary under the scheme?
  Currently credit / cashless facilities are available at all empanelled  Private hospitals / diagnostic centers during emergency treatment for all  beneficiaries. In this regard, Agreements with these hospitals have been  signed. In such cases, the bill will be sent by the empanelled hospital to  concerned offices from where the health card to the beneficiary has been issued. 
  In  case of pensioners, the credit / cashless facility is available during  non-emergent conditions also in all empanelled private hospitals. For this an  authorization / permission from Authorized Medical Attendant is required.  Agreements in this regard have been entered with all empanelled private  institutions.
  Credit / Cashless facility is  available to self and dependents of Ministers, MLAs, Ex. MLAs and Ex.  Metropolitan Councilors of GNCT of Delhi in all empanelled hospitals in the  specialties the hospitals are recognized for. Bills in respect of Ministers  shall be submitted in General Administration Department of GNCT of Delhi and of  MLAs, Ex. MLAs and Metropolitan Councilors shall be submitted to Delhi  Legislative Assembly.
  Credit / Cashless facility is also  available to dependents of IAS (AGMUT) & DANICS officers posted on  deputation / transfer to outside Delhi.
  10. Where should I deposit  my medical reimbursement bills?
  The medical reimbursement bills along with filled Performa  along with other essential supportive documents are to be deposited to the  concerned office from where the Medical Facility card has been issued. However,  bills of pensioners shall be forwarded to DGEHS cell of DHS for payment after  due verification of validity of the card and dependent members of the  pensioner.
  11.  My spouse is also in service, whether he/she can also avail the benefits?
  If both husband and wife are in service, only one of them  will contribute to the scheme and both of them will be getting the benefits  under the scheme, the spouse being dependent on the contributing member for  medical reimbursement purpose, in accordance to CS(MA) rules & the spouse  shall not avail medical reimbursement from his/her office. For  this purpose both of them shall have to give a joint undertaking in his/her  office.
  12.  Whether the scheme is applicable to the employee where medical allowance is  being given?
  No, this scheme is not applicable to the employees who are getting  any medical allowance. 
  13.  Is the scheme benefits available to pensioners residing outside Delhi also?
  Vide OM dated 21st Feb 2005, the scheme has been extended to  cover the DGEHS beneficiaries residing in National Capital Region (NCR) outside  Delhi, though  on a limited basis. For this all, governmental health institutions in NCR are  recognized for the purpose of medical treatment. All CGHS recognized private  hospitals/diagnostic centers in these areas are also recognized as referral  institutions for which prior permission of competent authority will be required  for undergoing treatment. 
  14.  Who is a competent authority to sanction advance?
  Under the scheme, now the financial power to sanction advance  for medical treatment to the tune of 90% of expected expenditure of treatment  has been decentralized and delegated to head of the departments vide OM dated  21.2.2005.
  15. Whether fixed medical allowance is  allowed to family pensioners also?
  Yes, the fixed medical allowance is  admissible to family pensioners.
  16. Is there any provision of change of  dispensary / hospital to which I am attached?
  No change of dispensary / hospital is  permissible except on change of residence of the card holder or any valid  reason to the satisfaction of issuing authority. When there is any change of  residence necessitating change of dispensary / hospital, the beneficiary should  submit an application in duplicate to the card issuing authority together with  DGEHS Medical Facility Card. The card issuing authority shall make entry in the  appropriate column. Then the beneficiary shall submit request to the Officer  I/C of the old dispensary / Hospital, who will make entry in his records and  then handover the index card to the card holder with the direction to hand over  the index card to the Officer I/C of new dispensary / hospital. 
  17. Where can a pensioner deposit his/her bills for  reimbursement.
  A pensioner can deposit individual  bills for reimbursement, completed in all respect, directly in Directorate of  Health Services or to the AMA concerned who in turn will send bills to DHS for  reimbursement.

Note – The above description is brief and general information about  the scheme. For further details refer various office orders issued from time to  time about the scheme.

Ph. No. - 22391435