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Minister
Satyendar Jain
DGEHS
Sanction Orders issued in DGEHS
Important Office Memorandums and Office Orders
Government Hospitals or Dispensaries or Empanelled hospitals and diagnostic centers in Delhi and NCR
Approved rates for treatment and investigative procedures
Downloadable forms
Important Links
Frequently Asked Questions
FREQUENTLY ASKED QUESTIONS

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 comprehensive medical facilities to the eligible Delhi Government employees and pensioners, Ministers, Ex and sitting MLAs, Ex Metropolitan Councilors and Retired and sitting Judges of Delhi High Court, on the pattern of Central Government Health Scheme on the basis of contribution by the beneficiaries.

2. Who can become the member of the scheme?

     
  • All Delhi Government working and retired employees (including family pensioners)
    and their dependent family members (As per CS (MA) rules are eligible for becoming the
    member of Delhi Govt. Employees Health Scheme.
  •  
  • The family pensioners are also eligible to become the members of the scheme.
  •  
  • Ministers, MLAs, Ex. MLAs, Ex. Metropolitan Councilors of GNCT of Delhi.
  •  
  • Judges and Ex. Judges of Hon’ble High court of Delhi
  •  
  • The membership of the scheme is compulsory for all employees.
  •  
  • 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 annual
    installments. Deposition of lump sum contribution equal to ten years contribution shall
    make the pensioner and dependents beneficiary for the life term. The contribution to be
    paid is calculated on the basis of the prevalent monthly rates of contribution applicable.
  •  
  • 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. IAS & DANICS officers on deputation outside Delhi can also opt for the
    scheme as per provisions of the scheme.
  •  
  • Autonomous/statutory bodies fully funded by Delhi Govt. may opt for Delhi Government
    Employee Health Scheme.
  •  
  • The benefits of the scheme are prospective in nature i.e. from the date of becoming the
    member.
  •  
  • The pensioners have the option either to opt the scheme or opt the fixed medical
    allowance at the time of retirement.

3. From where the Medical Facility card will be issued to me?

Sr.No. Category Submission of bills to
1 Ministers of GNCT of Delhi General Administrative Department
2 Ex. and sitting MLA and Ex. Metropolitan Councilors Delhi Legislative Assembly
3 Retired and sitting judges of Delhi High Court Registrar, Delhi High Court
4 Delhi Govt. serving employees Concerned Department from where drawing the salary
5 Delhi Govt. Pensioners Concerned Department from where retired
6 IAS (AGMUT) & DANICS officer on deputation / transfer DGEHS Cell, DHS (HQ)

4. What are the rates of subscription of the scheme?

Sr.No. Grade pay drawn per month Rate of monthly Subscription
1 Up to Rs. 1,650 Rs.50.00
2 Rs.1,800, Rs.1,900 and Rs.2400,
Rs.2,400 and Rs.2,800
Rs.125.00
3 Rs.4,240 Rs.225.00
4 Rs.4,600, Rs.4,800 Rs.5,400 and
Rs.6,600
Rs.325.00
5 Rs.7600 and above Rs.500.00

Contribution shall be recovered from the monthly salary bills. Pensioners / Family pensioners
  shall pay contribution at prevalent rates equal to ten years contribution in lump sum.  

5. I am a pensioner and did not opt for the scheme at the time of retirement. Whether now
can I join the scheme?


  Yes, the scheme is open ended now and a eligible pensioner can become member of the scheme at any time by paying in the requisite contribution, as applicable on the date.

6. I have deposited a lump-sum of 60 months contribution 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 the provisions of the scheme before 2003, the medical facilities will be provided to such pensioners under the scheme on life long basis.

7. My spouse is also in service, whether he/she can also avail the benefits?

As per CS (MA) rules in Case spouse of employee is also Govt. servant then if only one of
the spouses wants to avail the benefits of the scheme, the other spouse being considered
dependent for the purpose of medical benefits may be beneficiary provided he/she is not
getting any type of medical benefit/allowance in this regard from his/her office. A joint
declaration in this regard that both of them will be getting the benefits under the scheme
may be obtained from them while issuing the membership/health card.

8. Whether the scheme is applicable to the employee where medical allowance is being
given?


No, dual benefits are not allowed under the scheme.

9. Is the scheme benefits available to pensioners residing outside Delhi also?

Yes Beneficiaries residing in NCR areas outside Delhi are allowed to get treatment even
during non-emergent conditions from Government Institutions and Government / CGHS
empanelled centers after referral from Government institutions in concerned areas or in Delhi as
per provisions of the scheme.

10. What are the hospitals recognized under the 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 empanelled/ empanelled as
referral health facilities.

Beneficiaries residing in NCR areas outside Delhi are allowed to get treatment even
during non-emergent conditions from Government Institutions and Government / CGHS
empanelled centers after referral from Government institutions in concerned areas or in Delhi as
per provisions of the scheme.

DGEHS may not have any agreement with all CGHS empanelled institutions in NCR
therefore the CGHS empanelled hospitals may charge more but reimbursement shall be restricted
to ceiling DGEHS rates.

11. Do I need a referral to avail treatment facilities in these hospitals?

For treatment at any of the center / state government hospital / dispensary, Autonomous
hospitals of center / state government, hospitals / dispensaries of other government bodies like
MCD, NDMC, Delhi cantonment board etc. no referral from concerned AMA is required.

The attached dispensary /hospital shall be the single window for taking care of health
requirement of the beneficiary .The Authorized Medical Attendant (AMA) at the attached Delhi
Govt. allopathic dispensary / hospital will be competent to accord permission / authorization for
treatment / tests in DGEHS empanelled 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.

12.  Whether referral is necessary for investigations advised in OPD by empanelled
       private hospital or government institutions?   


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/
Referral for undergoing Specific operative / IPD procedure shall continue to be obtained from
AMA before actually undergoing the same.

 

13.  Are there any credit facilities for the beneficiary under the scheme?   

The cashless facilities as per entitlement in empanelled private hospitals / diagnostic centers in
Delhi will be available to serving employees and pensioners in emergent conditions on
production of valid DGEHS card. The cashless facilities will also be available to the pensioner
beneficiaries even in non-emergent conditions on the authorization of the AMA. Cashless
treatment is also available to self and dependent family members of Ministers, MLAs, Ex. MLAs
and Ex. Metropolitan Councilors 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.


14. Where should I deposit my medical reimbursement bills?


Sr.No. Category Submission of bills to
1 Ministers of GNCT of Delhi General Administrative Department
2 Ex. and sitting MLA and Ex. Metropolitan Councilors Delhi Legislative Assembly
3 Retired and sitting judges of Delhi High Court Registrar, Delhi High Court
4 Delhi Govt. serving employees Concerned Department from where drawing the salary
5 Delhi Govt. Pensioners Concerned Department from where  retired
6 IAS (AGMUT) & DANICS officer on deputation / transfer DGEHS Cell, DHS (HQ)


15.  Who is a competent authority to sanction 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 may be issued by the
concerned HOD on production of copies of valid Medical card, Estimate provided by
Government / Private empanelled Hospital, OPD card and an application for the same.


16.  Is there any provision of change of dispensary / hospital to which I am attached?   

Change of dispensary / hospital is not allowed ordinarily except in case of change of
residence of the card holder, opening of new health facility or any other valid reason to the
satisfaction of card issuing authority. In case of any justified reason 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. The beneficiary then 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 and shall retain a photocopy of the same in record.

 

17.  How can I procure machines / equipments under the scheme?

Reimbursement of the cost of various artificial appliances (Initial Supply, replacement
and repair) including the cost of Heart Pace Maker and replacement of pulse generator (except
AICD), cost of replacement of diseased Heart Valves, Hearing Aids, Artificial Electronics
Larynx, Knee and Hip implants, Intraocular lenses, Coronary Stents and Brain implants etc. shall
be made by the concerned Head of the Department as per rules defined in CS(MA) Rules 1944
and CGHS Rules applicable at the time of procurement.

 

18.  Whether any prior special Permission is required for treatment / equipments –    

  Prior permission of Director Health Services / HOD is required in following cases:

  • For Procurement of equipments / machines like BIPAP, CPAP, AICD, Oxygen
    Concentrator, Neuro-Implants, Cochlear Implant etc. Reimbursement shall be
    made by the concerned Head of The Department as per prevalent CS(MA)/
    CGHS Rules
  •  
  • Prior special Permission of Director of Health Services is required for Costly
    treatments like Liver Transplant and Bone marrow Transplant etc.
  •  
  • Prior special Permission of Head of the Department is required for In Vitro
    Fertilization (IVF) treatment on the recommendations of Head of the Department
    of Gynecology of Government Hospital.

 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.

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Last Updated : 29 Jun,2015