Concerns and Refund Procedures for CGHS Services: A Review of Recent Complaints

Concerns and Refund Procedures for CGHS Services: A Review of Recent Complaints

Complaints have been reported against private empaneled hospitals regarding the denial of credit and services, as well as instances of overcharging. The details of these complaints, along with the actions taken to address them, are provided in the attached Annexure.

In accordance with the guidelines established by Office Memorandum No. S.11012/1/2016-CGHS(P) dated September 19, 2016, there are procedures for refunding subscription fees for the Central Government Health Scheme (CGHS). Refunds are processed after deducting the amount corresponding to the period during which the CGHS card was utilized by the family pensioner.

Recently, two cases were received via physical letters in Nagpur city concerning refunds of one-time payments. These cases involve individuals who surrendered their pensioner CGHS cards and subsequently acquired serving CGHS cards through their spouses, who secured employment. The cases highlight the need for clarity and prompt action in processing refunds to ensure beneficiaries receive the appropriate financial adjustments in a timely manner.

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT
OF HEALTH AND FAMILY WELFARE

LOK SABHA

UNSTARRED QUESTION NO. 5717
TO BE ANSWERED ON 4TH APRIL, 2025

TREATMENT IN CGHS PANEL HOSPITALS

5717. SHRI Y S AVINASH REDDY:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) whether it is a fact that some hospitals/CGHS dispensaries, empanelled hospitals are not giving proper treatment and OPD staff/doctors are also showing utter negligence, insulting and avoiding the CGHS beneficiaries especially pensioners and their family members, if so, the details thereof and the reasons therefor.

(b) whether the Government refunds the one-time payment/adjust the payment paid for pensioner CGHS card after surrendering the pensioner card and taking the serving CGHS cards by the spouse on getting employment, if so, details thereof, and

(c) the number of such cases noticed/registered in each office/CGHS along with the action taken thereon?

ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

(SHRI PRATAP RAO JADHAV)

(a) to (c): Some complaints have been received against private empaneled hospitals regarding denial of credit/services and overcharge amount. The details such complaint along with action taken is attached at Annexure.

Instruction for refund of subscription, after deducting an amount for the period for which CGHS card was utilized as family pensioner, are in place. vide Office Memorandum No. S.11012/1/2016-CGHS(P) dated 19.09.2016. Two cases through physical letter were received in Nagpur city, for refund of one-time payment/adjust the payment paid for pensioner CGHS card after surrendering the pensioner card and taking the serving CGHS cards by the spouse on getting employment.

ANNEXURE

List of complaints along with action taken

नोट :- हमारे वेबसाइट www.indiangovtscheme.com पर ऐसी जानकारी रोजाना आती रहती है, तो आप ऐसी ही सरकारी योजनाओं की जानकारी पाने के लिए हमारे वेबसाइट www.indiangovtscheme.com से जुड़े रहे।