CGHS: Great news for millions using the CGHS (Central Government Health Scheme)! The central government has finally cleared up the confusion surrounding OPD consultation fees. The Ministry of Health and Family Welfare stepped in after a big change in CGHS rates last year led to ongoing questions about when the OPD fee would be Rs 700 and when it would be Rs 350. This confusion was causing issues for many hospitals and patients.
What’s the scoop?
The government has made it clear that the Rs 700 OPD consultation fee applies only to super-specialist doctors. This means that if a patient sees a doctor with a recognized DM or MCh degree practicing in that super-specialty, then the Rs 700 fee can be charged. This will only apply in CGHS-empanelled hospitals. For specialist doctors who don’t have a super-specialist degree like DM or MCh, the general OPD fee of Rs 350 will be charged.
On top of that, the ministry has reiterated the rules for IPD (Inpatient Disability) cases. According to CGHS, a maximum of two consultations per day by a specialist are allowed in IPD cases. This rule is already in place, and there are no new changes. The government aims to avoid unnecessary and extra billing during treatment, so patients aren’t hit with unexpected financial burdens.
Tips for CGHS beneficiaries
CGHS beneficiaries are encouraged to keep a few things in mind before heading to an OPD. Patients should verify the doctor’s qualifications (DM/MCh), ensure the hospital is CGHS-listed, and the bill should clearly indicate whether the consultation is for a specialist or super-specialist. The government believes this new clarification will boost transparency and help prevent incorrect billing, benefiting both CGHS beneficiaries and hospitals.
What is special in this health insurance plan?
This mediclaim policy covers hospitalization expenses within India. Sum insureds can be chosen between ₹10 lakh and ₹20 lakh. Co-payment is also available, where the cost is split between the insurance company and the policyholder in a 70:30 or 50:50 ratio. This allows for a higher or lower premium to be chosen as per your convenience.
What expenses will be included?
Room rent is capped under the policy. Expenses up to 1% of the sum insured per day will be covered for a normal room and up to 2% for an ICU. Medical expenses incurred 30 days prior to hospitalization and up to 60 days after discharge are also included. AYUSH treatments (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) will be fully covered, up to 100% of the sum insured.
Advanced medical facilities will be covered up to 25% of the sum insured, but this can be increased to 100% by availing an optional rider. If no claims are made in a given year, a cumulative bonus of 10% will be available every year, up to a maximum of 100% of the sum insured.
This scheme is cheap
This plan is cheaper than a standard health insurance policy. Discounts of up to 28% are available for the 70:30 option and up to 42% for the 50:50 option. Importantly, there is no GST on this policy, which will further reduce premiums. Paripoorna Mediclaim Ayush Bima will soon be available to CGHS beneficiaries as a retail policy through New India Assurance Company Limited offices and online platforms.
