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INTRODUCTION Delhi Government Employees Health Scheme (DGEHS) was launched in April 1997 with a view to provide medical facilities to Delhi Government employees and pensioners on the pattern of Central Government Health Scheme on the basis of monthly contribution. For this purpose, the Directorate of Health Services is providing Health cards to all the Delhi Government Departments/Offices on receiving their requirement. The cards are issued to the employees by the respective offices, which entitles them to free treatment in dispensary/hospital of Govt. of Delhi. In case of non-availability of medicines in the dispensary/hospital, the employee is entitled to reimbursement of the cost of the medicines. Some private hospitals have also been empanelled under the scheme for providing treatment/diagnostic facilities, where a beneficiary can go after referral from Authorised Medical Attendant in Non-emergency/routine cases and may also approach these hospitals directly in case of emergency. The hospitals/diagnostic centres provide treatment/diagnostic facility to beneficiaries at CGHS approved rates and also provide credit facility to beneficiaries during emergency condition to cad holders. In case of pensioners, they can avail of the benefit if they agree to have the rates of subscription deducted from their monthly pension or make a lump sum payment which is equivalent to their subscription for five years i.e. 60 months. Pensioners who have settled outside Delhi will be able to avail of the benefit only if treated in Delhi. The scheme has been modified vide O.M. No. F.342/81/2003/H&FW/3264 Dated 06-10-2003 . The terms and conditions relating to medical attendance/medical reimbursements etc. shall be as under :1. INSTITUTIONS FOR MEDICAL ATTENDANCE/TREATMENT: • 26 Private hospitals/laboratories/diagnostic centers have been recognized under the scheme vide OM no F25(III)/CME/DGEHS/27/MED/DHS/2004-05/ dt 24 May 2004 and dt 23.08.2004. List of these private medical institutions (Allopathy/ISM) recognized under the scheme is placed at the end of webpage. • It is further stated that these private institutions will be in addition to the institutions being run by Delhi Govt./Local bodies/Autonomous bodies controlled by Delhi Govt., situated in Delhi as per CS(MA) Rules: Medical treatment any where out side Delhi will be considered for reimbursement, in case of emergency only as per provisions of CS(MA) Rules. Similarly, employees who do not opt to become members of the scheme shall be continued to be governed by the CS(MA) Rules. 2. REFERRING AUTHORITY/AUTHORIZED MEDICAL ATTENDANT: • The Authorized Medical attendant for referral purposes will be the CMO/MO I/C of the dispensary to which the patient is attached. • The beneficiary will have the option of availing facility of treatment/diagnostic procedures etc. in a recognized institution of his /her choice, as are being allowed for the CGHS beneficiaries. • In emergency conditions the patient can go to any of the recognized institutions of his/her choice, directly, without, without being formally referred by AMA 3. MEMBERSHIP OF THE SCHEME The membership of scheme will be compulsory for all employees in due course. However, for the time being, the membership of the scheme will be continued to be optional, for both serving
2. 5001-7500 Rs. 4. The purchase of medicines from private source/markets will be separately reimbursed as per entitlement on the basis of cash memo and appropriate essentiality certificate. 3001-5000 Rs. All required medicines will be supplied from the dispensary/hospitals of Government of Delhi. The rate of monthly contribution Delhi Government Employees/ Pensioners Health Scheme have been revised according to Pay range/Pension/Family pension and the corresponding contribution required for DGEHS beneficiaries is as under: Pay Range Upto Rs. 3000 Rs. 3001-6000 Rs. All Private recognized hospitals and diagnostic centers will ensure provision/supply of required medicines/equipments/appliances/consumable etc. residing in areas not covered by the scheme. (at present being Rs. Fixed medical allowance will also be granted to retired persons only. till further orders. but who do not opt to become member of the scheme. with prior approval of concerned CDMO/MS of the Hospitals. FIXED MEDICAL ALLOWANCES 1.15001& above Penson/Family Pension Upto Rs. required for the serving Government employees/pensioners of Government of Delhi. 100/-pm) to the retired persons/pensioners. 5. 1501-3000 Rs. one chemist shop will be selected and earmarked and linked with each dispensary/hospital. will be dealt with as per prevailing CSMA Rule. In certain unavoidable circumstances or if the employees/pensioners is forced to purchase the medicines/consumables etc. . Fixed medical allowances will be granted as per CGHS rule. residing in the areas covered by the scheme. 7501 & above Rate of contribution 15 30 50 75 100 monthly The above rates of contribution will be effective with effect from 1. Accordingly. • The sanction of advance for treatment if required. In case of non-availability of prescribed medicine. AVAILABILITY/SUPPLY OF MEDICINES EQUIPMENTS/APPLIANCES AND MEDICAL REIMBURSEMENT 1. from market. the same will be reimbursed later on by the concerned department. A lump sum payment of 120 months (10 years) membership contribution by the pensioners (as per eligible category) will enable them to avail such medical facilities for life long with prospective effect. 4. 2. as per CS(MA) Rules. duly signed by the AMA. 6001-10000 Rs.9. attending the institutions for treatment on emergency basis and thereafter the Private Institutions will be reimbursed the said amount from the concerned department directly (from where the Serving Government employees draw salary & retired Government servant had last retired and avails pensionary benefits). 3.Government employees as well as pensioners. All our efforts will be made to ensure codal formalties and foolproof measure for appropriate selection of chemist shops.10001-15000 Rs. 1500 Rs.03 (The date of approval by the Cabinet). in these institutions the CMO/MO I/C of the dispensaries/hospitals will purchase them from identified and approved local chemists.
However. 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. Directorate of Health Services (HQ) F17. the membership of the scheme will be continued to be optional. from the date of becoming the member. Delhi. Karkardooma. The medical facility Card is to be issued to the employees after being duly filled in. as the case may be. In case of treatment in Private/Recognized Hospitals. .e. The second copy of the card is to be sent to the Medical Officer Incharge of the dispensary. 5. 4.The CSMA Rule will also be applicable to the serving employees & pensioner of Delhi Government barring specific terms and conditions mentioned earlier in this scheme. the medical reimbursement will be up to the maximum ceiling of package amounts/as per entitlement. for the time being. 3. 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 FREQUENTLY ASKED QUESTIONS 1. The third copy is sent to State Program Officer (DGEHS). The membership of the scheme is prospective in nature i. the issuing authority will be concerned department from the pensioner has retired.10032. By contributing the stipulated contribution/subscription one can become the member of the scheme. 2. • GUIDELINE FOR OFFICES FOR ISSUING THE HEALTH CARD 1. 5. 2. based either on approved package rates of CGHS or the CS(MA) Rules. Who can become the member and How? The membership of scheme will be compulsory for all employees in due course. to which the employee want to be attached. 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. What is this ‘Delhi Government Employees Health Scheme’ all about? Delhi Government 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 monthly contribution by the beneficiaries. for both serving Government employees as well as pensioners. This card shall be used by the employee for availing medical facilities. The dispensary to which the beneficiary wants to be attached should be clearly mentioned on the index card as well as medical facility card. In case of pensioners. After being filled up. till further orders.
6001-10000 Rs. I have deposited a lumpsum of 60 months contribution in 1997 before the modified scheme was notified in 2003. this subscription can be deposited on monthly or yearly basis or as a lumpsum. this contribution is deducted from the salary on monthly basis.2003 as per following list: Pay Range Penson/Family Pension Rate of monthly contribution Upto Rs. . 5. 1501-3000 30 Rs.For this one can approach the office from where the employee is working or has retired from. A lump sum payment of 120 months (10 years) membership contribution by the pensioners (as per eligible category) will enable them to avail such medical facilities for life long with prospective effect.15001& above Rs. the matter is under consideration of government. 3000 Upto Rs. the beneficiary will be issued a medical facility card. 3.10001-15000 Rs. In case of pensioners. however. whether I can become Life member for the scheme? There is a provision for becoming a life member for pensioners only. I am a pensioner. 6. the medical facilities will continues to be provided to such pensioners under the scheme. What is the subscription of the scheme ? Subscription of the scheme is as per para 3 of OM dated 6. The pensioners who do not opt for the scheme are to get fixed medical allowance at RS 100/. 7501 & above 100 In case of employees. 4. Will I be getting the medical benefits? For those pensioners who have deposited 60 months contribution as per scheme orders in 1997. The facilities under the scheme are currently available in Delhi only.per month. From where the Medical Facility card will be issued to me? The medical facility card will be issued from the office where the employee is working or from the office from where retired in case of pensioners. that will entitle the beneficiary the benefit s of scheme at empanelled hospitals.10. till the time decision is taken. 3001-5000 50 Rs. 3001-6000 Rs. 1500 15 Rs. On becoming the member. 5001-7500 75 Rs.
F17. 7.The concerned office should indent such Medical Facility Card/Index Cards from State Programme Officer (DGEHS). the bill will be sent by the empanelled hospital to concerned offices from where the health card to the beneficiary has been issued/ or to the office from where retired in case of pensioners. In non-emergent/routine cases for getting treatment/diagnostic facility from the empanelled hospitals/diagnostic centres. 9. Agreements with these hospitals have been signed. Are there any credit facilities for the beneficiary under the scheme? Currently credit facilities are available at 26 notified hospitals/diagnostic centres during emergency treatment only. What are the hospitals empanelled under the scheme ? Out of 41 hospitals provisionally recognised vide OM dated 6.2004. Delhi 32. However. Karkardooma. 10.10. Directorate of Health Services (HQ). 26 empanelled Private hospitals/ diagnostic centers have been notified under the scheme vide OM No.2003. during emergency the patient can directly approach the empanelled hospitals. the Medical Officer Incharge/Medical Superintendent will be the Authorised Medical Attendant for the respective beneficiaries. F25(III)/CME/DGEHS/27/MED/DHS/2004-05/ dt 24 May 2004 and dt 23. Where should I deposit my medical reimbursement bills? The medical reimbursement bills along with essentiality certificate are to be deposited for reimbursement to the concerned office from where the Medical Facility card have been issued. In this regard. Few other hospitals/diagnostic centres are in the process of empanelment. The list of recognised/empanelled hospitals/diagnostic centres is given elsewhere on this web page. These hospitals will be providing treatment/diagnostic facilities at CGHS rates to the beneficiaries of the scheme. In such cases.8. 7. During emergency conditions the hospitals will be providing credit facilities to the beneficiaries of the scheme. . referral from Authorised Medical Attendant (AMA) is required followed by permission from appropriate authority. These hospitals/diagnostic centres are in addition to hospitals under Delhi Government hospitals/autonomous hospitals under Delhi Government and dispensaries. Do I need a referral to avail treatment facilities in these hospitals? All beneficiaries are supposed to get attachment to one of the Delhi Government Dispensary/Hospital.
this scheme is not applicable to the employees who are entitled for any other allowance /medical facility. . Patparganj. in accordance to CS(MA) rules & the spouse shall not avail medical reimbursement from his/her office. only one of them will contribute to the scheme and both of them will be getting the benefits under the scheme. whether he/she can also avail the benefits? If both husband and wife are in service. the spouse being dependent on the contributing member for medical reimbursement purpose. Imaging. LIST OF RECOGNISED HOSPITALS/DIAGNOSTIC CENTRES UNDER DGEHS 1. 3. 10B. 6. Delhi -92 Indian System of Medicine Bapu Nature Cure Hospital & Yogashram. New Delhi 16 Specialized purpose-Ophthalmology Diwan Chand Satyapal Aggarwal Imaging Research Centre. Sunder Lal Jain Hospital . MB Road. Preet Vihar. EP Study. Purpose recognised for Arya Vaidya Sala Kottakkal. New Delhi. Delhi 91 Indian System of Medicine Batra Hospital and Medical Research Centre. MRI. Tughlakabad Instt. Green Park. 18-19X. Kasturba Gandhi Marg. A-23. 7. Hospital/Diagnostic Centre. 5. Karkardooma Instt. Aurobindo Marg. New Delhi. Cardio Vascular procedure. CT and MRI Dr Lal Path Labs Pvt. Area. Address. 8. 11.1 All Radiological Investigations and Nuclear Medicine Dr Anand’s imaging and Neurological Research Centre. CT. Whether the scheme is applicable to the employee where medical allowance is being given? No. Hanuman Road. Area. Chemotherapy & Cancer Radiation Therapy CD Diagnostic CT Scan Centre. 4. Ltd. My spouse is also in service.11. G14. CABG. Delhi 92 Conventional Radiology. PTCA. New Delhi -01 Lab 2. Ayurvedic Hospital & Research Centre. 54. Ashok Vihar Delhi 52 CT Scan Centre for Sight.62 Cardiac Procedures like CAG.
New Delhi 44 All Radiological Investigations & Nuclear Medicines. Laparoscopic Surgeries. New Delhi –60. Green Park.. Organ Transplant (Renal. Cardiac Surgery.Delhi -95 Conventional Radiology. diagnostic (except Cardiac Surgery) Mata Channan Devi Hospital. Urology. Specialized purpose. specialised purpose and Dialysis. New Delhi 60 MRI Premadhar Research Institute and Hospitals in Ayurveda. Deep Vihar. 14. Vascular Surgery Mahajan Nuclear Medicine and Bone Densitometry Centre. D-29.(Near Tel. 21. New Delhi-16 MRI Indraprastha Apollo Hospital. 11. Prahladpur Road. C-1 Block. 12. Sec 24 Rohini). 18. 20. Dialysis. Radiation Therapy. Laproscopic Surgery. Rajinder Nagar. Rohini. Cardio Thoracic. Mathura Road. 13. 16. 15. Rohtak Road. Sir Ganga Ram Hospital. Joint Replacement. Sir Ganga Ram Hospital. Ganga Ram Hospital Marg. 22. 18.54 General and specialised purpose. Lithotripsy. Diagnostic except cardiac surgery Millenium Bone Densitometry and Osteoporosis Research Centre Pusa Road. 17. Rajinder Nagar. Cardiology. Cancer Chemotherapy and Radiotherapy Sant Paramanand Hospital. New Delhi –05. Diagnostic except cardiac surgery 10. Sector 5. New Delhi 65 Lithotripsy Rajiv Gandhi Cancer Institute & Research Centre. CT North MR Scan Research Institute. USG and Mammography GMR Institute of Imaging and Research (MRI Scans Pvt Ltd). Sir Ganga Ram Hospital. Delhi .9.Naturopathy.Ophthalmology New Delhi Scan Institute. Bone Densitometry Mohan Eye Institute. Vivek Vihar. East of Kailash . Delhi . Exchange). . Yoga Sciences. Rajinder Nagar. New Delhi 26 General & specialized purpose. Liver). A-13. Non invasive Cardiac Procedures. New Delhi-58 General purpose. New Delhi –60. Delhi 42 Indian System of Medicine RG Stone Urological Research Institute. Non-Invasive Cardiac Procedure etc. Sarita Vihar.85 Specialized purpose – Cancer diagnosis. 19. New Delhi –60 Nuclear Medicine and Bone Densitometry Maharaja Agrasen Hospital. Alipur Road. Punjabi Bagh. Pooth Kalan (opp. Dr Savita Jain’s Arun Imaging Centre. Janakpuri. Dialysis.
Lajpat Nagar IV. 25. St Stephens Hospital.52 General and Specialized purpose except cardiac surgery. Delhi -54 General purpose & Diagnostic Escorts Heart Institute & Research Centre Okhla Road. Diagnostic procedures The Heart Centre. Delhi – 54 General and Specialised purpose treatment and diagnostic procedures Sunder Lal Jain Charitable Hospital. . New Delhi –24 Non-invasive Cardiac Procedures Tirath Ram Shah Charitable Hospital. Rajpur Road. New Delhi-110025 Cardiovascular Surgery. Delhi . 27. Invasive and non-invasive Cardiology and Pediatric Cardiology 24. Tis Hazari. This issues with the approval of Director Health Services. Ashok Vihar Phase III.23. 26. 2. Ring Road.
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