Important news for government employees, these rules are going to be implemented from December 15, you will get benefits

There is work news for government employees. The Central Government’s Ex-Servicemen Contributory Health Scheme (ECHS) has made a major change in the treatment prices. The new CGHS package rates will be applicable for all hospitals and beneficiaries from December 15. The Health Ministry had issued a notification in this regard in October itself. This decision will benefit lakhs of ex-servicemen families. The facility of cashless treatment to service pensioners and other eligible beneficiaries will continue as before. But if the treatment is done in a non-empaneled private hospital, the claim will be accepted only on the basis of Non-NABH rates. With this decision, every patient will know what is the fixed cost in which city and hospital.

Let us know what benefits we will get from the new rates of CGHS.

• According to media reports, from December 15, treatment in all ECHS affiliated hospitals and reimbursement claims made by beneficiaries will be done at the new CGHS rates. Semi-private wards have been considered as the basis in the new rates list and this list is available on the ECHS website.
• Apart from this, service pensioners and other authorized categories will continue to get cashless treatment as before.
• Rates will be higher in NABH/NABL accredited hospitals as per the hospital’s affiliation. Lower admissible rate will be applicable for non-accredited (Non-NABH/NABL) hospitals.
• Hospitals which do not have quality recognition will get 15% less money than before and big and advanced hospitals will get 15% more money.
• The North-Eastern region, Jammu-Kashmir and Ladakh have been placed in Tier-2. The price of treatment will be different in Delhi, Guwahati or any small city and everywhere else. Rates will also change depending on the ward. 5% less price for patients in general ward.
  Semi-private will get 5% more price than normal and private ward will get 5% more price.
• The prices of services like OPD, certain treatments, tests and day-care will remain the same for everyone.
• The old CGHS rules will remain applicable for cancer surgery but new rates will be applicable for chemotherapy, testing and radiotherapy. If for any reason the patient has to get treated in a non-empaneled private hospital, reimbursement will be available only up to the non-NABH rates of the concerned city.

MoA renewal mandatory for hospitals

• According to media reports, as soon as the new rates come into effect from December 15, all private affiliated hospitals will have to renew their MOA (Memorandum of Agreement).
• Hospitals must submit an undertaking before December 15 that they accept the new rates and rules.
• If the undertaking is not submitted on time, it will be considered depaneled i.e. removed from the list.
• Hospitals have to initiate fresh MoA through online hospital empanelment module of ECHS.
• It is mandatory to update the new MoA within 90 days from the date of implementation of the new rates.
• The treatment and reimbursement rules for all ECHS beneficiaries will be as per the new CGHS rates.

ECHS: How will the new rates be decided?

ECHS has also clarified the formula for calculating the rates. For example, if A is the basic price of the package, then the hospital will prepare the bill as per the ward entitlement written on the ECHS card of the patient, A 5% on General Ward, A + 5% on Semi Private Ward, A + 5% on Private Ward.