‘CGHS cover applies even to hospitals not on government list’

The Supreme Court (SC) said that reimbursement cannot be denied to retired government employees and their families covered under the Central Government Health Scheme (CGHS) even if they received treatment in a hospital not empanelled under the plan.
The court passed the order on a PIL (Public Interest Litigation) filed by former Indian Revenue Service officer and advocate Shiva Kant Jha who was treated for a heart ailment at Fortis Escorts Hospital in Delhi and Jaslok Hospital in Mumbai in 2003. There was some hardship in reimbursement from the government in this case.
The SC bench said “no fetters” could be placed on the rights of a government employee during his lifetime to get the best medical treatment and it was wrong to reimburse bills on the basis of rates fixed under CGHS in case the employee got treatment from a hospital which is not empanelled.
“The right to medical claim cannot be denied merely because the name of the hospital is not included in the government order,” the bench said.
“The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment. Once it is established, the claim cannot be denied on technical grounds,” the bench said.



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