Patient who are recovering from Organ transplant surgery with the need to purchase OPD medicines, based on the advice of the treating specialist for up to a period of six months if they are not in a position to visit central government health scheme (CGHS) wellness centre or to send an authorized representative.
The reimbursement of purchase of medicines has terms and conditions on restricted medicines having CGHS rate contract, shall be limited to the CGHS rates. reimbursement in respect of other medicines for which there is no rate contract under CGHS, shall be limited to 85% of MRP or actual expenditure incurred, whichever is lower (since 15% discount is the minimum discount prescribed under CGHS for Local Chemists). products manufactured/ marketed as food supplement, cosmetics and ayurvedic preparations advised by allopathic doctors are not reimbursable, as per extant CGHS guidelines. This is applicable for almost all categories of central government employees, which include in particular all government employees working under the central government and their dependent family members, living or working in CGHS-covered areas. The main purpose of this scheme is streamlining reimbursement claims, evaluate services of empaneled chemists, hospitals and diagnostic centres and resolve grievances.
