What are the facilities under DGEHS and their cost benefits?
With a strong urban healthcare system and a thriving private-sector presence, Delhi is quickly becoming a significant healthcare center in the nation.With numerous hospitals, including super specialty hospitals, autonomous hospitals offering thousands of beds, and a chain of hundreds of allopathic dispensaries, the Delhi Government has developed a substantial health infrastructure. Thousands of doctors and other allied health professionals oversee the delivery of healthcare services.A holistic, humane, and patient-centric approach to healthcare delivery is what the government has increased its focus on, and for this reason, targeted programs and schemes are being planned for greater outreach to all facets of society. The government also strives to make healthcare delivery accessible and affordable to all.
The Delhi Government Employees Health Scheme (DGEHS) is a welfare scheme designed to give access to high-quality medical care to Delhi government employees and retirees on the basis of a monthly contribution by the recipients, similar to the Central Government Health Scheme. It is designed after the CGHS model and typically adheres to its rates and regulations. DGEHS was established in April 1997 with the aim of providing comprehensive medical services to government employees, retirees, and dependents, following the format of the Central Government Health Scheme.
Basic criteria for eligibility
Membership in the scheme is required of every employee. Pensioner membership in the scheme is optional. When retiring, employees will have the choice of joining the scheme.
Those who choose lifelong membership at the time of retirement will have the subscription deducted in a lump sum (equivalent to a ten-year subscription).The scheme is also available to retiring officials from the Indian Administrative Service, Indian Forest Service of AGMUT cadre, DANICS/UTCS cadres, and their family pensioners.
Autonomous or statutory organizations that are entirely supported by the Delhi government may opt for the scheme.Employees and retirees who are eligible for other medical benefits or medical facilities are not covered under the scheme.
The family pensioners of such expired pensioners would continue to receive benefits from the scheme in the event that the primary pensioner beneficiary who has contributed for everlasting benefits expires.
The scheme’s membership is prospective in nature, meaning it begins on the day the member joins. The required contribution/subscription must be made in order to join the scheme. One can go to the office where the person works or has retired from in order to join. A medical facility card that entitles the beneficiary to the benefits of the scheme at accredited hospitals will be given to the beneficiary upon becoming a member.
Pensioners who choose not to participate in the scheme are still eligible for a fixed medical allowance of ₹100 per month.
Salient Features of the Scheme
- Employees and pensioners can receive comprehensive healthcare services through a network of Delhi Government dispensaries, hospitals, and government- and privately-impaneled hospitals and diagnostic centers.
- The program’s rewards are dependent on CGHS.
- Membership is required for active employees but not for retirees.
- All beneficiaries have access to the cashless facility in an emergency, but pensioners can use it in both an emergency and a non-emergency.
Hospitalsrecognizedunder the scheme
The schemerecognizes all medical facilities (hospitals/dispensaries) run by the National Capital Territory of Delhi Government, autonomous bodies under the Delhi Government, local organizations like the MCD, NDMC, and Delhi Cantonment Board, as well as Central Government and other government organizations [like AIIMS, Patel Chest Institute (University of Delhi), etc.].Furthermore, a few private hospitals and diagnostic labs that are occasionally notified are also acknowledged as referral medical facilities.
According to the provisions of the scheme, pensioner beneficiaries who live outside Delhi in NCR areas are permitted to receive treatment from government institutions and CGHS-recognizedcenters, even for non-emergent conditions, after being referred by government institutions in the affected areas or in Delhi.
For beneficiaries living in these locations, private, accredited hospitals and diagnostic centres in the NCR zone outside of Delhi would be the same as those for CGHS beneficiaries as notified from time to time by CGHS.The hospitals will offer credit facilities to the scheme’s beneficiaries in times of emergency.
Is there a need for a referral to access hospital services?
There is no need for a referral in order to receive care at any DGEHS-empanelled private hospital, Center/State government hospital or dispensary, Autonomous hospitals of the Center/State government, or hospitals or dispensaries run by other governmental entities like the MCD, NDMC, Delhi cantonment board, etc. Although an AMA (Authorized Medical Assistant) referral is not necessary for AYUSH therapy, it is nevertheless advisable to see government AYUSH specialists before receiving care in a privately impanelled AYUSH hospital.
Facilities accessible to DGEHS members
The following facilities are available to Delhi Government Employees Healthcare Scheme (DGEHS) members:
- Facilities for outpatient care across all systems.
- Emergency services under the allopathic system.
- Free prescription drug distribution to pension beneficiaries.
- Super-specialized medical care, such as kidney transplantation, CABG, joint replacement, etc.
- Services for family welfare.
- Specialized medical care and diagnosis in government- and privately-accredited hospitals and diagnostic facilities that fall under DGEHS.
Credit or cashless options offered by the scheme
Currently, all recognized private hospitals and diagnostic centres offer credit/cashless payment options for all beneficiaries receiving emergency care.Agreements with these hospitals have been signed in this regard. In these situations, the bill will be submitted by the hospital with the impanelled status to the relevant offices where the beneficiary’s health card has been issued or, in the case of pensioners, where they had retired.All private hospitals offer the credit/cashless option to retirees for non-emergency ailments as well. The concerned hospital will be needed to obtain authorization or a permit from the appropriate authority for this. All private institutes, with the exception of the Rajiv Gandhi Cancer Institute, have entered into agreements in this regard.
All pensioners and serving employee beneficiaries in Delhi will have access to cashless care in urgent situations at recognizedimpanelled private hospitals and diagnostic facilities upon presentation of a valid DGEHS Card.With the approval of the AMA (Authorized Medical Assistant), all pensioner beneficiaries in recognizedimpanelled private hospitals/diagnostic centres in Delhi would have access to cashless care facilities for non-emergent OPD (Out Patient Department) treatment, indoor treatments, and investigations as per entitlement.
According to the terms and conditions of the contract negotiated with these hospitals/diagnostic centres, payments must be made within 60 days and will be sent by these hospitals to the concerned departments (from where the DGEHS Card has been obtained).
What aboutthose who live outside of Delhi?
The scheme has been limitedly expanded to include DGEHS recipients who live outside of Delhi in the National Capital Region (NCR).In order to provide medical care, governmental health institutes in the NCR are recognized. All private hospitals and diagnostic centres in these areas that have received recognition from the CGHS are also recognized as referral facilities, where patients must first obtain permission from the concerned authorities before receiving treatment.
Final Remarks
The program’s main objective is to give the Delhi government’s employees, pensioners, and their dependent families access to high-quality medical care. Employees and retirees who live in the National Capital Region are now included in the supply of facilities. The Delhi Cabinet adopted the DGEHS in July 2010, which calls for the empanelment of hospitals to offer beneficiaries access to cashless credit facilities during emergency medical care.DGEHS’s goals are to offer comprehensive medical care to Delhi Government beneficiaries, including honourable ministers, MLAs, former MLAs, pensioners from the GNCT of Delhi, and judges of the high court.DGEHS meets the medical requirements of qualified beneficiaries. Due to the size of its beneficiary base and its open-ended generous approach to healthcare delivery, DGEHS is the benchmark healthcare facility provider for Delhi government employees and pensioners.
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