Central Services (Medical Attendance) Rules, 1944
[1] Overview [2] Definition [3] Medical Attendance [4] Travelling Allowance for Medical Attendance Journey [5] Consultation with Specialist [6] Medical Treatment [7] Treatment at Residence [8] Other Medical Facilities [9] Counter Signature of Certificates [10] Transfer to Foreign Service [11] Treatment Outside India [12] Authorised Medical Attendant (AMA) [13] Guidelines [14] Medical Advance [15] Final Claim [16] Difference between CS(MA)Rule & CGHS
**************************************************
[1] Overview
1.1 Central Services (Medical Attendance) Rules, 1944, hereinafter it is known as CSMA Rule is a specific rule which facilitates Central Government Employees & their dependent family members for free medical treatment.
1.2 Main useful topics which are essential to be known to every Government employee are to be discussed here. Juice of the rule are discussed in successive paras hereinafter.
1.3 In exercise of the powers conferred by sub-section (2) of section 241, read with sub-section (3) of section 313 of the Government of India Act, 1935, the Governor General – in – Council is pleased to make the rule Central Services (Medical Attendance) Rules, 1944.
1.4 This CSMA rule apply to all Government servants other than (i) those in Railway service and (ii) those of Non-Gazetted rank stationed in or passing through Calcutta, whose conditions of service are prescribed by Rules made or deemed to be made by the Central Government, when they are on duty, leave or Foreign Service in India or when under suspension [Rule 1(2)].
1.5 Serving Central Government employees residing outside the CGHS covered areas shall be covered under CS(MA) Rules.
1.6 In all CGHS covered cities, the serving Central Government employees, residing within the municipal limits of the city, shall be given one time choice to opt for CGHS instead of CS(MA) Rules from the nearest CGHS wellness centre [Ministry of Health OM dtd: 06/04/2018].
1.7 Facility of medical treatment under CSMA rule is extended to dependent family members of the Central Government employee which includes –
(a) Spouse, irrespective of income.
(b) Father, Mother fully dependent on the Government Servant.
(c) Unmarried, unemployed Son up to 25 years of age.
(d) Unmarried daughter with no age-limit.
1.8 As per instant guidelines, the validity period of a private recognised hospitals under CS(MA) Rules are for a fixed period of 4 years from the date of issue of relevant order/OM.
1.9 Relaxation of Rules: In case of serious accidents or illness, a Government servant or his/her family members may be admitted in the nearest private hospital for emergent treatment in the absence of a Government or recognized hospital nearer than the private hospital. Reimbursement of expenditure may be allowed in such cases by the Heads of Departments as defined in Rule 3(1)(f) of Delegation of Financial Powers Rules subject to the condition that reimbursement shall be restricted to CGHS package rate.
1.10 As per Government of India, Ministry of Health & Family Welfare, Medical Services Division No. 17020/1/2010-MS dtd: 21st October, 2011, Medical Examination Scheme was introduced to all Central Civil Services Group-A officers of above 40 years of age. For this purpose, Medical Examination fee has been fixed by the government – (a) For male officers – Rs. 2,000/- (b) For female officers – Rs. 2,200/-
[2] Definition (Rule 2)
2.1 Some useful definitions are required to be known to all. Hence, important definitions under this rule are discussed hereinafter.
2.2 Authorised Medical Attendant (AMA): Authorised Medical Attendant means –
(i) in respect of a Government servant who belongs to a Central Service, Class I, or whose pay is not less than Rs.500 per mensem, the Principal Medical Officer of the district appointed by the Government to attend its officers in the district;
(ii) in respect of Government servant not belonging to a Central Service Class I, whose pay is less than Rs.500 but more than 150 per mensem, an assistant surgeon grade-I (Medical Graduate), or other medical officer appointed by the Government to attend its officers in the station.;
(iii) in respect of any other government servant an Assistant Surgeon Grade II (Medical Licentiate), or other Medical Officer, similarly appointed [Rule 2(a)].
2.3 Government Hospital (Rule 2d): “Government Hospital” includes a Military Hospital, subject to the provisions of Appendix 32 to the Regulations for Medical Services of the Army in India, 1937, a hospital maintained by a local authority and any other hospital with which arrangements have been made by the Government for the treatment of government servants [Rule 2(d)].
2.4 Medical Attendance (Rule 2e): “Medical Attendance” means-
(i) in respect of a government servant specified in Rule 2(a)/Mentioned at Para 2.1, attendance in hospital or at the residence of government servant, including such pathological, bacteriological, radio-logical or other methods of examination for the purpose of diagnosis as are available in any government hospital in the district and are considered necessary by the authorized medical attendant and such consultation with specialist or other medical officer in the services of the Government stationed in the state as the authorized medical attendant certifies to be necessary, to such extent and in such manner as the specialist of medical attendant determine;
(ii) in respect of any other government servant but excluding a member of the central service class IV, attendance at a hospital or in the case of illness which compels the patient to be confined to his residence, at the residence of the government servant, including such methods of examination for purposes of diagnosis as are available in the nearest government hospital and such consultation with a specialist or other medical officer of the government stationed in the district as the authorized medical attendant certifies to be necessary to such extent and in such manner as the specialist for medical officer may, in consultation with the authorized medical attendant, determine;
(iii) in respect of a member of the central service, class IV, attendance at a hospital including such methods of examination for purposes of diagnosis as are available in the nearest government hospital and such consultation with a specialist or other medical officer of the government stationed in the district as the authorized medical attendant certifies to be necessary to such extent and in such manner as the specialist or medical officer may, in consultation with the authorized medical attendant, determine.
2.5 Patients [Rule 2 (f)]: “Patients” means a government servant to whom these Rules apply and who has fallen ill [Rule 2(f)].
2.6 State [Rule 2 (g)]: “State” means the State in which a patient has fallen ill [Rule 2(g)].
2.7 Treatment [Rule 2 (h)]: “Treatment” means the use of all medical and surgical facilities available at the Government hospital in which the Govt. servant is treated and includes-
(i) the employment of such pathological, bacteriological, radio-logical, or other methods as are considered necessary by the authorized medical attendant;
(ii) the supply of such medicines, vaccines, sera or other therapeutic substances as are ordinarily available in the hospital;
(iii) the supply of such medicines, vaccine, sera or other therapeutic substances not ordinarily so available as the authorized medical attendant may certify in writing to be essential for the recovery or for the prevention of serious deterioration in the condition of the Government servant;
(iv) such accommodation as is ordinarily provided in the hospital and is suited to his status; accommodation in general or free wards in the hospital being regarded as suitable for a member of the Central Services, Class IV;
(v) such nursing as is ordinarily provided to in-patients by the hospitals; and
(vi) the specialist consultation described in clause (e) but does not include diet or provision at the request of the Govt. servant or accommodation superior to that described in sub-clause (iv) [Rule 2(h)].
[3] Medical Attendance (Rule 3)
3.1 A Government servant is entitled for free of charge to medical attendance by the authorized medical attendant [Rule 3(i)].
3.2 Where a Government servant is entitled under Rule 3(i), free of charge, to receive medical attendance, any amount paid by him on account of such medical attendance shall, on production of a certificate in writing by the authorized medical attendant in this behalf be reimbursed to him by the Central Government [Rule 3(ii)].
[4] Travelling Allowance for Medical Attendance Journey (Rule 4)
4.1 As per Rule 4(i), when the place at which a patient falls ill is more than 5 (Five) miles (8 km) by the shortest route from the consulting room of the authorized medical attendant-
(a) the patient shall be entitled to traveling allowance for the journey to and from such consulting room, or
(b) if the patient is too ill to travel, the authorized medical attendant shall be entitled to traveling allowance for the journey to and from the place where the patients is.
4.2 As per Rule 4(ii), application for traveling allowance under Rule 4(i)/discussed at Para 4.1 shall be accompanied by a certificate in writing by the Authorized Medical Attendant stating that medical attendance was necessary and if the application is under clause (b) of that sub-rule that the patient was too ill to travel.
[5] Consultation with Specialist (Rule 5)
5.1 As per Rule Rule 5(1), if the Authorized Medical Attendant is of opinion that the case of a patient is of such a serious or special nature as to require medical attendance by some person other than himself, he may, with the approval of the Chief Administrative Medical Officer of the State (which shall be obtained beforehand unless the delay involved entails danger to the health of the patient)-
(a) send the patient to the nearest specialist or other Medical Officer as provided in Rule 2 (e)/discussed at Para 2.4 above, by whom, in his opinion, medical attendance is required for the patient; or
(b) if the patient is too ill to travel, summon such specialist or other medical officer to attend upon the patient.
5.2 As per Rule 5(2), a patient sent under Rule 5(1)(a)/discussed at Para 5.1 above shall on production of a certificate in writing by the authorized medical practitioner under rule, the patience will be entitled for traveling allowances for his/her medical journeys to and from the headquarters of the specialist or to other medical officer.
5.3 As per Rule 5(3), a specialist or other medical officer summoned under Rule 51(b)/discussed at Para 5.1 shall, on production of a certificate in writing by the authorized medical attendant in this behalf be entitled to travelling allowance for the journey to and from the place where the patient is.
[6] Medical Treatment (Rule 6)
6.1 As per Rule 6 (1), a Government servant shall be entitled for treatment free of charge –
(a) in such Government hospital at or near the place where he falls ill as can in the opinion of the authorized medical attendant provide the necessary and suitable treatment; or
(b) if there is no such hospital as is referred to in Rule 6(1)(a) in such hospital other than a Government hospital at or near the place as can in the opinion of the authorized medical attendant, provide the necessary and suitable treatment;
6.2 As per Rule 6(2), where a Government servant is entitled under Rule 6(1)/discussed at para 6.1 free of charge, to treatment in a hospital, any amount paid by him on account of such treatment shall, on production of a certificate in writing by the authorized medical attendant in this behalf, be reimbursed to him by the Central Government.
6.3 Government servants who have subscribed to Medical Insurance Policies can claim reimbursement from both Insurance Company and Department subject to condition that the reimbursement should not exceed the total expenditure on the treatment.
[7] Treatment at Residence (Rule 7)
7.1 As per Rule 7 (1), if the authorized medical attendant is of opinion that owing to the absence or remoteness of a suitable hospital or to the severity of the illness, a Govt. servant cannot be given treatment as provided in Rule 6 (1)(a)/discussed at Para 6.1, the Government servant may receive treatment at his residence.
7.2 As per Rule 7(2), a Government servant receiving treatment at his residence under Rule 7(1) shall be entitled to receive towards the cost of such treatment incurred by him a sum equivalent of the cost of such treatment as he would have been entitled, free of charge, to receive under these rules if he had not been treated at his residence.
7.3 As per Rule 7(3), claims for sums admissible under Rule 7(2) shall be accompanied by a certificate in writing by he authorized medical attendant stating-
(a) his reasons for the opinion referred to in sub-rule (1); and
(b) the cost of similar treatment referred to in sub-rule (2).
[8] Other Medical Facilities (Rule 8)
8.1 As per Rule 8(1), charges for services rendered in connection with but not included in medical attendance on, or treatment of, a patient entitled, free of charge, to medical attendance or treatment under these Rules, shall be determined by the authorized medical attendant and paid by the patient.
8.2 As per Rule 8(2), if any question arises as to whether any service is included in medical attendance or treatment it shall be referred to the Government and the decision of the Government shall be final.
8.3 Dental treatment can be availed by CS(MA) beneficiaries in any private hospitals recognized under CGHS/CS(MA) Rules and the hospitals recognized by the State Government subject to conditions under rule [Rule 8].
8.4 Government servants are eligible for reimbursement of expenses incurred on the surgery and post-operative care of the donor of the kidney to them or to ta member of their family for transplantation. If the same is undertaken at private recognized hospital. Reimbursement will be restricted to CGHS approved rates [Rule 8].
8.5 Artificial Appliances – Reimbursement if prescribed by specialist of Government and recognised hospitals admissible in the following cases –
(a) Procurement/Adjustment/Repair of Artificial Orthopaedic Appliances.
(b) Procurement/Adjustment/Repair of Artificial Digital Hearing Aid.
(c) Cost of Heart Pacemaker and Replacement of Pulse Generator.
(d) Replacement of diseased Heart Valves, Artificial Electronic Larynx.
(e) Cost of knee and hip implants – OM dtd: 26/09/2917.
(f) Cost of Nebulizer.
(g) Cost of Oxygen Concentrator – [Rule 8(1)].
(h) Cost of CPAP Machine and BIPAP Machine for domiciliary use of beneficiaries subject to the prescribed conditions.
(i) various appliances as ordered by government from time to time.
[9] Countersignature of Certificates (Rule 9)
9.1 As per Rule 9, the Controlling Officer of a patient may require that any certificate required by these Rules to be given by the Authorised Medical Attendant for traveling allowance purposes shall be countersigned-
(a) in the case of a certificate given by the principal medical officer of a district, by the Chief Administrative Medical Officer of the State; and
(b) in the case of a certificate given by any other medical officer, by the principal medical officer of the district.
[10] Transfer to Foreign Service (Rule 10)
10.1 As per Rule 10, No Government servant shall be transferred to foreign service unless the foreign employer undertakes to afford to him so far as may be privileges not inferior to those which he would have enjoyed under these Rules if he had been employed in the service of the Government of India.
[11] Treatment Outside India (Rule 11)
11.1 As per Rule 11(1), a Government Servant shall be eligible to obtain medical treatment outside India or, as the case may be, to claim reimbursement of the cost of medical treatment obtained inside or outside India in accordance with the provisions of this rule.
11.2 As per Rule 11(2), a Government Servant desirous of availing of medical treatment outside India may make an application through the Department/Ministry to which the Government servant is attached to the Standing Committee established under this rule in the form specified by the Standing Committee.
11.3 As per Rule 11(3), a Government servant desiring to avail of medical treatment outside India for himself or for a member of his family for any treatment specified below shall, subject to the other provisions of this rule, be eligible for medical treatment outside India. The specified treatments –
(i) Complex/high risk Cardio Vascular Surgery cases for treatment at Centres with extensive experience;
(ii) Bone marrow Transplant;
(iii) Complex Medical and Oncological Disorders, such as leukaemia and Neo-plastic conditions;
(iv) Complex high risk cases in Micro Vascular and Neuro Surgery for treatment at Centres with extensive experience;
(v) Treatment of extremely complex ailments other than those mentioned above which in the opinion of Standing Committee can only be treated abroad and fall in the high risk category.
11.4 As per Rule 11(4), it shall be competent for the Central Government to review from time to time the list of treatment facilities as specified in Rule 11(3)/discussed at Para 11.3 and make such additions or deletions as it may deem fit by notification in the Official Gazette.
11.5 As per Rule 11(5), the Central Government may for purposes of this rule, constitute a Standing Committee consisting of: –
(a) the Director-General of Health Services in the Ministry of Health in the Central Government,
(b) the Director-General of Armed Forces Medical Services.
(c) the Director-General of the Indian Council of Medical Research, and
(d) the Joint Secretary in the Ministry of Health and Family Welfare (Convener), for purposes of considering and recommending to the Central Government cases for medical treatment outside India.
11.6 As per Rule 11(6), on receipt of an application for medical treatment outside India, the Standing Committee may, after due consideration, satisfied that the ailment or treatment can be treated only outside India, issue a certificate to the concerned Department or Ministry to which the applicant Government servant is attached conveying its approval of the application and the concerned Department or Ministry shall, on the strength of that certificate incur necessary expenditure in getting the Government servant concerned or the member of his family treated outside India in accordance with the procedure laid down by the Standing Committee.
11.7 As per Rule 11(7), it shall be competent for the Central Government to authorize reimbursement of expenditure on medical treatment obtained outside India, if it is satisfied that the prior approval could not be obtained by the Central Government servant due to circumstances beyond control subject to the condition that the Government servant fulfills all other conditions relating to medical treatment outside India under this rule.
11.8 As per Rule 11(8), the Standing Committee may, if it is satisfied that in the interest of the Government servant or the member of his family obtaining treatment abroad it is essential so to do, recommend one attendant to accompany the Government servant or the member of his family, as the case may be, and the expenditure so incurred shall also be eligible for reimbursement.
11.9 As per Rule 11(9), where the Standing Committee, on receipt of an application for medical treatment outside India consider that adequate facility for treatment of the ailment sought to be treatment is available in any medical institution within India, it shall record such a finding and authorize treatment of such ailment in such medical institution within India whereupon the cost of such treatment shall be reimbursed.
11.10 As per Rule 11(10), for purposes of Rule 11(9)/discussed at para 11.9, the Ministry of Health in consultation with the Standing Committee shall, from time to time, notify the names of such institutions along with the ailments and the types of treatment available in such institutions.
11.11 As per Rule 11(11), the scale of expenditure and the eligibility for treatment for which a Government servant or a member of his family is entitled, shall be identical to the scale of expenditure and the eligibility of an official of the Indian Foreign Service of the corresponding grade in the Ministry of external Affairs under any Assisted Medical Attendance Scheme for the time being in force.
[12] Authorized Medical Attendants
12.1 Department of the Central Government or Head of Department as specified in SR 2(10) is empowered to appoint Medical Officers under the employ of the Central Government, State Governments and Union Territories, as also Medical Officers not in Government employ, i.e. private registered medical practitioners as Authorized Medical Attendants.
12.2 Under CS(MA) Rules, if no such Medical Officer is appointed, the following are AMAs: –
(a) For Group ‘A’ Officers & others drawing pay not less than Rs. 2500 p.m. – Principal Medical Officer of the District.
(b) For Officers drawing pay not less than Rs. 2500 p.m. but above Rs. 1200 p.m. – Assistant Surgeons, Grade – I, in the station and
(c) For rest – Assistant Surgeons, Grade-II (Medical Licentiate), or if he is not available Assistant Surgeon, Grade-I (Medical Graduate).
12.3 Private Medical Practitioners are appointed as AMAs where adequate number of Government Doctors in various systems of medicines are not available or when their services are not available within a radius of 5 kilometres or because of the remoteness of the area.
12.4 The Authorized Medical Attendant (AMA) of a Government Servant is determined with reference to the place he falls ill, irrespective of whether it is the permanent/temporary residence or a place of casual stay.
12.5 In places where AMAs are appointed, they should be consulted. If no AMA is appointed in a suburban area, treatment may be taken from AMA employed in a Government hospital in the adjoining city, but not from private medical practitioner appointed as AMA outside the place of duty [Rule 2(a)].
12.6 As per Rule 5, if the condition of the patient so requires, the AMA can –
(a) send the patient to the nearest Specialist or other Medical Officer, or
(b) summon the Specialist/Medical Officer to attend on his patient who is too ill to travel.
[13] Guidelines
13.1 The treatment at the consulting room of AMA is limited to 10 (Ten) days with a maximum of 4 (Four) consultations and normally 10 (Ten) injections. The number of injections may go up to 15 (Fifteen) depending on patient’s ailment.
13.2 The limit of 10 (Ten) days treatment as discussed at para 13.1 may be increased to 40 (Forty) days if the treatment is taken in Indian system of Medicines and in Homoeopathy. The total number of consultations however be remaining 4 (Four) at an interval of 10 (Ten) days.
13.3 If hospitalization is not considered necessary, but treatment is expected to be prolonged requiring more than four consultations or more than a course of 15 (Fifteen) injections, as the case may be, either separately or concurrently, the patient should be referred to out-patient department of Government/recognised hospital.
13.4 Cases of medical treatment requiring hospitalization have to be referred to Government/recognized hospital.
13.5 Separate claim is to be preferred for each spell of illness or an entirely new disease.
13.6 To justify a claim for a second time, for the recurrence of the same disease, there should be a reasonable gap between the closing of the first spell and the recurrence of the second spell.
13.7 If a patience consults the same AMA in regard to the super-imposition of another disease during the course of treatment of one disease, it is regarded as a fresh consultation and charge for at full rates.
13.8 Every consultation after the first for the same illness of the same patient with the same AMA is treated as subsequent consultation and charged for at the prescribed lower rates.
13.9 Purchase of Allopathic medicine and drugs can be made from any chemist/druggist licensed under the Drugs and Cosmetics Act and rules framed thereunder. Purchase of Ayurvedic/Siddha/Unani medicines can be made only from approved pharmacies.
13.10 The claim for reimbursement should be preferred within 6 (Six) months. However, subject to certain conditions, the Departments/Ministries may condone the delay beyond 6 (Six) months [Ministry of Health & Family Welfare, Department of Health & Family Welfare OM No. S.14025/19/2015-MS dtd: 27th May 2015].
13.11 Reimbursement of medical claims of a Government servant who are admitted in the Hospitals before retirement but discharged after their retirement should be made by their own Office/Department/Ministry concerned [Rule 1].
13.12 The medical prescription issued by an AMA/Government Specialist prescribing diagnostic tests/investigation is valid for a single use within a period of 2 (two) weeks from the date of prescription unless specified by them in the prescription as valid beyond two weeks.
[14] Medical Advance
14.1 Medical Advance is admissible to all Government servants irrespective of pay limit for in-patient (admitted to hospital) in a recognized hospital.
14.2 Medical Advance may also be paid for treatment of TB, Cancer, Acute Myeloid Leukemia and Cronic Active Hepetitis ‘B’, ‘C’ & ‘D’ at the consulting room of the Medical Officer, at the residence of the Government Servant or as an out-patient.
14.3 Medical Advance is granted for purchase/replacement/repair and adjustment of admissible artificial appliances as discussed in para 8.5 above.
14.4 Medical Advance may be granted to temporary Government servant subject to surety from a permanent Government servant.
14.5 Amount of Medical Advance: Medical advance in different medical circumstances is granted to Government servant. These circumstances are –
(a) For in-door treatment: 90% of the approved package rate under CGHS on receipt of a certificate from the treating medical practitioner of Government/Recognised hospital.
Advance should be released within 10 (Ten) days of receipt of the request.
(b) For Out-door treatment: 90% of the estimated expenditure if the expenditure exceeds Rs. 10,000.
(c) For TB where the duration of treatment is more than 3 months: 80% of the estimated cost or Rs. 36,000 whichever is less.
14.6 The advance may be paid in one or more installments for the same illness or injury, subject to the limit prescribed.
14.7 In case of serious illness/accidents where the official is unable to apply, the advance may be sanctioned on an application in writing made on his behalf by his/her spouse or other legal heir.
14.8 Adjustment of Advance: Advance paid to be adjusted against the relevant claim and balance if any may be recovered from pain in 4 (Four) installments. In case of prolonged treatment, reimbursement may continue to be allowed on the basis of necessary certificate in this regard, the advance being adjusted in the final claim preferred in the first time.
14.9 When advance is paid direct to the hospital, the employee should submit the adjustment bills for final settlement within one month from the date of his discharge from hospital. The Head of Office will correspond direct with the hospital for refund of the underutilized balance, if any.
[15] Final Claim
15.1 Medical final claim form: (a) for Indoor treatment: Form No. Med-104 and Med-93 (b) for Out-door treatment: Form No. Med-103 & Med-93.
15.2 Documents required: The following documents required for admission of final claim in audit:
(a) Final claim forms as discussed above at para 15.1 as the case may be, duly filled in all respect – 2 sets with signature of medical officer under whom the patience was under treatment.
(b) Government permission for treatment.
(c) All medical receipts (medicine/tests etc.) – one set original and one Xerox. All such medical receipts should be counter signed by the concerned medical officer with official seal.
(d) Manual list of medicines consumed in two copies supported by connected slips.
(e) If possible, enclose recognition of the private hospital under CGHS/CSMA rule and also enclose package rate of CGHS for the said treatment/disease/surgery/test etc.
[16] Difference between CS(MA)Rule & CGHS
16.1 CS(MA) is a rule laid down by the Government of India whereas CGHS is a health scheme which prescribes rates for medical treatments.
16.2 Under CS(MA) rule every Government servant is eligible for free medical treatment as discussed at para 1.4 above whereas CGHS is a health scheme which is a subscription based paid services for serving employees.
16.3 CS(MA) rule is extends across the country whereas CGHS services are restricted to 27 defined CGHS covered cities only.
16.4 CS(MA) rule is for serving Government servants only whereas CGHS services are available for Retired Government servants also.
16.5 CGHS services extends to – (a) Serving Government servant (b) Ex-MP (c) Serving MP (d) Press personals and accordingly entitled coloured cards are issued categorically whereas CS(MA) is available to only serving Central Government servants.
16.6 Details about CGHS is discussed in subject CGHS. Please visit the page for more clarifications and knowledge.
**********************************