EMPANELMENT OF PRIVATE HOSPITALS , EXCLUSIVE EYE HOSPITALS / CENTRES

EXCLUSIVE DENTAL CLINICS, CANCER HOSPITALS/UNITS, DIAGNOSTIC

LABORATORIES & IMAGING CENTRES UNDER CGHS-2017

The Central Government Health Scheme (CGHS) provides comprehensive health Care
facilities to the Central Government employees / pensioners and certain other categories of
beneficiaries as notified by the Central Government from time to time. With a view to ensuring
comprehensive health care facilities to CGHS beneficiaries, CGHS has been empaneling private
hospitals, exclusive Eye hospitals / Centers, exclusive Dental Clinics, Cancer Hospitals/units,
diagnostic laboratories and imaging centers periodically.
In this background, willing hospitals, exclusive Eye hospitals / Centres, exclusive Dental
Clinics, Cancer Hospitals/units, diagnostic laboratories and imaging centres are invited to submit
their applications for empanelment under CGHS.
The eligible private health Care Organizations seeking empanelment and having prescribed
infrastructure and staff and willing to accept the rates of various treatment procedures/ investigations
notified by CGHS and other conditions as detailed in the Application document and Memorandum of
Agreement (MOA) may apply for the same in the prescribed format .
Under the CGHS Empanelment Scheme 2017 the hospitals, exclusive Eye hospitals /
Centres, exclusive Dental Clinics, Cancer Hospitals/units, diagnostic laboratories and imaging
centres accredited by National Accreditation Board for Hospitals and Health Care providers
(NABH)* / National Accreditation Board for Testing and Calibration Laboratories (NABL) shall be
considered for empanelment under CGHS. Non-Accredited HCOs can also apply and shall be
considered as per the details given in the succeeding paragraphs.
* The Hospitals accredited by National Accreditation Board for Hospitals and Health Care providers
(NABH) or its equivalents such as Joint Commission International (JCI), ACHS (Australia) or by any
other accreditation body approved by International Society for Quality in Health Care (ISQua) shall
be considered as accredited equivalent to NABH.
i) Under the new empanelment Scheme 2017, applications for empanelment shall be
submitted only by new HCOs seeking empanelment. Already empaneled HCOs
would only fill up undertaking at Annexure IV. All NABH (or Equivalent) /NABL
Accredited HCOs (including existing), which qualify as per the terms and conditions of
empanelment shall be empanelled for two years and they shall submit MOA and
Performance Bank Guarantee.
ii) All QCI recommended existing HCOs shall also be empanelled for two years and they
shall submit MOA and Performance Bank Guarantee.
iii) The otherwise eligible Non-NABH/ Non-NABL accredited new HCOs shall be
inspected by QCI first and after receipt of recommendation from QCI, they shall be
considered for empanelment under CGHS and shall submit MOA and PBG. If new
HCOs have already obtained QCI recommendation it must have been obtained on or
after 1.10.2016.
iv) The applications shall be examined on quarterly basis. Under the continuous
empanelment scheme applications received shall be scrutinized on quarterly basis
on the last working day in the month of March, June, September and December.
v) Differential rates shall be applicable to the private hospitals & diagnostic laboratories
and Imaging centres empanelled under CGHS depending on their NABH / NABL
accreditation status.
vi) CGHS also reserves the right to prescribe/ revise rates for new or existing treatment
procedure(s) / investigation(s) from time to time.

The applications shall be submitted to the Additional Director, CGHS of concerned City.
PART - I – EMPANELMENT OF HOSPITALS, EXCLUSIVE EYE HOSPITALS /
CENTRES, EXCLUSIVE DENTAL CLINICS, CANCER HOSPITALS/UNITS.

PART- II - EMPANELMENT OF DIAGNOSTIC LABORATORIES & IMAGING

CENTRES

PART I
(For Empanelment of Hospitals, exclusive Eye hospitals / centres,
exclusive Dental clinics, Cancer Hospitals/units, in all CGHS
covered cities except Mumbai)

A. MINIMUM NUMBER OF BEDS REQUIRED

(Not for exclusive Eye hospitals/centres & Exclusive Dental clinics)

I) METRO CITIES (EXCEPT MUMBAI) ……………………. 50

OTHER CITIES ……………………………………… ….. 30

NB: The number of beds as certified in the Registration Certificate of State

Government / Local Bodies/ NABH/ Fire Authorities shall be taken as the valid bed
strength of the hospital.

B. CATEGORIES OF HEALTH CARE ORGANIZATIONS:

The hospital shall be empanelled for all the facilities available in the hospital (except IVF and
other assisted reproductive treatment procedures). In case some facility is available in the
hospital but, is not offered to CGHS beneficiaries, the hospital is liable to be removed from
CGHS panel.

CGHS would consider the following categories of health care Organizations for
empanelment

(a) NABH Accredited Hospitals-

The hospitals applying under this category must be accredited by National
Accreditation Board for Hospitals and Health Care providers (NABH) or its equivalent
such as Joint Commission International (JCI), ACHS (Australia) or by any other
accreditation body approved by International Society for Quality in Health Care
(ISQua).
(b) NON NABH Accredited Hospitals-

C. CANCER HOSPITALS/UNITS

Cancer hospitals/units having all treatment facilities for cancer - surgery,

Chemotherapy and radio-therapy (approved by BARC / AERB).

(a) NABH Accredited Cancer Hospitals/ Units

(b) Non-NABH Accredited Cancer Hospitals/ Units
 D. EXCLUSIVE EYE HOSPITALS/ CENTERS:

No minimum bed strength is prescribed for empanelment of exclusive Eye

hospitals/centres

(a) NABH Accredited- Exclusive Eye Hospitals/Centres

(b) Non-NABH Accredited Exclusive Eye Hospitals/ Centres

E. EXCLUSIVE DENTAL CLINICS

No minimum bed strength is prescribed for empanelment of exclusive Dental Clinics

However there shall be a minimum of ‘2’ Dental chairs for all Dental clinics applying
for empanelment under CGHS.

(a) NABH accredited - Exclusive Dental Clinics

(b) Non- NABH accredited - Exclusive Dental Clinics

ELIGIBILITY CRITERIA FOR HOSPITALS/ CANCER HOSPITALS/ EXCLUSIVE EYE CENTRES/

EXCLUSIVE DENTAL CLINICS/STAND ALONE DIALYSIS CENTRE
1. The health care Organizations must fulfill the requirements as detailed above depending
on the category under which the hospital / exclusive eye hospital / centre, exclusive
dental clinic, cancer hospital/unit/ is seeking empanelment and submit copies of the
required documents.
2. The health care Organization must have been in operation for at least one year. Copy of
audited balance sheet, profit and loss account for the last financial year (Main documents
only- summary sheet)
3. Copy of NABH Accreditation in case of NABH Accredited health care Organizations.
4. Copy of QCI recommendation in case of Non-NABH accredited health care
Organizations.
5. List of treatment procedures /investigations/ facilities available in the applicant health
care Organization.
6. A Demand Draft for Rs.1000/- as application fee (non-refundable) drawn in the name of
‘Pay & Accounts Officer, CGHS in case of Delhi/NCR or in favour of concerned Additional
Director in case of CGHS cities outside Delhi, from any Scheduled or commercial or
Nationalized Bank.
7. A Demand Draft for Rs.1,00,000/- as [Link] in the name of ‘Pay & Accounts
Officer, CGHS, Delhi/NCR or in favour of concerned Additional Director in case of CGHS
cities outside Delhi from any Scheduled or commercial or Nationalized Bank.
8. State registration certificate / Registration with Local bodies, wherever applicable.
9. Compliance with all statutory requirements including that of Waste Management.
10. Fire Clearance certificate and details of Fire safety mechanism as in place in the health
care Organization. Exclusive Eye centres, exclusive dental Clinics, have to enclose a
certificate regarding fire safety of their premises.
11. Registration under PNDT Act, if Ultrasonography facility is available.
12. AERB approval for imaging facilities/ Radiotherapy, wherever applicable.
13. Certificate of Undertaking in original as per the format annexed.
14. Certificate of Registration for Organ Transplant facilities, wherever applicable.
15. An Applicant Health care Organization must have the capacity to submit all claims / bills
in electronic format to the Bill Clearing Agency and must also have dedicated equipment,
software and connectivity for such electronic submission.
16. An Applicant Health care Organization must submit the rates for all treatment procedures
/ investigations/ facilities available with them and as charged by them.
 17. An Applicant health care Organization must give an undertaking accepting the terms and
conditions spelt out in the Memorandum of Agreement (Draft at Annexure V) which
should be read as part of this application document.
18. Applicant Health care Organizations must certify that they shall charge as per CGHS
rates and that the rates charged by them are not higher than the rates being charged
from their other patients who are not CGHS beneficiaries. They shall also certify that in
case lower rates are charged to any Government / private organization in future, they
shall also charge the reduced rates from CGHS beneficiaries.
19. Applicant Health care Organizations must certify that they are fulfilling all special
conditions that have been imposed by any authority in lieu of special concessions such
as but not limited to concessional allotment of land or customs duty exemption.
20. Applicant Health care Organizations (except exclusive eye hospitals/centres, exclusive
dental clinics/standalone dialysis centre) must agree for implementation of EMR/ EHR as
per the standards notified by Ministry of Health & Family Welfare within one year of their
empanelment.
21. Applicant Hospitals, cancer hospital/units must have minimal annual turnover of Rs.2.00
Crores for Metro cities and Rs.1.00 Crore for Non- Metro cities. Exclusive Eye
hospitals/Centres, Exclusive Dental Clinics, must have a minimal annual turnover of Rs.
20 Lacs in Metro Cities and Rs.10 Lacs in Non- Metro Cities. Further, the business from
CGHS in the last financial year should not exceed more than 50% of the total business. A
certificate to this effect from the Chartered Accountant is to be given by the applicant
Health Care Organization.
22. Photo copy of PAN Card.
23. Name and address of their bankers.
24. If several Branches of HCO of the same organization /Group have applied for
/empanelled under CGHS in the same city or another city the details shall be submitted.
25. Copies of the documents mentioned in Annexure-III must be submitted (wherever
applicable).
PART II
(Diagnostic Laboratories & Imaging Centres)
(For Empanelment in all CGHS covered cities except Mumbai)

CATEGORIES OF DIAGNOSTIC LABORATORIES / IMAGING CENTRES

CGHS would consider the following categories of diagnostic laboratories and imaging
centres for empanelment :

a. NABL / NABH accredited Diagnostic Laboratories/ Imaging Centres

b. Non- NABL / Non- NABH accredited Diagnostic Laboratories/ Imaging Centres

ELIGIBILITY CRITERIA FOR DIAGNOSTIC LABORATORIES/ IMAGING CENTRES

1. The diagnostic laboratory/imaging centres must fulfill the Criteria as specified above and
must submit the copies of the required documents.
2. The Diagnostic laboratory/imaging centre must have been in operation for at least one year.
Copy of audited balance sheet, profit and loss account for the last financial year (Main
documents only- summary sheet-) are to be submitted.
3. Diagnostic Laboratories and Imaging Centres must have the capacity to submit all claims /
bills in electronic format to the Bill Clearing Agency and must also have dedicated
equipment, software and connectivity for such electronic submission.
4. Copy of NABL / NABH Accreditation in case of NABL / NABH Accredited Diagnostic
Laboratory/ imaging centre.
5. Copy of QCI recommendation in case of Non-NABH/Non-NABL accredited
laboratories/imaging centres.
6. Lists of investigation facilities available with diagnostic lab/imaging centre are to be
submitted.
7. A Demand Draft for Rs.1000/ - as tender document fee (non-refundable) drawn in the name
of ‘Pay & Accounts Officer, CGHS, Delhi/NCR or in favour of concerned Additional Director in
case of CGHS cities outside Delhi from any Scheduled or commercial or Nationalized Bank.
8. A Demand Draft for Rs.1,00,000/- as [Link] in the name of ‘Pay & Accounts Officer,
CGHS, Delhi/NCR or in favour of concerned Additional Director in case of CGHS cities
outside Delhi from any Scheduled or commercial or Nationalized Bank.
9. Diagnostic lab / Imaging Center must have been registered with State Government / Local
bodies, wherever applicable.
10. Compliance with all statutory requirements including that of Waste Management.
11. Documents to establish that fire safety mechanism is in place.
12. Registration under PNDT Act, if Ultrasonography facility is available.
13. AERB approval for imaging facilities, wherever applicable.
14. Certificate of Undertaking as per the format annexed.
15. Diagnostic lab / Imaging Center must submit the rates for all investigations services available
with it and as charged by it from other patients.
16. Diagnostic lab / Imaging Center must give an undertaking accepting the terms and conditions
spelt out in the Memorandum of Agreement (Draft at Annexure V) which should be read as
part of this application document.
17. Diagnostic lab / Imaging Center must certify that they shall charge CGHS beneficiaries as
per CGHS rates and that the rates charged by them are not higher than the rates being
charged from their patients who are not CGHS beneficiaries
18. Diagnostic lab / Imaging Center must certify that they are fulfilling all special conditions that
have been imposed by any authority in lieu of special concessions such as but not limited to
concessional allotment of land or customs duty exemption.
19. The Diagnostic lab / Imaging center must fulfill the above criteria, wherever applicable and
annex copies of relevant documents.
20. Minimum annual turnover of diagnostic lab / imaging centre must be 20 lac for Metro cities
and Rs. 10 lac for Non-Metro cities. Further, the business from CGHS in the last financial
year should not exceed more than 50% of the total business. A certificate to this effect from
the Chartered Accountant is to be given by the applicant diagnostic lab/ imaging centre.
21. Photo copy of PAN Card.
22. Name and address of their bankers.
23. Copies of the documents mentioned in Annexure-III must be submitted (wherever
applicable).
24. If several Branches of HCO of the same organization /Group have applied for /empanelled
under CGHS in the same city or another city the details shall be submitted
25. In addition the imaging centres shall meet the following criteria:

i. MRI Centre

Must have MRI machine with magnet strength of 1.0 Tesla or more.

ii. CT Scan Centre

 Whole Body CT Scanner with scan cycle of less than one second (sub-second)
Must have been approved by AERB

iii. X-ray Centre /Dental X-ray/OPG centre

X- Ray machine must have a minimum current rating of 500 MA with image
intensifier TV system
Portable X-ray machine must have a minimum current rating of 60 MA
Dental X-ray machine must have a minimum current rating of 6 MA
OPG X-ray machine must have a current rating of 4.5 -10 MA

Must have been approved by AERB

iv. Mammography Centre

Standard quality mammography machine with low radiations and biopsy

attachment.

v. USG / Colour Doppler Centre

It should be of high-resolution Ultrasound standard and of equipment having
convex, sector, linear probes of frequency ranging from 3.5 to 10 MHz should
have minimum three probes and provision/facilities of trans Vaginal/ Trans
Rectal Probes.

Must have been registered under PNDT Act

vi. Bone Densitometry Centre

Must be capable of scanning whole body

vii. Nuclear Medicine Centre

Must have been approved by AERB / BARC

APPLICATION FORM
Annexure –I is the application format to be filled up and submitted by New HCOs
which are not already empanelled under CGHS.
Annexure –IV is to be submitted by the HCOs already empanelled to agree for the
terms and conditions of empanelment and CGHS rates and willingness to continue
under CGHS.

Hospitals/cancer unit shall fill up Annexure-Ia

Exclusive Eye hospitals/Centres shall fill up Annexure-Ib-Eye

Exclusive Dental Clinics shall fill up Annexure-Ic –Dental

Diagnostic Labs
Imaging Centres shall fill up Annexure Id - Lab

Annexure –II is Certificate of Undertaking.

Annexure –III is list of documents (wherever applicable) that are to be submitted.
2. DEPOSITION OF FEE FOR APPLICAION AND EMD

Application document fee of Rs. 1000/- (non-refundable) and Earnest Money of Rs.
100,000/-(One lac) in the form of Demand Draft from any Scheduled Bank, payable to ‘Pay
& Accounts Officer, CGHS Delhi, in case of Delhi and NCR /Concerned Additional Director in
case of other cities has to be submitted by the new HCOs. Physical DD shall be delivered
along with the Application form.

3. SUBMISSION OF APPLICATION FORM BY NEW HCOS

Completed and duly signed application form along with enclosures (in duplicate) shall be
placed in closed envelop. The requisite Demand Draft for Rs.1000/ and 1, 00,000/- shall be
enclosed in another closed cover and titled. Both the envelops and shall be enclosed in a
sealed covered with address and contact number of the HCO and shall be delivered at the
Office of Director (CGHS), Nirman Bhawan, New Delhi in case of Delhi & NCR and at the
office of Additional Director of concerned City in other cities.

4. EARNEST MONEY REFUND

 In case the application is rejected on technical grounds Demand Drafts for Earnest
Money shall be returned in full.
 In case, the application is rejected after inspection of documents on the grounds of
submitting incorrect information then 50% of the Earnest Money would be forfeited and
the balance amount would be refunded in due course.

5. TECHNICAL SCRUTINY OF APPLICATIONS

The application forms for empanelment under CGHS shall be opened for initial scrutiny by a
team under Additional Director, CGHS of concerned city to verify whether the requisite
documents and DDs for Rs.1000/- and Rs.1, 00,000/- are submitted.

In case of incomplete application the same shall be returned along with the DD for Rs.1,
00,000/- However, the application fee of Rs.1, 000/- is non-refundable.

Only one authorized representative shall be allowed to be present at the time of opening of
the Application forms.

In case of return of incomplete applications, the deficiencies shall be recorded and signature
of authorized representative shall be taken as an acknowledgement.

The applications may be examined on quarterly basis. Under continuous empanelment

scheme applications received shall be scrutinized on quarterly basis on the last working day
in March, June, September and December.

6. TECHNICAL EVALUATION

The Screening Committee of CGHS under chairmanship of Additional Director, CGHS of

concerned city shall examine the applications subsequently to determine whether they fulfill
the eligibility criteria.

7. CGHS RATES

All the eligible Hospitals, exclusive eye hospitals / centres, exclusive dental clinics, cancer
hospitals/units and diagnostic centres shall agree for CGHS notified rates applicable for
semi-private ward. The rates for NABH/NABL accredited HCOs shall be 15% more than the
 rates for non-accredited HCOs. The CGHS package rates are for semiprivate ward. The
rates for CGHS beneficiaries entitled for private ward shall be 15% more than the rates for
semi-private ward. The rates for General ward shall be 10% less than the rates of semi-
private ward. .For cancer surgery Tata Memorial rates as decided by CGHS would apply.

8. OFFER OF EMPANELMENT AND SIGNING OF MEMORANDUM OF AGREEMENT

i. All Existing HCOs and all eligible NABH / NABL accredited health Care Organizations
shall sign a Memorandum of Agreement with Addl. Additional Director, CGHS of
concerned city and submit revalidated PBG.

ii. All eligible Non – NABH / Non- NABL new Health Care Organizations shall be
inspected by QCI and they shall be considered for empanelment only after receiving
recommendation from QCI. Application submitted by new HCOs must be
accompanied by QCI recommendation. Once considered for empanelment they shall
sign a Memorandum of Agreement with Additional Director, CGHS of concerned city
and submit PBG.

The health Care Organizations, which are selected for empanelment, will have to enter into
an agreement with CGHS for providing services at rates notified by CGHS as per the copy
provided at annexure V. This MOA has to be executed on Rs.100/- non-judicial Stamp
paper.

9. VALIDITY OF CGHS RATES

The rates shall be valid for two years and is extendable by another year with mutual
agreement.
The empanelled Organizations shall not charge more than CGHS rates.

10. EMR / EHR

The empanelled health Care Organizations (except eye hospital/centre, dental clinics,
Diagnostic Labs/Imaging Centres) shall have to implement Electronic Medical Records and
EHR as per the standards and guidelines approved by Ministry of Health & Family Welfare
within one year of its empanelment.

11. EMPANELMENT WITH AUTONOMOUS BODIES-

All empanelled hospitals/ diagnostic centres/ exclusive eye centres/ exclusive dental clinics
shall also agree for empanelment with any autonomous body/ public sector undertaking at
CGHS Rates, on the recommendation of Ministry of Health & Family Welfare.

12. PERFORMANCE BANK GUARANTEE (PBG)

Private Hospitals, Exclusive Eye Hospitals / Centres, Exclusive Dental Clinics, Cancer
Hospitals/Units, Diagnostic Laboratories & Imaging Centres that are recommended for
empanelment after the initial assessment shall also have to furnish a performance Bank
Guarantee valid for a period of 30 months i.e. six months beyond the empanelment period,
to ensure efficient services and to safeguard against any default:

Hospitals/ Cancer hospitals/units Rs. 10.00 lac

Eye Hospital/Centre Rs.2.00 lac
Dental Clinics Rs.2.00 lac
Diagnostic Centre Rs.2.00 lac
 (PBG for Charitable Health Care Organizations shall be 50% of the above amount)
In case of health care Organizations already empanelled under CGHS, they shall submit a
new Performance Bank Guarantee valid for a period of 30 months to cover entire period of
empanelment and 6 months beyond.

13. BILLING TO BE IN ELECTRONIC FORMAT

All Billing is to be done in electronic format and medical records need to be submitted in
digital format to the Bill Clearing agency (BCA) for necessary processing. In addition to this
physical submission of hard copies will also have to be done to the BCA.

14. FEE FOR PROCESSING OF BILLS/CLAIMS

Bill clearing Agency (BCA) would charge a processing fee @ 2% of claimed amount and
service tax thereon with a minimum of Rs.12.50/- and maximum of Rs. 750/- per bill. CGHS
reserves the right to revise these charges from time to time.

15. CORRUPT AND FRAUDULENT PRACTICES

“Corrupt practice” means the offering, giving, receiving or soliciting of anything of value to
influence the action of the public official.
“fraudulent practice” means a misrepresentation of facts or execution of a contract to the
detriment of CGHS, and includes collusive practice among hospitals /authorized
representative/service providers designed to hike the bills or misguide the beneficiaries or
any such practice adhered to .
CGHS will declare a health care Organization ineligible, either indefinitely or for a stated
period of time, to be empanelled if it at any time determines that health care Organization
has engaged in corrupt and fraudulent practices in executing contract.

16. INTERPRETATION OF THE CLAUSES IN THE TENDER DOCUMENT

In case of any ambiguity in the interpretation of any of the clauses in the application, the
interpretation of Additional Director, CGHS of the clauses shall be final and binding on all
parties.

17. LIST OF DOCUMENTS AT ANNEXURE III

The documents listed at Annexure III shall be enclosed with every application.

18. MONITORING AND MEDICAL AUDIT

CGHS reserves the right to inspect the health care Organization at any time to ascertain
their compliance with the requirements of CGHS.
Bills of empanelled health care Organizations shall be reviewed periodically for
irregularities including declaration of planned procedures / admissions as ‘emergencies’,
unjustified investigations/treatment, overcharging and prolonged stay, etc., and if any
empanelled health Care Organization is found involved in any wrong doings, then the
concerned hospitals/other health care Organizations would be suspended/ removed from
CGHS panel and would be black listed for specified period for future empanelment with
CGHS. Bank guarantee shall also be forfeited.
19. EXIT FROM THE PANEL

The Rates fixed by the CGHS shall continue to hold good unless revised by CGHS. In case
the notified rates are not acceptable to the empanelled health care Organizations, or for
any other reason, the health care Organization no longer wishes to continue on the list
under CGHS, it can apply for exclusion from the panel by giving one month notice. Patients
already admitted shall continue to be treated.

20. NODAL OFFICERS

Empanelled health care organizations shall notify two Nodal officers for CGHS
beneficiaries, one of them being of the rank of Deputy MS/ Addl. MS, who can be contacted
by CGHS beneficiary in case of any eventuality.

21. DISPLAY FOR PUBLIC RATIO OF C-SEC VIS-À-VIS NORMAL DELIVERIES

Empanelled hospital shall agree to display for Public the ratio of C-Sec Deliveries vis-à-vis
Normal deliveries near reception and update on Quarterly basis
 APPLICATION FORM
Annexure-Ia
FOR

EMPANELMENT OF HOSPITALS, CANCER HOSPITALS/UNITS IN CGHS

COVERED CITIES (EXCEPT MUMBAI)

1. Name of the CGHS city where hospital is located.

2. Name of the hospital

3. Address of the hospital

4. Tel / fax/e-mail

Telephone No
Fax
e-mail address
Name and Contact details of Nodal
persons

Whether NABH Accredited

Whether QCI recommended

Details of Accreditation and Validity period

 a. Details of the application fee draft of Rs. 1000/-

Name & Address of the Bank DD No. Date of Issue

Details of the draft of EMD of Rs. 100000/-

Name & Address of the Bank DD No. Date of Issue

b. Total turnover during last financial year

(Certificate from Chartered Accountant is to be enclosed).

c. Turnover from CGHS during last financial year

(Certificate from Chartered Accountant is to be enclosed.)

5. Applied For empanelment as

Hospital for all available facilities

Cancer Hospital/Unit

(Please select the appropriate column)

6. Total Number of beds

7. Categories of beds available with number of total beds in following type of wards

Casualty/Emergency ward
ICCU/ICU
Private

Semi-Private (2-3 bedded)

General Ward bed (4-10)
Others

8. Total Area of the hospital

Area allotted to OPD
Area allotted to IPD
Area allotted to Wards

9. Specifications of beds with physical facilities/ amenities

Dimension Number
of ward of bed in
Length
Breadth each ward
(Seven Square Meter Floor area per bed required-) (IS: 12433-Part 2:2001)

10. Furnishing specify as (a), (b), (c), (d) as per index below Index

(a) Bedsides table

(b) Wardrobe
(c) Telephone
(d) Any other

11. Amenities specify as (a), (b) (c) (d) as per index below Amenities

(a) Air conditioner

(b) T.V.
(c) Room service
(d) Any other

12. Nursing Care

Total No. of Nurses

No. of Para-medical staff

Category of bed Bed/Nurse Ratio (acceptable Actual bed/nurse standard) ratio

a) General 6:1
b) Semi-Private 4:1
c) Private 4:1
d) ICU/ICCU 1:1
e) High dependency Unit 1:1

13. Alternate power source Yes No

14. Bed occupancy rate Bed turnover rate

(Norm 85%)

General bed
Semi-Private Bed
Private Bed

Av daily census
Note: Bed occupancy rate = ______________________
Av No. of bed available
(i.e. number of authorized bed)

Total discharge during a year

Turnover ratio = --------------------------------------
Bed compliment
 1. No. of in house Doctors
2. No. of in house Specialists/Consultants

17. Laboratory facilities available - Pathology Biochemistry Microbiology

or any other

18. Imaging facilities available

19. No. of Operation Theaters.

20. Whether there is separate OT for Septic cases

21. Supportive services

Boilers/sterilizers
Ambulance
Laundry
Housekeeping
Canteen
Gas plant

22. Waste disposal system as per statutory requirements

Dietary
Others (preferably)
- Blood Bank
- Pharmacy
- Physiotherapy
 23. ESSENTIAL INFORMATION REGARDING CARDIOLOGY & CTVS

Number of coronary angiograms done in last one year

Number of Angioplasty done in last one year

Number of open heart surgery done in last one year

Number of CABG done in last year

24. RENAL TRANSPLANTATION, HAEMODIALYSIS/ UROLOGY-UROSURGERY-

Number of Renal Transplantations

done in one year (2012-13)
Number of years of duration of facilities

Number of Hemodialysis unit.

Criteria for Dialysis:

- The center should have good dialysis unit neat, clean and hygienic like a
minor OT.
- Centre should have at least four good Haemodialysis machines with
facility of giving bicarbonate Haemodialysis.
- Centre should have water-purifying unit equipped with reverse
osmosis.
- Unit should be regularly fumigated and they should perform regular
antiseptic precautions.
- Centre should have facility for providing dialysis in Sero positive cases.
- Centre should have trained dialysis Technician and Sisters and full time
Nephrologist and Resident Doctors available to combat the complications
during the dialysis.
- Centre should conduct at least 150 dialyses per month and each session
of hemodialysis should be at least 4 hours.
- Facility should be available 24 hours a day.

Yes No
. Whether it has an immunology lab.
If so, does it exist within the city
where the hospital is located Yes No

Whether it has blood transfusion

Service with facilities for screening Yes No
HIV markers for Hepatitis (B&C), VDRL

Whether it has a tissue typing unit

DBCA/IMSA/DRCG scan facility Yes No
and the basic radiology facilities
 25. LITHOTRIPSY-

No. of cases treated by lithotripsy

in last one year ( 2012-2013)

Average number of sitting required

Per case

Percentage of cases selected for

Lithotripsy, which required conventional
Surgery due to failure of lithotripsy

26. LIVER TRANSPLANTATION- Essential information reg.

Technical expert with experience in liver
Transplantation who had assisted in at least Yes No
fifty liver transplants.
(Name and qualifications)

Month and year since Liver Transplantation

is being carried out

No. of liver transplantation done during

the last one year

Success rate of Liver Transplant

Facilities of transplant immunology lab.

Tissue typing facilities Yes No

Blood Bank Yes No

27. ORTHOPAEDIC JOINT REPLACEMENT

Whether there is Barrier Nursing for Isolation for patient.
a.
b. Facilities for Arthroscopy Yes No
28. NEUROSURGERY.

9.1 Whether the hospital has aseptic

Operation theatre for Neuro Surgery Yes No

Whether there is Barrier Nursing for Yes No

Isolation for patient.
a.
Whether, it has required instrumentation
for Neuro-surgery Yes No
Facility for Gamma Knife Surgery , Yes No
Facility for Trans-sphenoidal endoscopic Yes No
Surgery,
Facility for Stereotactic surgery Yes No

29. GASTRO-ENTEROLOGY
Whether the hospital has aseptic Operation theatre
for Gastro-Enterology & GI Surgery
Yes No

Whether, it has required instrumentation

for Gastro-Enterology – GI Surgery Yes No

Facilities for Endoscopy – specify details

 30. E.N.T. – Essential information reg.
Whether the hospital has aseptic
Operation theatre for ENT Yes No

Whether, it has required instrumentation

for E.N.T. Surgery including diagnostic procedures Yes No

Facilities for Endoscopy – Yes No

Facilities for reconstruction surgery – Yes No

31. Oncology

.
I. Whether the hospital has aseptic
Operation theatre for Oncology – Surgery Yes No

II. Whether, it has required instrumentation

for Oncology Surgery Yes No

III. Facilities for Chemotherapy Yes No

IV. Facilities for Radio-therapy ( specify ) Yes No

V. Radio-therapy facility and Manpower shall be as Yes No

VI. Per guidelines of BARC

VII. Details of facilities under Radiotherapy

32. Endoscopic / Laparoscopic Surgery:

Criteria for Laparoscopic/Endoscopic Surgery:

- Center should have facilities for casualty/emergency ward, full-fledged

ICU, proper wards, proper number of nurses and paramedical, qualified
and sufficient number of Resident doctors/specialists.
- The surgeon should be Post Graduate with sufficient experience and
qualification in the specialty concerned.
- He/She should be able to carry out the surgery with its variations and
able to handle its complications.
- The hospital should carry out at least 250 laparoscopic surgeries per
year.
- The hospital should have at least one complete set of laparoscopic
equipment and instruments with accessories and should have facilities
for open surgery i.e. after conversion from Laparoscopic surgery.

Yes No

SIGNATURE OF APPLICANT OR AUTHORIZED AGENT

 Annexure-I b(eye)
APPLICATION FORM

FOR

EMPANELMENT OF EXCLUSIVE EYE HOSPITALS/CENTRES IN CGHS

COVERED CITIES ( EXCEPT MUMBAI )

1. Name of the CGHS city where Eye hospital /centre is located.

2. Name of the Eye hospital/ centre

3. Address of the Eye hospital / centre

4. Tel / fax/e-mail

Telephone No
Fax
e-mail address
Name and Contact details of Nodal
persons

Whether NABH Accredited

Whether QCI recommended

Details of Accreditation and Validity period

5. Details of the application fee draft of Rs. 1000/-

Name & Address of the Bank DD No. Date of Issue

Details of the draft of EMD of Rs. 100000/-

Name & Address of the Bank DD No. Date of Issue

6. Total turnover during last financial year

(Certificate from Chartered Accountant is to be enclosed).

7. Turnover from CGHS during last financial year

(Certificate from Chartered Accountant is to be enclosed.)

1. FOR IOL IMPLANT:

(i) Phacoemulsifier Unit (IIIrd or IVth generation) – minimum 2 with extra hand
pieces
(ii) Flash/rapid sterilizer – one per OT
(iii) YAG laser for capsulotomy
(iv) Digital anterior segment camera
(v) Specular microscope

Yes No
Whether beds available
( General, Semi Private, Private or Deluxe Room Yes No
(If yes, specify the number)
Gl. ward Semi-Pvt. ward Pvt. Ward
 9 ) OCULOPLASTY & ADENEXA:

Specific for Oculoplasty & Adenexa:

Specialized Instruments and kits for:
(i)Dacryocystorhinostomy
(ii) Eye lid Surgery e.g ptosis and Lid reconstruction Surgery
(iii) Orbital surgery
(iv) Socket reconstruction
(v) Enucleation/evisceration

(Vi) Availability of Trained, proficient Oculoplasty surgeon who is trained for

Oculoplasty ,Lacrimal and Orbital Surgery

10). A) INVESTIGATIVE FACILITIES:

(i) Syringing, Dacryocystography
(ii) Exophthalmometry
(iii) Ultrasonography – A&B Scan

(iv) Imaging facilities - X-ray, CT Scan & MRI Scan

(v) Ocular pathology, Microbiology services
(vi)& Blood bank services.
(vii) Consultation facilities from related Specialties
such as ENT, Neurosurgery, Hematology, Oncology

(B) OPERATIVE (O.T.) FACILITIES:

Specialized instruments & Kits for the following surgeries should be available.
(i) Dacryo cystorhinostomy
(ii) Lid surgery including eyelid reconstruction &
Ptosis correction.
(iii) Orbital surgery
(iv) Socket reconstruction
(v) Enucleation & Evisceration
(vi) Orbital & Adnexal Trauma including Orbital fractures.

(C) PERSONNEL:
(i) Resident Doctor Support
(ii) Nursing care (24 hours)
(iii) Resuscitative facilities
11) STRABISMUS SURGERY:
Functional OT with Instruments needed for strabismus surgery

YES NO

Availability of set up for Pediatric Strabismus - Orthoptic room with distance fixation
targets (preferably child friendly) may have TV/VCR, Lees/Hess. Chart

YES NO

12) GLAUCOMA:
(1) Specific: Facilities for Glaucoma investigation & management.

a) Applanation tonometery
b) Stereo Fundus photography/OCT/ Nerve fibre Analyser
c) YAG Laser for Iridectomy
d) Automated/Goldmann fields (Perimetry)
e) Electrodiagnostic equipments (VER, ERG, EOG)
f) Colour Vision – Ishiahara Charts
g) Contrast sensitivity – Pelli Robson Charts
h) Pediatric Vision testing – HOTV cards
i) Autorefractometers
j) Synaptophore (basic type with antisuppresion)
k) Prism Bars
l) Stereo test (Randot/TNO)
m) Red – Green Goggles
n) Orthoptic room with distance fixation targets
(Preferably child friendly) may have TV/VCR.
o) Lees/Hess chart

SIGNATURE OF APPLICANT OR AUTHORIZED AGENT

 APPLICATION FORM

FOR

FOR EMPANELMENT OF EXCLUSIVE DENTAL CLINICS IN CGHS

COVERED CITIES( EXCEPT MUMBAI)

1. Name of the CGHS city where Exclusive Dental clinic is located.

2. Name of the Exclusive Dental Clinic

3. Address of the Exclusive Dental Clinic

4. Tel / fax/e-mail

Telephone No
Fax
e-mail address
Name and Contact details of Nodal
persons

Whether NABH Accredited

Whether QCI recommended

Details of Accreditation and Validity period

5. Details of the application fee draft of Rs. 1000/-
Name & Address of the Bank DD No. Date of Issue

Details of the draft of EMD of Rs. 100000/-

Name & Address of the Bank DD No. Date of Issue

6. Total turnover during last financial year

(Certificate from Chartered Accountant is to be enclosed).

7. Turnover from CGHS during last financial year

(Certificate from Chartered Accountant is to be enclosed.)

8. Exclusive Dental Clinic : (Infrastructure and technical Specifications)

2. Number of Dental Chairs:

(A) (i)For General Dental Clinic

(Availability of recovery bed for Dental Clinic)
(if available, specify the number of beds)
……………….
(ii)For Specialized Dental Clinic
(Whether beds are available for
Specialized Dental Clinic)… Yes No
If, Yes Number

(B) Whether separate O.T. YES No

available for aseptic / septic cases
(For specialized Dental clinics)

(C) Alternative Power supply Yes No

Give details

(D) (a)Laboratory facilities for routine Clinical Pathology, Bio-chemistry,

Microbiology ………………. Yes No

(b) Routine facilities for X-ray OPG Dental X-ray

(E) Dental X-ray Machine

IOPA 60-70 Kv, 8 mA, Exposure Yes No

(with minimum radiation leakage) time selection 0.01 to 3 seconds

O.P.G. Machine 60-70 Kv, 8 MA Yes No

* All Specialists employed on regular and visiting basis must possess Dental Council of India’s
recognized qualifications. A Post Graduate should head each specialty.

SIGNATURE OF APPLICANT OR AUTHORIZED AGENT

 APPLICATION FORM

FOR

EMPANELMENT OF DIAGNOSTIC LABORATORIES/ IMAGING CENTRES

IN CGHS COVERED CITIES (EXCEPT MUMBAI)

1. Name of the CGHS city where DIAGNOSTIC LAB / IMAGING CENTRE is located.

2. Name of the Diagnostic Lab / Imaging Centre

3. Address of the Diagnostic Lab / Imaging Centre

4. Tel / fax/e-mail
Telephone No
Fax
e-mail / website address

Whether NABL/NABH recommended

Whether QCI recommended

(wherever applicable)

Applied for ----------------------------------- Diagnostic Lab (Facilities to be mentioned)

Applied for ……………………………….Imaging Centre (Facilities to be mentioned)

Nuclear Medicines Lab
X-Ray
Ultra Sonography
CT Scan
MRI
ECG / EEG/ Nerve Conduction velocity
Others (for listed procedures)

Details of application fee of Rs. 1000/-

Name of bank Address of bank DD no. Validity

Details of EMD amount of Rs. 100000/-

Name of bank Address of bank DD no. Validity

5. Total turnover during last financial year

(Certificate from Chartered Accountant is to be enclosed).

6. Turnover from CGHS during last financial year

(Certificate from Chartered Accountant is to be enclosed.)

CRITERIA FOR LABORATORY DIAGNOSTIC CENTER: -

Indicate (√ ) for Yes and (x) for No in the Box

1) Laboratories (Clinical Pathology):

- Space: Minimum 10X12 ft.

Adequate space for collection of samples and dispatch of

reports. Waiting space - Minimum for 10 patients.

- Equipment:

Microscope , fully automatic hematology cell counter

Incubator centrifuge machine fridge (300 liters)
Automated Electrophoresis apparatus Automated Coagulation apparatus
Cytology and histopathology related set up
Needle Destroyer Trolley for waste disposal with Bags.
- Manpower with Qualification:

Technician –
 Diploma in MLT and adequate experience of handling pathology specimens
including Cytology and Histopathology.

Facilities for Waste Management: Provision for waste management as per the
Biomedical waste Act., 1998

- Quality Control:

Arrangement for Internal and external quality control.

- The set up should be able to handle the workload with adequate staff and
equipment. Reports should be available at the earliest depending on the test.

- Backup of Generator, UPS, Emergency light

- General requirements for Pathological Diagnostic Centers:

 Minimum workload of 40-50 samples per day (not tests).

 Slides for Histopathology / Cytology should be preserved a reasonable period.
 Records of patients /investigation should be well maintained and updated.
 Charges should be displayed on the notice board.
 Fire fighting system should be in place wherever it is necessary.

2) Laboratory (Biochemistry):-

- Space for working lab minimum 10X12 ft.

Reception and sample collection should have an area for

at least 10 patients to sit.
Laboratory (Preferably air-conditioned)
Washing area/waste disposal.

- Equipment:

Refrigerator Water-bath Hot-air-oven Centrifuge machine

Photo-electric calorie meter or Spectrophotometer or semi-auto-analyzer/auto
analyzer Flame Photometer or ISE Analyzer Micro-pipettes
All related Lab glassware and reagents needle destroyer
standard balance

- Manpower with qualification:

Technician with DMLT.

Provision for waste management as per
 the Biomedical waste Act., 1998:

- Quality Control:
Should be internal as well as external
- Backup of Generator, UPS, Emergency light
- 24 hours supply of water, provision for toilet.
Indicate (√ ) for Yes and (x) for No in the Box
Additional requirements for Laboratory for Hospitals/ Nursing Homes:-

- In addition to the criteria written above the following additional equipment will be
required

Blood Gas analyzer Elisa Reader HPLC and Electrophoresis

apparatus

3) Laboratory (Microbiology):

- Minimum Space required is 10X12 ft.

Receiving samples & labeling, sorting, registration,
minimum waiting space for 10 patients and
dispatch area.
Media room (autoclave, hot air oven, pouring hood) Area
required minimum 6X4 ft.
Processing of samples – staining, cultures etc.
- Equipment:
Non-expendable – Autoclave Hot Air oven water bath, incubator
centrifuge microscopes vortex ELISA reader.
Expendable – Chemicals, media, glassware, stationery etc.
- Manpower with qualification:
Technician - DMLT
- Provision for waste management as per the
Biomedical waste Act., 1998.
- Quality control:
Internal
External tie up with higher Organizations.
Backup of Generator, UPS, Emergency light.

SIGNATURE OF APPLICANT OR AUTHORIZED AGENT

 ANNEXURE-II

CERTIFICATE OF UNDERTAKING

1. It is Certified that the particulars given above are correct and eligibility criteria are satisfied..

2. That Hospital/ eye centre/Exclusive Dental Clinic/ Diagnostic laboratory/ Imaging Centre
shall not charge CGHS beneficiaries higher than the CGHS notified rates or the rates
charged from other patients who are not CGHS beneficiaries.

3. That the rates have been provided against a facility/procedure/investigation actually available
at the Organization.

4. That if any information is found to be untrue, Hospital/ Eye centre/Dental clinic/ Diagnostic
Centre would be liable for de-recognition by CGHS. The Organization will be liable to pay
compensation for any financial loss caused to CGHS or physical and or mental injuries
caused to its beneficiaries.

5. That the Hospital/ Eye centre/Dental clinic/ Diagnostic Centre has the capability to submit
bills and medical records in digital format and that all Billing will be done in electronic format
and medical records will be submitted in digital format.

6. The Hospital/ Eye centre/Dental clinic/ Diagnostic Centre will pay damage to the
beneficiaries if any injury, loss of part or death occurs due to gross negligence.

7. That the Hospital/ Eye centre/Dental clinic/ Diagnostic Centre has not been derecognized by
CGHS or any State Government or other Organizations.

8. That no investigation by central Government/State Government or any statuary Investigating

agency is pending or contemplated against the Hospital/ Eye centre/Dental clinic/
Diagnostic Centre.
9. Agree for the terms and conditions prescribed in the tender document.

10. Hospital agrees to implement Electronic Medical Records and EHR as per the standards
approved by Ministry of Health & Family Welfare
11. I / We hereby certify that I / we have read the entire terms and conditions of the Empanelment
document 2017 from Page No. _______ to ______ (including all documents like
annexure(s), schedule(s), etc .,), which form part of the contract agreement and I / we shall
abide hereby by the terms / conditions / clauses contained therein.

12. Also I / We are not under suspension at the time of applying for empanelment / blacklisted by
any PSU / Government Department / Financial Organization / Court.

SIGNATURE OF APPLICANT OR AUTHORIZED AGENT

 Annexure-III

Copies of the following documents (wherever applicable) are to be submitted along with
Application

1. Copy of legal status , place of registration and principal place of business of the health
care Organization or partnership firm, etc.,
2. A copy of partnership deed ,/ memorandum and articles of association, if any
3. Copy of Customs duty exemption certificate and the conditions on which exemption was
accorded.
4. Copy of the license for running Blood Bank.
5. Copy of the documents full filling necessary statutory requirements.

SIGNATURE OF APPLICANT OR AUTHORIZED AGENT

 Annexure-IV
EMPANELMENT ACCEPTANCE LETTER
(To be given on Health Care Organizations Letter Head)

Date:

To,
______________________
______________________
______________________
______________________
______________________

Sub: Acceptance of Terms & Conditions of application.

Applied for : -
________________________________________________________________________________
________________________________________________________________________________
______

Dear Sir/Madam,

1. I/ We have been presently empanelled under CGHS,………………………….since ………….

as …………………………………………………………………. and have read terms and conditions
of stated in all the pages of Document for empanelment 2017 and Memorandum of and I/we
want to continue my/our empanelment under CGHS as per the terms and conditions as
contained in the Document for Empanelment 2017 and in the accompanying Memorandum of
Agreement.

2. I / We hereby certify that I / we have read the entire terms and conditions of the
Empanelment document 2017 from Page No. _______ to ______ (including all documents
like annexure(s), schedule(s), etc .,), which form part of the contract agreement and I / we
shall abide hereby by the terms / conditions / clauses contained therein.

3. Also I / We are not under suspension at present/ blacklisted by any PSU / Government
Department / Financial Organization / Court.

Yours Faithfully,

(Signature of the Bidder, with Official Seal)

 DRAFT MOA Annexure-V

F. No. D.12034/22/14/CGHS-Desk-I
Government of India
Ministry of Health & F.W.
CGHS Division

All the Hospitals, Exclusive Eye Hospitals/ Centres, Exclusive Dental Clinics and
Diagnostic Laboratories/ Imaging Centers (existing and new) for empanelment under CGHS
are required to prepare the Agreement between the Additional Director, CGHS and the
concerned Health Care Organization on a non-judicial stamp paper of Rs. 100/- for further
necessary action.

(Additional Director, CGHS)

 AGREEMENT
BETWEEN
ADDITIONAL DIRECTOR, CGHS
AND
…………………………………Name of the City (except Mumbai)

This Agreement is made on the ________ day of _________, 2017 between the President of India
acting through ADDITIONAL DIRECTOR, Central Government Health Scheme, Ministry of Health &
F.W., Government of India having its office at Nirman Bhawan, New Delhi (hereinafter called CGHS,
which expression shall, unless repugnant to the context or meaning thereof, be deemed to mean
and include its successors and assigns) of the First Part

AND

……………………………………….. (Name of the Hospital with Address) of the Second Part.

WHEREAS, the Central Government Health Scheme is providing comprehensive medical care
facilities to the Central Government Employees / Pensioners and such other categories of
beneficiaries as are decided from time to time.

AND WHEREAS, CGHS proposes to provide treatment facilities and diagnostic facilities to the
Beneficiaries in the Private empanelled Hospitals, exclusive eye hospitals/centres, exclusive dental
clinics, Diagnostic Laboratories/ Imaging centres in -------------(Name of City)

AND WHEREAS, (Name of the Hospitals, Exclusive Eye Hospitals/ Centres, Exclusive Dental
Clinics and Diagnostic Laboratories/ Imaging Centers) has agreed to give the treatment / diagnostic
facilities available in the HCO to the CGHS Beneficiaries in the Health Care Organization at the
rates offered by CGHS:
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
……………………………………………………

NOW, THEREFORE, IT IS HEREBY AGREED between the Parties as follows:

1. DEFINITIONS & INTERPRETATIONS

1.1 The following terms and expressions shall have the following meanings for purposes of
this Agreement:
1.1.1 “Agreement” shall mean this Agreement and all Schedules, supplements,
appendices, appendages and modifications thereof made in accordance with
the terms of this Agreement.
1.1.2 “Benefit” shall mean the extent or degree of service the beneficiaries are
entitled to receive as per the rules on the subject.
1.1.3 “Bill Clearing Agency “(BCA) means the agency appointed by CGHS for
processing of Data/ Bills of all CGHS beneficiaries (both serving and
pensioner) attending the empanelled Private Hospitals and for making
payment.
1.1.4 “Card” shall mean the CGHS Card, issued by any competent authority, of any
CGHS city.
1.1.5 “Card Holder” shall mean a person having a CGHS Card .
1.1.6 “CGHS Beneficiary” shall mean a person who is eligible for coverage of CGHS
and hold a valid CGHS card for the benefit.
1.1.7 “Coverage” shall mean the types of persons to be eligible as the beneficiaries
of the Scheme to health services provided under the Scheme, subject to the
terms, conditions and limitations.
1.1.8 “Diagnostic Center” shall mean the (Name of the Diagnostic Center)
performing tests / investigations
1.1.9 “ Imaging Centre” shall mean the (Name of the Imaging Centre) performing X-
ray , CT Scan, MRI, USG, etc.,
1.1.10 “Emergency” shall mean any condition or symptom resulting from any cause,
arising suddenly and if not treated at the early convenience, be detrimental to
the health of the patient or will jeopardize the life of the patient.
1.1.11 “Empanelment” shall mean the hospitals, exclusive eye hospitals/centres,
exclusive dental clinics, Diagnostic Laboratories/ Imaging centres authorized
by the CGHS for treatment/ investigation purposes for a particular period.
1.1.12 “Hospital” shall mean the (Name of the Hospital) while performing under this
Agreement providing medical investigation, treatment and the healthcare of
human beings.
1.1.13 “De-recognition of Hospital” shall mean debarring the hospital on account of
adopting unethical practices or fraudulent means in providing medical
treatment to or not following the good industry practices of the health care for
the CGHS beneficiaries after following certain procedure of inquiry
1.1.14 “Party” shall mean either the CGHS or the Hospital and “Parties” shall mean
both the CGHS and the Hospital .

1.1.15 “CGHS “Package Rate” shall mean all inclusive – including lump sum cost of
inpatient treatment / day care / diagnostic procedure for which a CGHS
beneficiary has been permitted by the competent authority or for treatment
under emergency from the time of admission to the time of discharge including
(but not limited to) – (i) Registration charges, (ii) Admission charges, (iii)
Accommodation charges including patients diet, (iv) Operation charges, (v)
Injection charges, (vi) Dressing charges, (vii) Doctor / consultant visit charges,
(viii) ICU / ICCU charges, (ix) Monitoring charges, (x) Transfusion charges and
Blood processing charges (xi)Pre Anesthetic checkup and Anesthesia
charges, (xii) Operation theatre charges, (xiii) Procedural charges / surgeon’s
fee, (xiv) Cost of surgical disposables and all sundries used during
hospitalization, (xv) Cost of medicines and consumables (xvi) Related routine
and essential investigations (xvii) Physiotherapy charges etc. (xviii) Nursing
care charges etc.

Package rates also include two pre-operative consultations and two post-
operative consultations.

In case of surgical procedures, where its name is not listed under CGHS
rate list, the rates given under other minor/major surgery under each
specialty shall be applicable

Cost of Implants / stents / grafts is reimbursable in addition to package rates

as per CGHS ceiling rates or as per actual, whichever is lower.

If there is no CGHS prescribed ceiling rate for any implant

reimbursement shall be limited to 60% of the MRP including GST &
HCOs cannot charge more than that amount from CGHS beneficiaries.

In case a beneficiary demands a specific Brand of Stent / Implant and give his
consent in writing, the difference in cost over and above the ceiling rate may
be charged from the beneficiary, which is non-reimbursable.

During In-patient treatment of the CGHS beneficiary, the hospital will not ask
the beneficiary or his / her attendant to purchase separately the medicines /
sundries / equipment or accessories from outside and will provide the
treatment within the package rate, fixed by the CGHS which includes the cost
of all the items.
However, the following items are not admissible for reimbursement:
Toiletries
Sanitary napkins
Talcum powder
Mouth fresheners
 In cases of conservative treatment / where there is no CGHS package rate,
calculation of admissible amount would be done item wise as per CGHS rates
or as per AIIMS rates , if there is no CGHS rate for a particular item.

Package rates envisage up to a maximum duration of indoor treatment as

follows:

Upto 12 days for Specialized (Super Specialties) treatment

Upto 7 days for other Major Surgeries
Upto 3 days for/ Laparoscopic surgeries / elective Angioplasty / normal
deliveries and
1 day for day care / Minor (OPD) surgeries.

Short admission/OPD treatment for injections, infusion, etc. Rs.500/- would be

reimbursed for all categories of beneficiaries.

However, if the beneficiary has to stay in the hospital for his / her recovery
for a period more than the period covered in package rate, in exceptional
cases, supported by relevant medical records and certified as such by
hospital, the additional reimbursement may be allowed, which shall be limited
to accommodation charges as per entitlement , investigations charges at
approved rates, doctors visit charges (not more than 2 visits per day per
specialists / consultants) and cost of medicines for additional stay). If more
than one specialist is required to be consulted for treatment then the bills
would be accepted only with proper justification of visits of different specialist.

No additional charge on account of extended period of stay shall be allowed if

that extension is due to infection on the consequences of surgical procedure/
faulty investigation procedure etc.

The empanelled health Care Organization cannot charge more than CGHS
approved rates when a patient is admitted with valid CGHS Card with prior
permission or under emergency. In case of any instance of overcharging the
overcharged amount over and above CGHS rate (except inadmissible items
and difference paid due to implant/stent of a specific brand chosen by CGHS
beneficiary) shall be paid to the beneficiary and shall be recovered from the
pending bills of the hospital.

If any empanelled health care Organization charges from CGHS beneficiary

for any expenses incurred over and above the package rates vis-à-vis
medicine, consumables, sundry equipment and accessories etc., which are
purchased from external sources, based on specific authorization of treating
doctor / staff of the concerned hospital and if they are not falling under the list
of non-admissible items, reimbursement shall be made to the beneficiary and
the amount shall be recovered from the pending bills of hospitals.

1.1.16.“BCA” shall mean a Third Party Administrator authorized by CGHS to process

the medical reimbursement claims or to carry out medical audit.

Annexures-I shall be deemed to be an integral part of this Agreement.

The terms and conditions stipulated in the application document shall be read as part
of this agreement.
2. DURATION OF AGREEMENT

The Agreement shall remain in force for a period of 2 years or till it is modified or revoked,
whichever is earlier. The Agreement may be extended for another year subject to fulfillment
of all the terms and conditions of this Agreement and with mutual consent of both parties.

3. CONDITIONS FOR PROVIDING TREATMENT/SERVICES

A. GENERAL CONDITIONS

The hospitals, Exclusive Eye hospitals/centres, Exclusive Dental Clinics and Diagnostic
centres shall be empanelled for all facilities/services available in the health care
organization as approved by NABH/NABL/QCI and shall not be empanelled for selected
specialties/ facilities.

The Hospitals, Exclusive Eye Hospitals/centres, Exclusive Dental clinics, Diagnostic Laboratories/ Imaging
Centres shall investigate / treat the CGHS beneficiaries only for the condition for which they
are referred with due authorization letter.

In case of unforeseen emergencies of these patients during admission for approved

procedure, ‘provisions of emergency treatment’ shall be applicable.

It is agreed that CGHS beneficiaries shall be attended to on priority.

CGHS has the right to monitor the treatment provided in the Private Hospitals, exclusive eye
hospitals/centres, exclusive dental clinics, Diagnostic Laboratories/ Imaging centres.

B. AUTHORISATION LETTER FOR TREATMENT

The treatment/procedure shall be performed on the basis of the authorization letter issued by
the Chief Medical Officer of the concerned CGHS dispensary in case of pensioners and by
the administrative department / Ministry in case of serving employees and on the production
of a valid CGHS card by the beneficiary.
In case of investigations for which CGHS rates are prescribed no such authorization letter is
required and investigations are performed on the basis of advice of Government
Specialist/CGHS Medical Officer and a valid CGHS Card.

C. INVESTIGATIONS PRIOR TO ADMISSION

All routine, related investigations regarding fitness for the surgery will be done prior to the
admission for any elective procedure and are part of package. However specialized
investigation would be reimbursed in addition to package rate.

D. ADDITIONAL PROCEDURES/INVESTIGATIONS

For any material / additional procedure / investigation other than the condition for which the
patient was initially permitted, would require the permission of the competent authority
except under emergency.

E. PROCEDURE WHERE EMERGENCY CASE NEEDS TREATMENT IN A SPECIALITY(s)

WHICH ARE NOT AVAILABLE IN THE HOSPITAL

The Hospital shall provide necessary treatment to stabilize the patient and transport the
patient safely to nearest recognized hospital under intimation to CGHS authorities. However
in such cases the Hospital will charge as per the CGHS rates only for the treatment provided.
In non-emergency cases the hospital shall not admit CGHS beneficiaries , if facility is not
available.
F. CHANGES IN INFRASTRUCTURE/STAFF TO BE NOTIFIED TO CGHS

The Hospital, Exclusive Eye centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging Centre shall
immediately communicate to Additional Director / Joint Director of CGHS of concerned city
about any change in the infrastructure /Shifting of premises. The empanelment will be
temporarily withheld in case of shifting of the facility to any other location without prior
permission of CGHS. The new establishment of the same Hospital shall attract a fresh
inspection, at the prescribed fee, for consideration of continuation of empanelment.

G. ANNUAL REPORT

The Hospital, Exclusive Eye centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging will submit an
annual report regarding number of referrals received, admitted CGHS beneficiaries, bills
submitted to the CGHS and payment received, details of monthly report submitted to the
Additional Directors / Joint Additional Directors of CGHS of concerned City. Annual audit
report of the hospitals will also be submitted along with the statement.

The Hospital, Exclusive Eye centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging shall submit all
the medical records in digital format.

H. EMR / EHR
The empanelled health Care Organizations (except eye hospital/centre, dental clinics,
Diagnostic Labs/Imaging Centres) shall have to implement Electronic Medical Records and
EHR as per the standards and guidelines approved by Ministry of Health & Family Welfare
within one year of its empanelment.
I. EMPANELMENT WITH AUTONOMOUS BODIES
All empanelled hospitals/ diagnostic centres/ exclusive eye centres/ exclusive dental clinics
shall also agree for empanelment with any autonomous body/ public sector undertaking on
same terms & conditions as with CGHS, on recommendation of Ministry of Health & Family
Welfare.
J. MEETINGS
Authorized signatory / representative of the empanelled health care organizations shall
attend the periodic meetings held by Additional Director / A.D. / J.D. / Department /
Establishment of CGHS required in connection with improvement of working conditions and
for redressal of grievances.

K. INSPECTIONS
During the visit by Additional Director / Joint Director/ CMO In-charge of the dispensary or
any other authorized representative of the Ministry of Health / Additional Directorate General
of Health Services / concerned Department, including BCA, the empanelled health care
organization’s authorities will cooperate in carrying out the inspection.

L. AID TO PUBLIC HEALTH AUTHORITIES

In case of any natural disaster / epidemic, the empanelled health care organizations shall
fully cooperate with the Ministry of Health / Additional Directorate General of Health Services,
Additional Director / Joint Director of CGHS of concerned city and will convey / reveal all the
required information, apart from providing treatment.

M. NO COMMERCIAL PUBLICITY

The Hospital, Exclusive Eye centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging Centre will not
make any commercial publicity projecting the name of CGHS / Ministry of Health & F.W. or
Government of India. However, the fact of empanelment under CGHS shall be displayed at
 the premises of the empanelled health Care Organization indicating that the charges will be
as per CGHS approved rates.

4. TREATMENT IN EMERGENCY

The following ailments may be treated as emergency which is illustrative only and not
exhaustive, depending on the condition of the patient:

 Acute Coronary Syndromes (Coronary Artery Bye-pass Graft / Percutaneous,

Transluminal Coronary Angioplasty) including Myocardial Infarction, Unstable
Angina, Ventricular Arrhythmias, Paroxysmal Supra Ventricular Tachycardia,
Cardiac Temponade, Acute Left Ventricular Failure / Severe Congestive Cardiac
Failure, Accelerated Hypertension, Complete Heart Block and Stoke Adam attack,
Acute Aortic Dissection.
 Acute Limb Ischemia, Rupture of Aneurysm, Medical and Surgical shock and
peripheral circulatory failure.
 Cerebro-Vascular attack-Stokes, Sudden unconsciousness, Head injury,
Respiratory failure, decompensated lung disease, Cerebro-Meningeal Infections,
Convulsions, Acute Paralysis, Acute Visual loss.
 Acute Abdomen pain.
 Road Traffic Accidents / with injuries including fall. Severe
 Hemorrhage due to any cause.
 Acute poisoning.
 Acute Renal Failure.
 Acute abdomen pain in female including acute Obstetrical and Gynecological
emergencies.
 Electric shock.
 Any other life threatening condition.

In emergency the hospital will not refuse admission or demand an advance payment
from the beneficiary or his family member and will provide credit facilities to the patient
whether the patient is a serving employee or a pensioner availing CGHS facilities, on
production of a valid CGHS card and the hospital shall submit the bill for reimbursement to
the concerned Deptt. / Ministry / CGHS. The refusal to provide the treatment to bonafide
CGHS Beneficiaries in emergency cases and other eligible categories of beneficiaries on
credit basis, without valid ground, would attract disqualification for continuation of
empanelment.

The nature and appropriateness of the emergency is subject to verification, which may be
verified, inspected or medically audited by the nominated authority on random basis at its
own discretion.

The Hospital will intimate all instances of patients admitted as emergencies without prior
permission to the CGHS authorities / BCA appointed by CGHS within the prescribed time.

5. ENTITLEMENTS FOR VARIOUS TYPES OF WARDS

CGHS beneficiaries are entitled to facilities of private, semi-private or general ward

depending on their pay drawn in pay band/ pension. These entitlements are amended from
time to time and the latest order in this regards needs to be followed. The entitlement is as
follows:-

S. No. Basic Pay drawn/Basic Pension Entitlement

1. Upto Rs. 47,600/- General Ward
2. Rs. 47,601/- to 63,100/- Semi-Private
Ward
3. Rs. 63,101/- and above Private Ward
 a. Private ward is defined as a hospital room where single patient is accommodated
and which has an attached toilet (lavatory and bath). The room should have
furnishings like wardrobe, dressing table, bed-side table, sofa set, carpet, etc. as
well as a bed for attendant. The room has to be air-conditioned.

b. Semi Private Ward is defined as a hospital room where two to three patients are
accommodated and which has attached toilet facilities and necessary furnishings.

c. General ward is defined as a hall that accommodates four to ten patients.

Treatment in higher Category of accommodation than the entitled category is not

permissible.

6. APPROVED RATES TO BE CHARGED

The empanelled health care organization shall charge from the CGHS beneficiary as per
the rates for a particular procedure / package deal as prescribed by the CGHS and attached
as Annexure (rate list), which shall be an integral part of this Agreement. The rates notified
by CGHS shall also be available on web site of Ministry of Health & F.W. at
[Link]

If any HCOs charges lower rates (lower than to CGHS rate/discounted rates) from any
private/ public organization, the HCOs shall immediately intimate to CGHS & charge
lower/discounted rate from CGHS beneficiaries also. Any default in this regard is liable to
invite suitable action against the Health Care Organizations including suspension of their
empanelment.

The package rate will be calculated as per the duration specified in the tender document.
No additional charge on account of extended period of stay shall be allowed if, that
extension is due to infection on the consequences of surgical procedure or due to any
improper procedure and is not justified.

The rate being charged will not be more than what is being charged for same procedure
from other (non-CGHS) patients or Organizations. An authenticated list of rates being
charged from other non-CGHS Organizations will also be supplied to CGHS within 30 days
of this Agreement.

The procedure and package rates for any diagnostic investigation, surgical procedure and
other medical treatment for CGHS beneficiary under this Agreement shall not be increased
during the validity period of this Agreement.
The empanelled health care organization agrees that during the In-patient treatment of the
CGHS beneficiary, the Hospital will not ask the beneficiary or his attendant to purchase
separately the medicines / sundries / equipment or accessories from outside and will
provide the treatment within the package deal rate, fixed by the CGHS which includes the
cost of all the items. Appropriate action, including removing from CGHS empanelment and /
or termination of this Agreement, may be initiated on the basis of a complaint, medical audit
or inspections carried out by CGHS teams / appointed BCA.

7. MODE OF PAYMENT FOR TREATMENT OF BENEFICIARIES

For serving employees (other than CGHS/ DGHS /Ministry of H&FW), the payment will be
made by the patient and he/she will claim reimbursement from his/her office subject to the
approved ceiling rates.
 In respect of the following categories of beneficiaries, treatment / procedures/services shall
be undertaken/provided on credit: No payment shall be sought from them and the bills
should be submitted to the BCA / Office of the Additional / Joint Additional Director, CGHS
of the concerned city.

o Pensioners,
o Ex-Members of Parliament,
o Sitting Members of Parliament
o Freedom Fighters,
o Serving CGHS/DGHS / Ministry of H&FW employees,
o Such other categories of CGHS cardholders as notified by the Government.

8. BILL CLEARING AGENCY (BCA)

Bill clearing Agency (BCA) would charge a processing fee @ 2% of claimed amount and
service tax thereon with a minimum of Rs.12.50/- and maximum of Rs. 750/- per bill.
CGHS reserves the right to revise these charges from time to time’

9. NOTIFICATION OF NODAL OFFICERS

Empanelled health care Organizations shall notify two Nodal officers for CGHS
beneficiaries, one of them being of the rank of Deputy MS/Addl. MS, who can be contacted
by CGHS beneficiaries in case of any eventuality.

10. INFORMATION TO BE PROVIDED TO THE BCA & CGHS BY HOSPITALS

EMERGENCY ADMISSIONS

The Hospital will intimate to the BCA and to CGHS within two(2) hours of such admission
and the BCA will respond with due authorization in four (4) hours. Treatment in no case
would be delayed or denied because authorization by the BCA is only confirmation of the
e-workflow in respect of such patient. Post discharge, the hospital would upload bills and
other documents as per requirement of CGHS within seventy two (72) hours.

REFERRED ADMISSIONS

Where the CGHS beneficiary visits the hospital with a proper referral and authorization
letter, the hospital will verify and submit information of admission to the BCA and to CGHS
online. The BCA would respond with an authorization within four (4) hours. Post discharge,
the hospital would upload bills and other documents as per requirement of CGHS within
seventy two(72) hours.

11. SUBMISSION OF BILLS TO BILL CLEARING AGENCY

In case of Pensioners, etc., where credit bills are sent to CGHS, the Private Empanelled
health care Organizations shall submit the physical bill as well as electronic bill to the Bill
Clearing Agency for processing of bills.

In case of serving employees the bills shall be submitted to concerned department in case
of employees of CGHS/DGHS & Ministry of Health & Family Welfare. In other cases of
serving employees the beneficiaries would submit the claim to their concerned department..

12. PROCESSING OF CLAIMS/BILLS BY THE BCA

CGHS would ensure that subject to fulfillment of prescribed conditions, payment of hospital
claims (admissible amount) is done expeditiously. Recoveries, if any, will be affected from
future bills of health care Organizations.
 The BCA during the course of the auditing will restrict the claims as per CGHS rules and
regulations. BCA will also examine in terms of

(a) Appropriateness of treatment including screening of patients records to identify

unnecessary admissions and unwarranted treatments
(b) Whether the planned treatment is shown as emergency treatment
(c) Whether the diagnostic medical or surgical procedures that were not required were
conducted by hospital including unnecessary investigations
(d) Maintaining database of such information of CGHS beneficiaries for future use.
(e) Whether the treatment procedures have been provided as per the approved rates
and the packages.
(f) Whether procedures performed were only those for which permission has been
granted

The BCA shall record their findings and intimate the same to the Private Hospital concerned
with a copy endorsed to CGHS authority of the city. The payment of the bill/claim to the
Private Hospital concerned will be made directly by the BCA after receipt of the physical
bills in respect of CGHS pensioner beneficiaries, etc.

13. MEDICAL AUDIT OF BILLS

There shall be a continuous Medical Audit of the services provided by the empanelled
Private Hospital.

14. DUTIES AND RESPONSIBILITIES OF EMPANELLED HEALTH CARE

ORGANIZATIONS

It shall be the duty and responsibility of the empanelled Hospital, Exclusive Eye centre, Exclusive
Dental clinic, Diagnostic Laboratory/ Imaging Laboratory/ Imaging Centre at all times, to obtain, maintain
and sustain the valid registration, recognition and high quality and standard of its services
and healthcare and to have all statutory / mandatory licenses, permits or approvals of the
concerned authorities under or as per the existing laws”.

15. NON ASSIGNMENT

The empanelled Hospital, Exclusive Eye centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging
Centre shall not assign, in whole or in part, its obligations to perform under the agreement,
except with the CGHS’s prior written consent at its sole discretions and on such terms and
conditions as deemed fit by the CGHS. Any such assignment shall not relieve the Hospital/
Eye centre/Dental clinic/ Diagnostic Centre from any liability or obligation under this agreement

16. EMPANELLED HEALTH CARE ORGANIZATION’S INTEGRITY AND OBLIGAITONS

DURING AGREEMENT PERIOD

The empanelled Hospital, Exclusive Eye centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging
Centre is responsible for and obliged to conduct all contracted activities in accordance with
the Agreement using state-of-the-art methods and economic principles and exercising all
means available to achieve the performance specified in the Agreement. The Hospital,
Exclusive Eye centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging Centre is obliged to act
within its own authority and abide by the directives issued by the CGHS. The Hospital,
Exclusive Eye centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging Centre is responsible for
managing the activities of its personnel and will itself be responsible for their
misdemeanors, negligence, misconduct or deficiency in services, if any.
17. PERFORMANCE BANK GUARANTEE (PBG)

Health Care Organizations that are recommended for empanelment after the initial
assessment shall also have to furnish a performance Bank Guarantee valid for a period of
30 months i.e. six month beyond empanelment period to ensure efficient service and to
safeguard against any default:

Hospitals/Cancer Units Rs. 10.00 lac

Eye Centres Rs.2.00 lac
Dental Clinics Rs.2.00 lac
Diagnostic Centres Rs. [Link]

(PBG for charitable Organizations would be 50% of above amount)

In case of health Care Organizations already empanelled under CGHS they shall submit a
new Performance Bank Guarantee/revalidated PBG valid for 30 months to cover entire
period of empanelment and 6 months beyond.

18. FORFEITURE OF PERFORMANCE BANK GUARANTEE AND REMOVAL FROM LIST

OF EMPANELLED ORGANIZATIONS

In case of any violation of the provisions of the MOA by the health care Organizations
empanelled under CGHS such as:

1. refusal of service,

2. undertaking unnecessary procedures,

3. prescribing unnecessary drugs/tests

4. over billing /intentional hiking of bills

5. Reduction in staff/ infrastructure/ equipment etc. after the hospital has been empanelled.

6. non-submission of the report, habitual late submission or submission incorrect data in the
report

7. refusal of credit to eligible beneficiaries and direct charging from them.

8. if not recommended by NABH/NABL/QCI at any stage

9. Discrimination against CGHS beneficiaries’ vis-à-vis general patients.

10. Repeated complaints by CGHS beneficiaries

The amount of 15% of Performance Bank Guarantee will be forfeited and the CGHS shall
have the right to de-recognize/ suspend empanelment of the health Care Organization as
the case may be. Such action could be initiated on the basis of a complaint, medical audit
or inspections carried out by CGHS teams at random.
The decision of the CGHS will be final.

19. LIQUIDATED DAMAGES

a. The Hospital, Exclusive Eye centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging Centre
shall provide the services as per the requirements specified by the CGHS in terms of
the provisions of this Agreement. In case of initial violation of the provisions of the
Agreement by the Hospital such as refusal of service or direct charging from the
CGHS Beneficiaries or defective service and negligence, the amount equivalent to
 15% of the amount of Performance Bank Guarantee will be charged as agreed
Liquidated Damages by the CGHS, however, the total amount of the Performance
Bank Guarantee will be maintained intact being a revolving Guarantee.
b. In case of repeated defaults by the Hospital, Exclusive Eye centre, Exclusive Dental clinic,
Diagnostic Laboratory/ Imaging Centre , the total amount of Performance Bank Guarantee
will be forfeited and action will be taken for removing the Health Care Organization
from the empanelment of CGHS as well as termination of this Agreement
c. For over-billing and unnecessary procedures, the extra amount so charged will be
deducted from the pending / future bills of the Hospital, Exclusive Eye centre, Exclusive Dental
clinic, Diagnostic Laboratory/ Imaging Centre and the CGHS shall have the right to issue a
written warning to the health Care Organization not to do so in future. The recurrence,
if any, will lead to the stoppage of referral to that particular Health care Organization
or suspension of empanelment from CGHS/ de-recognition from CGHS.

20. TERMINATION FOR DEFAULT

The CGHS may, without prejudice to any other remedy for breach of Agreement, by
written notice of default sent to the Hospital terminate the Agreement in whole or part:

If the empanelled Hospital, Exclusive Eye centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging
Centre fails to provide any or all of the services for which it has been empanelled within the
period(s) specified in the Agreement, or within any extension thereof if granted by the
CGHS pursuant to Condition of Agreement or If the Health Care Organization fails to
perform any other obligation(s) under the Agreement.

If the Hospital, Exclusive Eye centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging Centre in the
judgment of the CGHS has engaged in corrupt or fraudulent practices in executing the
Agreement and violating terms and conditions of empanelment.

21. INDEMNITY

The empanelled Hospital, Exclusive Eye centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging
Centre shall at all times, indemnify and keep indemnified CGHS / the Government against all
actions, suits, claims and demands brought or made against it in respect of anything done
or purported to be done by the Health Care Organization in execution of or in connection
with the services under this Agreement and against any loss or damage to CGHS / the
Government in consequence to any action or suit being brought against the CGHS / the
Government, along with (or otherwise), Health Care Organization as a Party for anything
done or purported to be done in the course of the execution of this Agreement. The Health
Care Organization will at all times abide by the job safety measures and other statutory
requirements prevalent in India and will keep free and indemnify the CGHS from all
demands or responsibilities arising from accidents or loss of life, the cause or result of
which is the Hospital negligence or misconduct.

The Health care Organization will pay all indemnities arising from such incidents without
any extra cost to CGHS and will not hold the CGHS responsible or obligated. CGHS / the
Government may at its discretion and shall always be entirely at the cost of the Health Care
Organization defend such suit, either jointly with the Health Care Organization enter or
singly in case the latter chooses not to defend the case

22. ARBITRATION

If any dispute or difference of any kind whatsoever (the decision whereof is not herein
otherwise provided for) shall arise between the CGHS and the Hospital, Exclusive Eye centre,
Exclusive Dental clinic, Diagnostic Laboratory/ Imaging Centre upon or in relation to or in connection
with or arising out of the Agreement, shall be referred to for arbitration The provisions of the
Arbitration and Conciliation Act, 1996 shall apply to the arbitration proceedings.
23. MISCELLANEOUS

 Nothing under this Agreement shall be construed as establishing or creating between

the Parties any relationship of Master and Servant or Principal and Agent between
the CGHS and the Health Care Organization. The Health care Organization shall
work or perform their duties under this Agreement or otherwise.
 The Health care Organization agrees that any liability arising due to any default or
negligence in not represent or hold itself out as agent of the CGHS.
 The CGHS will not be responsible in any way for any negligence or misconduct of the
Health Care Organization and its employees for any accident, injury or damage
sustained or suffered by any CGHS beneficiary or any third party resulting from or by
any operation conducted by and on behalf of the Hospital or in the course of doing its
performance of the medical services shall be borne exclusively by the hospital who
shall alone be responsible for the defect and / or deficiencies in rendering such
services.
 The Hospital/ Exclusive Eye centre/Exclusive Dental clinic/ Diagnostic Laboratory/ Imaging Centre
shall notify the Government of any material change in their status and their
shareholdings or that of any Guarantor of the in particular where such change would
have an impact on the performance of obligation under this Agreement.
 This Agreement can be modified or altered only on written agreement signed by both
the parties.
 Should the Hospital/ Exclusive Eye centre/Exclusive Dental clinic/ Diagnostic Laboratory/ Imaging
Centre get wound up or partnership is dissolved, the CGHS shall have the right to
terminate the Agreement. The termination of Agreement shall not relieve the hospital
or their heirs and legal representatives from the liability in respect of the services
provided by the Health care Organization during the period when the Agreement was
in force.
 The Hospital, Exclusive Eye centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging Centre
shall bear all expenses incidental to the preparation and stamping of this agreement.

24. OTHER SERVICES TO BE PROVIDED

The empanelled Private Health Care Organization will, on the request of CGHS, agree to
provide training to CGHS medical, Para-medical and nursing staff.

25. NOTICES

25.1 Any notice given by one party to the other pursuant to this Agreement shall be sent to other
party in writing by registered post or by facsimile and confirmed by original copy by post to
the other Party’s address as below.

CGHS: Additional Director CGHS, Ministry of Health & FW, Government of India, Nirman
Bhawan, New Delhi.

Hospital with address:

(………………………………………………………………………)

25.2 A notice shall be effective when served or on the notice’s effective date, whichever is later.
Registered communication shall be deemed to have been served even if it returned with
remarks like refused, left, premises locked, etc.
IN WITNESSES WHEREOF, the parties have caused this Agreement to be signed and executed on
the day, month and the year first above mentioned.

Signed by

Additional Director, Central Government Health Scheme

Ministry of Health & Family Welfare, Government of India
For and on behalf of
The President of India

In the Presence of
(Witnesses)

1.

2.

Signed by

For and on behalf of (Hospital)

Duly authorized vide Resolution No. ……… dated …….
of (name of Hospital)

In the presence of
(Witnesses)

1.

2.
 Performance Bank Guarantee

To:

(Additional Director, CGHS)

WHEREAS _____________________________________________________(Name of Health

Care Organization ) has undertaken, Agreement No. ______________
________________________ dated, __________________2013 to ________ ___________
_________ _______________________ (Description of Services) hereinafter called "the
Agreement".

AND WHEREAS it has been stipulated by you in the said Agreement that the Hospital,
Exclusive Eye hospital/centre, Exclusive Dental clinic, Diagnostic Laboratory/ Imaging Centre
selected for empanelment shall furnish you with a bank Guarantee by a nationalized bank for
the sum specified therein as security for compliance with the Hospital performance
obligations in accordance with the Agreement.
AND WHEREAS we have agreed to give the Hospital, Exclusive Eye hospital/centre,
Exclusive Dental clinic, Diagnostic Laboratory/ Imaging Centre a guarantee:

THEREFORE WE hereby affirm that we are Guarantors and responsible to you, on behalf of
Hospital / Diagnostic Centre (herein after referred to “the Second Part,” up to a total of
_________________________________(Amount of the guarantee in Words and Figures) and we
hereby irrevocably, unconditionally and absolutely undertake to immediately pay you, upon your first
written demand declaring the Second Part to be in default under the Agreement and without cavil or
argument, any sum or sums within the limit of ___________________________ as aforesaid,
without your needing to prove or to show this grounds or reasons for your demand or the sum
specified therein. This guarantee is valid until the ___________ day of ______________ 2009

Signature and Seal of Guarantors

_____________________________________
_____________________________________
Date _____________________________________
Address:_____________________________________