OVERVIEW OF MEDICAL ATTENDANCE RULES

1. Applicability:-
a. Applicable to:-
(i) All serving Central Government employees and their
families including probationers, Apprentices, Re-
employed pensioners, Police personnel industrial
and work-charged staff of Union Territories and
Central Government Departments not covered by
CGHS & ESI Scheme;
(ii) Central Government employees (including
employees covered under New Pension Scheme)
residing in non-CGHS areas;
(iii) Defence Accounts Department Personnel;
(iv) State Government employees on deputation with
Central Government;
(v) Civilian paid from the Defence Services Estimates
and their families;
(vi) Employees of the Ordinance and Ordinance
Equipment Factories and their family members;
(vii) Central Government employees and their family
members not covered by CGHS at headquarters
when they visit stations covered by CGHS.
Note:- 1. Central Government employees whose headquarters
are elsewhere than in Delhi/New Delhi (in non-CGHS covered
cities) and who visit Delhi/New Delhi on leave or on tour and also
members of their families, shall be governed not by CGHS but by
the Medical Attendance Rules.
2. Central Government employees themselves whose
headquarters are elsewhere than in Delhi/New Delhi (in non
CGHS covered cities) and whose families have been given
benefits of CGHS in Delhi shall be governed by Medical
Attendance Rules.
3. The Authorised Medical Attendants for these persons
shall be the Medical Officers designated as such by Delhi
Administration for their employees.
(viii) If a Central Government employee or a member of
his family covered under CGHS falls ill at a place not
covered under CGHS, the treatment will be
admissible under CS(MA) Rules. The reimbursement
will be at rates of Government/State hospital in that
City.
b. Not applicable to:-
(i) Defence services/Railway personnel;
(ii) Those covered by All India Services (M.A.) Rules, 1954;
(iii) Retired Govt. officials i.e. pensioners;
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Exception:-Medical expenses by Govt. servant who are
admitted in hospitals before retirement but discharged from the
hospital after a number of days on attaining the age of
superannuation, are to be reimbursed by the official’s own
Office/Department/Ministry concerned till alternate arrangement
is made by the Government.
(iv) Non-officials sent on deputation abroad. (Rule
1(2))
(v) Government employees who are governed by the CGHS while
in stations where this Scheme is functioning. (Note 2 below
Rule 1(2))
2. Medical Attendance:-
(i) Where CGHS facilities have not yet been introduced, a
Government employee shall be entitled, free of charge,
to medical attendance by the Authorised Medical
Attendant appointed by the concerned department.
(Rule 3(1))
(ii) For medical attendance at the hospital/dispensary (i.e.
at the O.P.D.) or at the residence of the patient, or at
the consulting room of the A.M.A. outside
hospital/dispensary hours, following conditions have
been prescribed:-
(a) The facility is available for the employee and his
family.
(b) Medical attendance which includes consultation
and prescription of medicines can be had from an
A.M.A. or at OPD of Govt. recognized hospital.
(Rule 3(2))
3. Treatment for specified diseases:-
Treatment for specified diseases may be received by a govt.
employee or a member of his family after getting
recommendation from A.M.A.
(i) Cancer including Hodgkin’s (i) Hospitals where
specialized
Disease and Leukaemias’ treatment for cancer is
available
(ii) Any Super-specialty
general purpose hospital
that provides treatment to
cancer patients (post
check-up is also available
without A.M.A.’s
recommendation and
obtaining prior approval of

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 the State Administrative
Medical Officer concerned.
(ii) Mental Diseases Govt. recognized mental hospital
(iii) (i)Poliomyelitis Govt. recognized poliomyelitis
Hospital
(ii)Cerebral Palsy and
(iii)Spastics
(iv) T.B. Govt. recognized T.B. hospital
(v) Leprosy Any State/Central Govt.
Institution/clinics/hospitals
etc. providing facilities for
treatment of Leprosy
(vi) Thalassaemia major Any State/Central Govt.
Institution/clinics/hospitals
etc. providing facilities for
treatment of Thalassaemia
Major
(vii) Diabetes All recognized hospitals
(viii) Hepatitis-B,C,D All recognized hospitals
4. Recognised Hospitals:-
(a) All State Govt. Hospitals including those maintained by
Municipal Committee/Corporation and District Boards
(b) All hospitals, primary health centres and dispensaries
recognised by State Governments for treatment of their
employees and/or members of their families.
(c) The hospitals/dispensaries attached to Public Sector
Undertakings/Projects/Port Trusts.
(d) Maternity and Child Welfare Centres with facilities for
indoor treatment and recognised by State Governments
(e) Cantonment General Hospitals in cantonment areas
where there are no Government hospitals for treatment of
Govt. employees and members of their families residing in
those areas and also in the adjoining areas outside
cantonment limits.
(f) All Railway Hospitals
(g) Pay Clinics started by the States of Bihar, Punjab,
Haryana, Uttar Pradesh, Madhya Pradesh, Rajasthan and
Chandigarh Administration.
(h) All hospitals recognised by the State Govt./CGHS
Rules/CS(MA) Rules
(i) Private hospitals in particular stations notified by the Govt.
of India from time to time.
(j) Hospitals recognised by the Govt. for treatment of certain
special diseases like cancer, mental illness, leprosy etc.
5. Concessions of Family:-
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 (i) Husband or Wife (including more than one wife and
judicially separated wife)
Note:- 1. When spouse governed by different Medical
Rules, stationed/residing at different stations
2. When spouse employed in State Government
3. When spouse is in receipt of fixed medical allowance
4. Where both are central govt. employees
(ii) Parents (including step mother)
Note:- 1. A female employee can include either her
parents or parents-in-law;
2. Parents residing with either the govt. employee or
with the family members in a station other than the
employee’s headquarters;
3. Children (including legally adopted children or step-
children)-(a) Son (till he starts earning or attains the
age of 25 years), (b) Daughter ( till she starts earning
or gets married (irrespective of age limit), whichever is
earlier, (c) Son who is suffering from any permanent
disability or permanently disabled brother (irrespective
of age limits)
(iii) Conditions for dependency:-
1. Income limit does not exceed Rs. 9000.00 on the
consideration of the claim;
2. In case of pensioners, pension before commutation
and pension equivalent of Death/Retirement Gratuity
are to be taken as income but dearness pension and
dearness relief are to be excluded;
3. The residential condition for members of families of
a Govt. servant having been waived, family members
may have medical attendance and treatment even if
they do not stay with the employee
[Link] Medical Attendant:-
1. The Medical Officers of the Central Govt., State
Govt. and Union Territories;
2. Private Registered Medical Practitioners (RMP) due
to non-availability of adequate numbers of doctors or
of the remoteness of the area.
3. Where no medical officer is appointed:-
(a) Principal Medical Officer of the District or
(b) An Assistant Surgeon, Grade I or
(c) An Assistance Surgeon, Grade II (Rule 2(a)
(B))
4. The A.M.A. is determined with reference to the place
at which he falls ill, whether it be his permanent
residence or place of casual stay or the place where he
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 may be spending his leave.
(Note 4 below Rule 2(a))
5. Where no A.M.A. is appointed then nearby Govt.
Hospital.
6. A Govt. employee may desire can consult a second
A.M.A., particularly in respect of diseases pertaining to
women and children but at no time an employee can
consult more than one A.M.A.
7. If required A.M.A. can refer to Specialist or summon
him for treatment of the patient.
8. In Delhi some A.M.A.’s are whole time employees of
the Central Govt. They cannot charge their fees for
medical attendance, including administration of
injections from employees, male or female, whether
attended to at the hospital or at the residence of the
employees concerned.
[Link] Expenses Reimbursable:- As per order
[Link] Treatment outside India of extremely complex
ailments:-
1. An employee desiring to avail of medical treatment
outside India for himself or for a member of his family
shall be eligible to obtain medical treatment outside
India for any treatment:-
(a) Complex/high risk Cardio Vascular Surgery cases;
(b) Bone Marrow Transplant;
(c) Complex medical and oncological disorders, such
as Leukemia and Neo-plastic conditions;
(d) Complex high risk cases in Micro Vascular and
Neuro-surgery;
(e) For treatment of extremely complex ailments
which in the opinion of Standing Committee can only
treated abroad and fall in the high risk category.
(Rule 11(3))
9. Guidelines for Medical Attendance and Treatment:-
(i)A separate claim for each spell of each disease
should be preferred;
(ii)There should be a reasonable gap between two
spells of disease;
(iii)If during a spell or treatment of a disease another
disease occurs, then consultation made for it will be
fresh first consultation and a separate new spell;
(iv)In case of prolonged treatment (extending beyond
10 days or requiring more than 15 injections), the
patient should be referred to the OPD of a Govt.
recognised hospital;
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 (v)In case of medical attendance received at the OPD
of a Govt. recognised hospital/dispensary, all charges
levied as per rules of such hospital/dispensary, shall be
reimbursed;
(vi)Medicines prescribed by the OPD doctor and
purchased from the market will be reimbursed except
preparations classified as food, tonics, vitamins,
disinfections, toilet preparations etc. Surgical sundries,
disposables like cotton, syringes, needles, catheters,
tubes etc. are reimbursable in full;
(vii)If necessary OPD doctor can authorise a patient for
hospitalization;
(ix)Treatment in AIIMS hospital can be had without any
prior permission and expenditures will be reimbursed
at AIIMS rates;
(x)Govt. employees 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 of the treatment.
10. Reimbursement in relaxation of rules in Emergent
cases:-
1. In cases of serious accidents or illness, an employee
or a member of his family may be admitted for
emergent treatment in the nearest private hospital in
absence of a govt. recognised hospital nearer than the
private hospital.
2. Controlling authorities will decide whether it is
necessary to admit the patient in a private hospital
under emergency.
3. (i) In case of employees or his family covered under
CS(MA) Rules, medical expenses in a non-empanelled
private hospital would be allowed as per the prevailing
non-NABH rates as applicable to a CGHS covered city
and non-NABH rates applicable to the nearest CGHS
covered city in case of non CGHS city, as the case may
be, or the actual, whichever is less.
(ii) Where package rates are prescribed under CGHS,
the non NABH rates of the nearest city (in case of non-
CGHS covered city) or the actual, whichever is less,
will be applicable.
11. Fixed Medical Allowance of Medical Claims:-
Employees working in the interior/remote localities
where no AMA is available within a radius of [Link]
entitled to fixed medical allowance of Rs.500 p.m.
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12. Time-limit for submission of Medical Claims:-
(a) Within 3 months from the date of completion of
treatment;
(b) May be relaxed by HOD/Jt. Secretary.
13. Advance for Medical Attendance and Treatment:-
An advance may be paid for meeting out expenses
for:-
(i) In-door treatment in a recognized hospital;
(ii) In cases of treatment for TB, Acute Myeloid,
Leukaemia(cancer) etc.;
(iii) For purchase of artificial appliances of
orthopedics;
(iv) Chronic active Hepatitis B, C & D
Note:-1. Application for advance should be accompanied with
necessary certificate from the Medical Officer/Specialist
indicating the duration of treatment and the anticipated cost
thereof.
2. For temporary officials, surety from permanent employee is
required.
14. Amount of advance:-
(a) For indoor treatment/OPD for diseases like TB/Cancer
etc.-Rs.10000.00 or the amount recommended by the
treating physician, whichever is less, where the duration of
the treatment is 3 months or less.
(b) For TB where the duration of treatment is more than 3
months-80% of the estimated cost or Rs. 36000.00,
whichever is less, on the certificate of the hospital
authority.
(c) For major illness including chronic active Hepatitis,
Bypass Surgery, Kidney Transplant, Leukaemia (Cancer)
etc.-90% of the package deal or the amount demanded by
the hospital, whichever is less; and the balance payable on
final adjustment.
15. Adjustment of advance:-
Adjustment bill may be preferred for final settlement within
one month from the date of discharge from hospital.
16. TA for Medical Attendance journeys:-
Admissibility:-
TA for journeys undertaken for medical treatment (both
ways)/attendance is admissible to the employees and their
families in following cases:-
(i) For patient i.e employee or a member of his family-
distance from patient fell ill to hospital/clinic is more
than 5 miles (8 kms).
(ii) For attendant or escort-when patient is unsafe
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(iii) For donor of kidney to the employee or a member of
his family
Entitlement:-
(i) As per entitlement of TA of the patient
(ii) Air fare can be allowedif there is any life threat of
patient during travel
(iii) If the patient travels his/her own conveyance,
conveyance charges limited to mileage as on tour
(only 50% permissible in case of family members) is
admissible
(iv) Ambulance charges is reimbursable if certified by
doctor
(v) For a kidney donor, if the donor is a member of
employee’s family or an employee of the Government,
TA will be payable at the rate applicable to the donor
employee; otherwise TA will be at the rates applicable
to done employee
Amount of advance:-
As per TA rules but against the adjustment of the
subsequent claim for TA on completion of journey or on 31 st
March whichever is earlier (Appendix VII
of CS(MA) Rules 1944)

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