CS (Medical Attendance Rules) 1944

These rules apply to all Govt. servants except covered under CGHS & other than those in
Railway service. However Railway employees on deputation to various other offices under
the Central Govt. are governed by these rules.

These rules also apply to:-

1. All central govt. servants who are on leave preparatory to retirement.
2. Govt. pensioners on their re employment under the Central Govt.
3. Defense Accounts Department personnel
4. A probationer
5. Apprentice who are in the whole time service of Govt.
6. All state govt. servants on deputation with the central govt.

These rules do not apply to-

1. Defence Service personnel
2. Govt. Servants who are on deputation abroad
3. Retired govt. Officials
4. Govt. Servants who are governed by CGHS while in stations where this scheme is
functioning.
5. Officers of All India Services and other persons who are governed by the All
India(MA) Rules, 1954
6. India based officers and staff serving in Missions abroad who are governed by the
Assisted Medical Attendance Scheme.

DEFINITIONS
“Medical Attendance” means attendance at the hospital (OPD) or at the residence of the
Govt. Servant or at the consulting room of the AMA whether at the hospital or at his own
residence.
“Treatment” means the use of all medical and surgical facilities available at the hospital.
Note: The exp. incurred in connection with treatment may be treated at reimbursable. No
reimbursement will be admissible if treatment is obtained to improve general physical
fitness/stamina/for cosmetic purpose/improve figure etc. The refund of the cost of
preparations which are not medicines but are primarily foods, tonics, toiled preparations or
disinfectant is not admissible under the Rules.
Authorized Medical Attendant(AMA)
Authorized Medical Attendant (AMA) means-Medical Officer whether or not under the
employ of the central Govt. appointed by (i) the Deptt. Of Health of the Govt. of India (ii)
any other Department of the GOI in relation to persons under the employ of that Deptt., (iii)
the Chairman of the Central Govt. Employees Welfare Co-ordination committee.

Who can be AMA

There are three categories of Medical Officers who can be appointed as AMA
(1) MOs under the employ of Central Govt.
(2) MOs who are not employees of the Central Govt.
(3) MOs in the employ of the State Govt. or UTs
Private regd. Medical Practitioner may also be appointed as AMA where adequate number of
Doctors in the employ of the Central Govt. or the State Govt. is not available or because of
the remoteness of the area in which the patient lives.

Choice of AMA- Employee should consult the AMA nearest to his residence. However he
may consult any other AMA provided he gives his option in writing.
No treatment outside normal duty station from private medical practitioners appointed as
AMAs. Treatment is to be taken from Govt. hospital

Exception in case of emergency:

In case of extreme emergency or unforeseen circumstances when an official or the member of
his family falls ill, he/she may be allowed to take treatment from any other empanelled AMA
even if he is not an AMA nominated by his deptt. Each case could be considered on merits by
the Controlling Officer who would be free to disallow a claim if he is not satisfied about
genuineness of the same after giving the aggrieved official an opportunity to explain his case.
The AMA of a Govt. Servant is determined with ref. to the place at which he falls ill, where it
be his permanent residence or place of casual stay or the place where he may be spending his
leave.

“Medical Attendance” includes attendance at the hospital/dispensary or at the residence of

the Govt. Servant or at the consulting room of the AMA whether maintained at the hospital or
at his own residence by arrangement with him.
No AMA should charge any fee for attendance upon, or professional services rendered to any
person at the hospital premises during hospital hours.
However if the professional services are rendered outside of the hospital, whether appointed
as AMA or rendering services as a specialist, is entitled to charge his fees at the prescribed
rates, if otherwise permissible.
No fee should be charged by MOs who are in receipt of NPA.
No AMAs from RMP owning private nursing homes.
Validity of panel- one year which is renewable.
When a MO can be his own AMA- He can be treated as AMA for himself and family only
when there is only one AMA.

Consultation/visiting fee of AMA

1. Medical P.G./Specialist- First consultation Rs. 100/- the Rs. 60/- for
subsequent consultation.
2. Medical Graduates (MBBS)- First consultation Rs. 70/- the Rs. 40/- for
subsequent consultation.
No separate charges for day and night consultation.

Fresh or subsequent consultation

Every consultation after the first in r/o of the same illness of the same patient should be
treated as “subsequent consultation”.
Where a patient after being cured of a particular illness develops a fresh illness & consults the
same doctor, that consultation should be regarded as a fresh consultation.
Where a patient consults the same doctor in regard to the super-imposition of another disease
during the course of treatment of one disease, that consultation should be regarded as a fresh
consultation.

Hospitals recognized by the State Govt./CGHS/CS(MA) Rules 1944

Central Govt. Employees and the member of their families may be permitted to avail of
medical facilities in any of the Central Govt., State Govt. Hospitals and the hospital
recognized by the State Govt./CGHS/CS (MA) Rules as well as the hospitals funded by
Central/State Govt. Subject to the condition that they will be reimbursed the medical Exp. at
the rates fixed by the Govt. Under the CGHS/CS (MA) rules.
If the treatment for a particular disease/procedure is available in the same city where the
Govt. Servant is employed he may be permitted to avail of medical services in any other city
without any TA/DA. In case treatment is not available in the city, he will be eligible for TA
for taking treatment in a different city.

Simplification of procedure for treatment at private hospital empanelled

under CGHS/CS(MA) Rules
Procedure for treatment at private hospital empanelled under CGHS/CS(MA) Rules has been
simplified now. Beneficiaries are allowed to undergo treatment at pvt. Hospitals empanelled
under CGHS/CS(MA) Rules for specific treatment as advised by Specialist in a Central/State
Govt. Hospital without any requirement of any other referral letter.
Serving Govt. Employees shall enclose the prescription in original while submitting the
medical claim to the concerned Ministry/deptt. for reimbursement.
Govt. Specialist shall not refer the beneficiaries to any particular empanelled hospital by
name but specify the treatment and mention ’referred to any empanelled hospital’.
Simultaneous treatment in two or more systems of medicine:-
Treatment for the same ailment should not be taken simultaneously in more than one system
of medicine. However no objection to treatment being received simultaneously in different
systems of medicine for different ailments. This should be done with the knowledge of the
attending doctor of the other system concerned.

Medical Attendance
A Govt. servant shall be entitled, free of charge to medical attendance by the AMA. If any
amount paid by him on account of such medical attendance shall on production of a
certificate be reimbursed to him by the Central Govt.

Limits for reimbursement of consultation fees and cost of medicines:-

Reimbursement of consultation fees at the prescribed rates should be restricted to the first
four consultations/visits at the rate of one consultation/visit a day. Cost of medicines
prescribed during these consultations only is reimbursable.
The intention is that, first four consultations at the rate of one consultation should be
completed within a period of ten days from the date of commencement of treatment in r/o one
single and continuous spell of illness in r/o a particular disease.
The limit of 10 days treatment may be increased to 20 days in case the treatment is had from
an AMA in Indian System of Medicines and in Homoeopathy. The total number of
consultation during 20 days would be four.
It has been provided that ‘medical attendance’ includes attendance at a hospital. Hence
medical attendance from the very beginning may also be received at the OPD of a Govt.
recognized hospital without the prior approval of the AMA. ‘Prolonged treatment’ should be
received only at the OPD. The MO at the OPD should be regarded as the AMA.
All charges for such attendance at the OPD levied should be reimbursed .
‘Medical Attendance’ is distinct from ‘medical treatment’. For the purpose of ‘medical
attendance’ there should be no repeated consultations which include ‘repeat ‘prescriptions.
NOTE: Govt. Have held that the fee paid for consultation on the tenth day of the treatment is
admissible in case no further medication is necessary i.e. no medicine is prescribed on that
consultation.

Travelling Allowance for Medical Attendance Journeys

When the place at which a patient falls ill is more than five miles by the shortest route from
the consulting room of the AMA
(a) the patient shall be entitled to TA for the journey to and from such consulting room
(b) if the patient is too ill to travel, the AMA shall be entitled to TA for the journey to and
from the place where the patient is.
Application for T.A. Shall be accompanied by a certificate in writing by the AMA stating that
medical attendance was necessary and the patient was too ill to travel.
Consultation with Specialist
If the AMA is of opinion that the case of patient is of such a serious or special nature as to
require medical attendance by some person other than himself he may-
(a) send the patient to the nearest specialist or other Medical Officer by whom in his opinion
medical attendance is required for the patient; or
(b) if the patient is too ill to travel, summon such specialist or other MO to attend upon the
patient.
A civil Surgeon is not entitled to charge any fees for professional services rendered to a Govt.
servant on the advice of AMA.
A patient should not be referred to a private specialist or clinic and under any circumstances
to a specialist -Govt. or private- outside the state.

Specialist consultation outside the district:-

Permission can be given subject to the condition that where the AMA is not the DMO , the
patient should be examined by the DMO before such permission is accorded.

Medical Treatment
A Govt. servant shall be entitled free of charge to treatment-
(a) in such Govt. hospital at or near the place where he falls ill; or
(b) if there is no such hospital, to a hospital other than a Govt. hospital at or near the place as
can in the opinion of AMA provide the necessary and suitable treatment.
Where a Govt. servant is entitled free of charge to treatment, any amount paid by him be
reimbursed to him by the central govt.
Controlling officer has the right to reject any claim if he is not satisfied with its genuineness.
While doing so he shall communicate to the claimant the reasons in brief for rejecting the
claim and the claimant may submit an appeal within a period of forty five days.
Cases of ‘medical treatment’ requiring hospitalization will normally be referred to a
Govt./recognized hospital by the AMA for admission.
If hospitalization is not required but treatment is expected to be prolonged requiring more
than four consultations, patient should be referred to the OPD of Govt./recognized hospital.
If in spite of specific advice of the AMA or the MO, a patient does not seek admission in the
hospital, the AMA or MO concerned should record a note to that effect while signing a
certificate necessary to be produced by the Govt. Servant for the purpose of claiming refund
from Govt. In such case no refund would be admissible.

Regarding tests/investigations/Procedures at pvt. Hospitals empanelled

under CGHS/CS(MA) Rules:-
Beneficiaries availing tests/investigations at empanelled pvt. Hospitals on the
recommendation of AMA, the medical prescription issued by AMA shall be treated for a
single use within a period of 30 days from the date of prescription. The medical prescription
would require revalidation after expiry of validity period. Prescription/advice issued by AMA
for any procedure is valid for three months.

In –patient treatment in hospital without consulting AMA permissible:-

A Govt. servant may be allowed to receive treatment as an in-patient without consulting his
AMA in a hospital where he is ordinarily entitled to receive treatment under the rules.

Hospitalization not allowed in Nursing Home/Clinics of AMAs even in emergent cases.

Payment/Reimbursement of medical exp. from two sources viz. from the Insurance Co.
and the CGHS:-
1. Reimbursement allowed from both the sources subject to the condition that the
reimbursement should not exceed the total exp.
2. First claim from Insurance Co. and second from CGHS as per approved package rates.
Original vouchers will be submitted to Insurance Co. And photocopies of vouchers duly
certified by Insurance Co. will be submitted to CGHS.

Entitlement of ward in case of hospitalization:-

Basic pay Ward Entitlement
Upto Rs.47600/- General ward
Rs. 47601 to 63100 Semi Pvt. Ward
Rs. 63101 & above Pvt. Ward

Higher category of accommodation is not permissible. However in case of emergency & non
availability of entitled accommodation, immediate Higher category of accommodation is
permissible .

Stay in hospital:- The average stay in hospital as in-patient should be reckoned as two weeks.
Any stay beyond three week should be considered as prolonged stay.

Introduction of Annual Medical Examination for the Group ‘A’ Officers of

Central Civil Services of age 40 year and above:-
(i) For Men Officers – Rs. 2,000/-
(ii) For Women Officers – Rs. 2200/-
Examination includes specific tests/investigations.
Treatment outside India
A Govt. servant shall be eligible to obtain medical treatment outside India for any treatment
for life threatening diseases specified below & whose treatment in not available within India.
 Complex Cardio Vascular Surgery.
 Bone Marrow Transplant.
 Complex Oncological Disorders.
 Complex Micro Vascular and Neuro Surgery.
 Other complex ailments which is the opinion of the Standing Committee can be
treated abroad.
Treatment abroad should be permitted for life threatening ailments.
An attendant can be permitted to accompany the patient.

Standing committee consists of:-

D.G. of Min. of Health, D.G.of Armed Forces Medical services, D.G. of ICMR,
Joint Secy. Of Min. of H & FW.

Guidelines for medical treatment abroad:-

Treatment abroad are entertained in r/o those cases only for which treatment is not available
in India.
Standing Committee may recommend one attendant.
Treatment abroad should be permitted in cases where the life of the patient is threatened.
Where the Standing Committee consider that adequate facility for treatment of the ailment is
available in any medical institution within India, it can authorise treatment in such medical
Institution.

Time –limit for medical claims

Final claims for reimbursement of medical expenses in r/o a particular spell of illness should
be preferred within six months from the date of discharge from hospital or completion of
treatment as shown in the last Essentiality Certificate issued by AMA.
Normally Controlling Officers should reject any claim presented after six months unless they
are satisfied with the reasons for delay.
Heads of Departments have been delegated powers to condone delay in submission of claims.
However it will be open for them to lay down monetary limits and the period up to which
delay can be condoned.
Each case should be considered on merit in order to prevent malpractices.
Grant of Advances

Terms & Conditions:-

(i) The advance would be admissible when treatment taken as an in-patient or as an out
patient.
(ii) The application of an advance should be supported by a certificate the patient is being
treated as an in-patient or out-patient at a hospital indicating the duration of treatment and the
anticipated cost thereof.
(iii) The advance should not be allowed in a case where treatment is being obtained at the
residence of the Govt. servant or at the consulting room of the AMA.

Limit of medical advance:-

(i) For outdoor treatment 90% of the total estimated expenditure subject to the condition that
the total cost is more than Rs. 10,000/-
(ii) 90% of the package deal where ever it exists or according to the estimate.

The advance will be paid direct to the hospital concerned.

For settlement of advance, the employees may be required to submit the adjustment bills
within a period of one month from the date of his discharge from the hospital.
All Central Govt. servants irrespective of their pay are eligible for grant of medical advance.
Advance may be given to wife/legal heir when Govt. servant unable to apply due to serious
illness.
Advance for purchase/replacement of artificial appliances may be given on the
recommendation of specialist.

Concessions for Families

Definition of Family:-
The term ‘family’ shall mean a Govt. Servant’s wife or husband, parents, sisters, widowed
sisters, widowed daughters, minor brothers, children, step children, divorced/separated
daughters and stepmother wholly dependent upon the Govt. servant.
A member of the family is treated as dependent only it his/her income from all sources
including pension and family pension is less than Rs. 9,000/- plus DA thereon.
The term ‘children’ will include children adopted legally.
The term ‘wife’ includes more than one wife.
Parents may reside either with the Govt. servant or with the family members at another
station.
Age –limits of dependants:-

1. Son Till he starts earning or attains the age

of 25 years or gets married whichever
is earlier

2. Daughters Till she starts earning or gets married

irrespective of age limit, whichever is
earlier

3 Son, Brother suffering from any permanent Irrespective of age limit

disability

4. Dependent divorced/widowed daughters Irrespective of age limit

5. Dependent unmarried/divorced/widowed Irrespective of age limit

sisters

6. Minor Brothers Upto the age of becoming major

Disability means:-
1. Blindness
2. low vision
3. leprosy cured
4. hearing impairment
5. locomotor disability
6. mental retardation
7. mental illness

When spouse employed in State Govt. etc.:-

Can choose either the facilities under the CS(MA) Rules or the medical facilities provided by
organization of spouse.

When both are Govt. servants:-

Can choose according to their status. They should furnish a declaration that who will prefer
the claim. If no declaration is given, medical concessions shall be availed according to the
status of husband.

Extension to Parents-in-law of female Govt. servants:-

A female Govt. servant can chooses either her parents or her parents-in-law. She can change
her option only once during the entire period of service.
Extension of benefit to adoptive parents:-
A family of adoptive child will include adoptive parents. However in that case the benefit
cannot be extended to real parents.

Reimbursement of medical exp. in emergency conditions.

Reimbursement of medical expenses incurred by a employee for treatment taken in non-
empanelled private hospitals in emergency would be allowed as per the prevailing CGHS
rates of CGHS covered city or nearest CGHS city in case non-CGHS covered places.
Reimbursement of medical expenses would be allowed as per prevailing CGHS rates.
For the medical treatment where package rates are prescribed under CGHS, package rates or
actual, whichever is less, will be applicable.
Reimbursement in excess of the approved rates will be admissible as per recommendations of
Technical Standing Committee which can recommend the relaxations of rules for permitting
full reimbursement of exp. Incurred by the beneficiary.

Entitlement for Indoor treatment:-

Basic Pay Ward Entitlement
(i) Upto Rs. 47600 General
(ii) Rs. 47601 to 63100 Semi Pvt. Ward
(iii) Rs. 63101 & above Private Ward

Package rates as per CGHS are for semi pvt. Ward. If entitlement is for general ward then
package rate would be less by 10% & in case of entitlement for Pvt. Ward, package rate will
increase by 15%.

When spouse governed by different medical rules, stationed/residing at

different stations & not in receipt of fixed medical allowance.
He/She can avail medical facility on production of a certificate from the employer that he/she
is not claiming medical facilities from the employer.
Govt. Employees can claim medical reimbursement for family members except spouse who
is in receipt of fixed medical allowance.

Reimbursement in relaxation of Rules in Emergent Cases

Treatment in private medical institutes in emergent cases:-
(1) Circumstances to justify treatment in pvt. Medical institute- In emergent cases
involving accidents, serious nature of disease, patient may be taken to a pvt. Hospital
in case no Govt. or recognized hospital is available nearer than the pvt. Hospital. The
controlling authority will decide on the merits of the case whether it was a case of real
emergency.
(2) Subsequent transfer to Govt. /recognized hospital: - Transfer of patient to Govt.
/recognized hospital after emergency is over depends on the advice of the concerned
hospital authorities. He should get discharged from the hospital when the hospital
authorities discharge him.

Payment procedure:-
(i) If likely exp. on emergent cases is beyond the capacity of Govt. Servant, concerned
Controlling Authority is authorized to meet directly the exp. on admissible items of
treatment. A certificate regarding the exp. likely to be incurred shall be obtained from
the hospital and furnished to the deptt.
(ii) Advance payment may also be made to hospital if demanded.
(iii) The charges on account of inadmissible items will be paid by the Govt. Servant.

Relaxation of procedures in r/o reimbursement claims:-

1. No need for verification of bills and essentiality certificates by treating doctors. In
case of doubt, concerned authorities may get the verification done from hospital.
However in case of treatment from AMA on OPD basis, essentiality certificates
would be required.
2. Request for reimbursement of exp. over & above approved rates would be sent to
Technical Standing Committee. If committee recommends full reimbursement, it
would be allowed by Secy/H&FW in consultation with IFD. Check list for full
reimbursement includes:-
(i) Treatment was obtained in Pvt. Hospital not empanelled and patient was
brought in unconscious state or severely incapacitated.
(ii) Was admitted for prolonged period for Head injury, Coma, Septicaemia, Multi
Organ failure etc.
(iii) Treatment was obtained under emergency for advanced malignancy.
(iv) Treatment was taken in higher type of accommodation due to non-availability
of entitled accommodation or isolation reason.
(v) Treatment was obtained in pvt. Hospital under emergency while on tour or
there is strike in Govt. Hospital.
(vi) Any other special circumstances.
Instruction for Govt. Servants:-
 Find out who is your AMA and consult him and proceed according to his advice.
 When you go to hospital as an in-patient, inform about your being a Central Govt. and
your pay to determine your accommodation.
 In emergent cases the patient can be admitted in a pvt. hospital in case no Govt. Or
recognised hospital is available nearby.
 At the time of leaving hospital after treatment, get all the bills, receipts and vouchers
from the hospital as these are necessary to claim reimbursement from your office.

 Prefer your claims for refund of medical exp. Incurred in the relevant application
form, giving full particulars called for therein and also attaching all the certificates
required to be produced under the rules within time limit.
 You can draw advance of money in order to enable you initially to meet exp. on
treatment.
 If you are taking treatment as in-patient from recognized empanelled Pvt. Hospital,
prior permission of such treatment from HOD is necessary.

Instructions for Doctors

 Investigations/tests should be carried out only at Govt. Hospital/laboratory.
 A patient should not be referred to private specialist except where specifically
provided for in Govt. Orders.
 A patient should be admitted in Govt./recognized hospital.
 Utmost economy should be exercised while prescribing medicines.
 Medicines should not be prescribed for all 10 days at a stretch. The daily dosage
should be mentioned in prescription.
 While signing medical bills, never certify items of food, tonics having more food
value, toiletries, disinfectants & other similar preparations.
 The designation and degree should be clearly indicated while signing the
reimbursement papers.
 Payment received from Govt. Servant as fee should be indicated in Essential
Certificate.
 Cases requiring prolonged treatment should be referred/admitted to hospitals.
 Essentiality Certificates in r/o medicines prescribed should be in prescribed form and
should legibly show the names of medicines.
 If a Govt. servant is not entitled to consult him, he should direct the patient to proper
AMA.
Instructions for Controlling Officers
 All claims for reimbursement of medical exp. are in prescribed form.
 Govt. Servants or family members consulted authorised AMA.
 Fee paid to AMA or Specialist is at prescribed rates.
 Accommodation provided in hospital is according to his entitlement.
 Except in emergency, treatment has been obtained in Govt./recognized hospital.
 Claim has been submitted within prescribed time limit.
 If the claim is beyond Rs. 2,00,000/-, sanction/approval of Internal Financial Division
is required to be obtained.
 It should also be checked that medicines have been purchased from registered
chemists and bill submitted are original one.
 As per rule, every official who prefers claim is r/o parents is required to submit a
undertaking in the first month of every calendar year that his/her parents are wholly
dependant on him/her and are residing with him/her. controlling officer should check
that such undertaking has been submitted by the concerned official before entertaining
his claim in r/o parents.
 The maintenance of prescribed control register should be ensured and it should also
be checked that entry of cash memos and other information have been made in
prescribed columns.

Travelling Allowance for Medical Attendance and/or Treatment

Central Govt. Servants and members of their families will be entitled for TA under the
conditions specified below for journeys undertaken by them to obtain appropriate medical
attendance and treatment to which they are entitled under the rules:-
1. Journey by rail/road/sea/air:- Patient and Attendant(if recommended) will be
entitled for TA/DA for the journey undertaken by rail, road, sea and air.
Airlifting in emergent cases permissible if time factor in saving life is crucial as certified by
MO/incharge of the hospital.

Certificate required to claim T.A.-TA will be admissible only when:-

(a) Journey undertaken is outside the limits of same city & exceeds 8 km each
way.
(b) It is certified by AMA/Specialist that the journey was unavoidably necessary
to obtain appropriate medical attendance & treatment.

Conveyance charges:-
When journey is undertaken within the same city and the distance travelled is more than 8 km
each way, Govt. Servant will be eligible for conveyance charges at the following rates :-
 (a) For the Govt. Servants:- Actual conveyance charges limited to mileage
allowance at tour rates.(without DA)
(b) For the members of family:- Actual conveyance charges limited to half of
mileage allowance at tour rates. (Without DA)

TA for attendant/escort: - An attendant/escort will be entitled for TA both ways provided it

is certified by Medical Authorities than an attendant/escort is necessary to accompany to the
place of treatment.

Ambulance Charges
Ambulance charges admissible subject to the following conditions:-
(1) If it is certified by medical authorities that use of any other mean of transport
will definitely endanger the life or aggravate the health condition of patient.
(2) Ambulance is used to convey the patient from one hospital to another hospital
for treatment or certain medical examination.
(3) Ambulance used belonged to Govt. or a social service organization like Red
Cross etc.
(4) Ambulance is used within the same city.

Treatment for Special Diseases

Cancer: - Treatment can be availed in any recognized cancer institutes on the
recommendation of AMA. Post treatment check-up suggested is also admissible without
recommendation of AMA.
Diabetes:- Cost of medicines may be reimbursed even for a period beyond three months on
the advice of AMA.
Mental Diseases:- Treatment may be received from any Govt. recognized Mental Hospital
on the advice of AMA subject to the following conditions:-
Duration of treatment maximum for three years.
1. Treatment should be allowed initially for six months. Further extendable in
blocks of six months.
2. For outdoor treatment, there should be no time limit. Depends on advise of
Medical Authorities.
3. If advised, reimbursement charges for attendant also admissible.
Other following diseases also have specific rules for treatment:-
1. Poliomyelitis, Cerebral Palsy and Spastics.
2. T.B.
3. Leprosy
4. Thalassaemia Major
5. Hepatitis ‘C’ & ‘D’