CS(Medical Attendance(Rules)1944

Extent of Application
These rules apply to all Govt. servants except those covered under CGHS or in
Railway service. However Railway employees on deputation to various other
offices under the Central Govt. are governed by these rules.
These rules 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.
 Authorised Medical Attendant(AMA)
• Authorised 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., 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(AMAs) outside their normal duty station.
• 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.
 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.
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.
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.
 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.
• 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.
 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 in Nursing Home/Clinics of AMAs even in emergent cases.

• 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/-
 Treatment outside India

A Govt. servant shall be eligible to obtain medical treatment outside India for any
treatment for life threatening diseases specified below:-
1. Complex Cardio Vascular Surgery.
2. Bone Marrow Transplant.
3. Complex Oncological Disorders.
4. Complex Micro Vascular and Neuro Surgery.
5. 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.
 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
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 fir purchase/replacement of artificial appliances.
 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 or gets married
irrespective of age limit, whichever
is earlier

3 Son, Brother suffering Irrespective of age limit

from any permanent
disability
4. Dependent Irrespective of age limit
divorced/widowed
daughters
5. Dependent unmarried/divorced/widowed Irrespective of age limit
sisters

6. Minor Brothers Upto the age of becoming major

• 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 can not 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 actuals, 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.