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Medical Reimbursement under CGHS for Heart Transplant at the private hospital – Central Govt Pensioner

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On 3.10.2019, the petitioner – retired Assistant Commissioner, Central Excise and Customs, Pune, was advised heart transplant. 

However, neither the Government hospitals nor the CGHS-empanelled Super Speciality Hospital was not performing such surgery.

The petitioner had availed the treatment at Sir H.N. Reliance Foundation Hospital, given medical condition.

On 3.12.2020, the petitioner addressed the letter to the respondent no.5 and requested for consideration of Rs.25 lakhs estimate for medical reimbursement. An endorsement was made that if treatment is availed from non-empanelled hospital, reimbursement will be at CGHS rates and excess amount by the patient.

On 6.1.2021, the petitioner requested the respondent no.2 for higher CGHS rate fixed in the years 2010-2014.  There was exchange of correspondence.

By the letter dated 30.11.2021, the claim of the petitioner for full reimbursement was rejected.

Finally by the letter dated 13.4.2022, the respondent no.5 informed that the High Power Committee did not recommend full reimbursement and the procedure was planned non-emergency surgery.

HELD that the present case indisputedly is a case of heart transplant which by all standards is a serious ailment. Certainly, the surgery is one of urgency and critical importance and could not have been postponed.   It is a special circumstance.   It is imperative that such surgeries are expedites in the interest of human life without an embargo of an expenditure which is secondary to human life.

It was necessary for the Committee to weigh the case of the petitioner with human sensitivity. 

Any employee, merely because he has retired, ought not to be differently treated when it comes to genuine and realistic health expenditure.   There is another aspect that the reimbursement rates are not revised from time to time in the absence of which, they are rendered unrealistic.

Judgment dated 6.6.2025 of the High Court of Bombay in Writ Petition No.7546 of 2022 of Anirudh Prataprai Nansi   Vs.   The Union of India and others

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