CSMA

CS(MA) stands for Central Services (Medical Attendance) Rules, 1944.

Think of it as a backup medical system for government employees who don't have CGHS (the health card system). It's like having a safety net for your medical needs when you're not in a CGHS city.

You will use CS(MA) Rules if:

• You are posted in a non-CGHS city (a city where CGHS doesn't work).
• You choose not to take CGHS even if you're in a CGHS city.
• Your family lives in a non-CGHS city.

Important: If you're in a CGHS city, you can choose between CGHS or CS(MA). But once you choose CS(MA) in a CGHS city, you cannot change back to CGHS in that same city. Most employees prefer CGHS if it's available.

"Dependent" means the person's total income from all sources (including pension) is less than ₹9,000 + DA (Dearness Allowance) per month. This rule applies to everyone except your spouse.

In CS(MA) Rules, there's a special person called an AMA (Authorised Medical Attendant).

• This is usually a government doctor appointed to look after government employees in your area.
• You need the AMA's permission (a referral) for many treatments.
• The AMA decides if you need to see a specialist or go to a bigger hospital.

1. Free Treatment (No payment needed)

You can get completely free treatment at all Central Government, State Government, Railway, Military, and Municipal hospitals. This includes:

• Doctor consultation
• Medicines available in the hospital
• Hospital bed, X-rays, blood tests, scans, and surgery

2. Reimbursement (You pay first, get money back later)

This happens when:

• There is no government hospital nearby.
• The government hospital doesn't have the treatment you need.
• It's an emergency situation (you can go to any private hospital).
• Your AMA refers you to a private hospital or specialist.

1. Visit Government Hospital: Go to the nearest government hospital and show your employee ID.
2. Meet the AMA: The doctor will check you. Treatment and medicines from the hospital pharmacy are free.
3. If Hospital Charges a Fee: Pay any small fees (like ₹50 for registration) and KEEP THE RECEIPT. You can submit this to your office to get the money back.
4. If You Need a Specialist: The AMA will give you a referral letter.
5. At Private Hospital (with referral): Show your referral letter, get treatment, and pay the full bill. Keep all receipts and bills.
6. Submit Bills: Submit all papers to your office within 3 months to get your money back (reimbursed at CGHS rates).

1. Go to ANY Hospital: You can go to any hospital, government or private. No permission is needed.
2. Get Emergency Certificate: This is VERY important. Ask the hospital for an "Emergency Certificate" signed by the doctor.
3. Keep All Papers: Keep all original bills, receipts, prescriptions, and the discharge summary.
4. Submit to Office: Submit all papers to your school/office within 3 months to get your money back at CGHS rates.

This is very important to understand!

• From Government Hospitals: 100% free. If you pay any small fees, you get the full amount back.
• From Private Hospitals: You get money back at CGHS rates (government-fixed rates), which are usually *less* than what private hospitals charge.

Example:

• Private Hospital Bill: ₹1,00,000
• CGHS Rate for that treatment: ₹60,000
• You get back: ₹60,000 only
• Your loss: ₹40,000 from your own pocket.

This is why the government always says: "Go to government hospitals first!"

Your room category in a hospital depends on your pay level:

Important: If you take a better room than you are entitled to, you must pay the extra cost yourself.

Time Limits:

• Preferred: Submit within 3 months of treatment ending.
• Maximum: Can be extended up to 6 months with a written explanation.

Where to Submit:

• Teachers/VPs: Submit to your Principal.
• Principals: Submit to your Regional Office.

Documents Required:

• Original bills and receipts
• Prescriptions
• AMA referral letter (if at a private hospital)
• Emergency certificate (if it was an emergency)
• Discharge summary
• All test reports (blood test, X-ray, etc.)
• Claim form (filled and signed)

• Special Diseases (Cancer, TB, etc.): You can get treatment at any government hospital or specialized government institute (like AIIMS).
• Dental Treatment: Only covered at government hospitals. Private dental clinics are NOT allowed.
• Maternity (Pregnancy): Covered for the wife of a male employee or a female employee. Normal and C-section deliveries are covered at government hospitals (free) or private hospitals (at CGHS rates).

Yes, you can use both!

1. Submit bills to your private insurance company first.
2. Get duplicate bills stamped by the insurance company.
3. Submit these duplicate bills to your office under CS(MA).
4. Your office will pay you the remaining balance, up to the approved CGHS rate.

You cannot get reimbursement for:

• Beauty treatments (cosmetic surgery)
• Spectacles/glasses or hearing aids (usually not covered)
• Dental treatment at private clinics
• Special food you order in the hospital
• Yoga classes, gym memberships, or health supplements

After retirement, CS(MA) Rules no longer apply. You have two main options:

1. Join CGHS: This is the best option if you live in or near a CGHS city.
2. Take Fixed Medical Allowance (FMA): Get ₹500 per month added to your pension and manage all your own medical expenses.

Do's:

• ✅ Always try government hospitals first - It's free!
• ✅ Keep all original receipts and bills safe.
• ✅ Get an AMA referral *before* going to a private hospital (unless it's an emergency).
• ✅ Submit your bills within 3 months.
• ✅ Get an "Emergency Certificate" in all emergency cases.

Don'ts:

• ❌ Don't go to a private hospital without a referral (unless it's an emergency).
• ❌ Don't throw away any paper (bills, prescriptions, reports).
• ❌ Don't delay submitting your bills.
• ❌ Don't expect to get 100% of your money back from a private hospital.