THE ALL INDIA SERVICES (MEDICAL ATTENDANCE) RULES, 1954

1. Authorised Medical Attendant:

The principal medical officer appointed by the Government to treat its officers in a specific station or
district where member of service falls ill. It also includes a medical officer of equal or slightly lower
rank attached to a local hospital or dispensary. If no such officer is appointed, the State Government
designates a suitable officer.

 Authorised Medical Attendant (AMA):

A Medical Officer appointed by the Government (Health Department, other departments, or
designated authorities) to provide medical care to Government servants.

 Appointment depends on pay grade and service group:

o High pay/Group A officers: Principal Medical Officer of the district.
o Mid-level pay: Assistant Surgeon Grade I.
o Lower pay or others: Assistant Surgeon Grade II or Grade I if Grade II
unavailable.
 Pay at the time of illness or suspension is used to determine category.
 AMA is determined based on where the government servant falls ill (residence, leave
place, etc.).
 Honorary Medical Officers outside hospitals are generally not considered AMAs,
except in some cases (e.g., Andhra State).

 District: The district where the Government servant falls ill.

 Government: Refers to State Government for Part A/B States, and Lieutenant
Governor/Chief Commissioner for Part C States.

 Government Hospital: Includes departmental dispensaries and hospitals maintained by

local authorities or those with government arrangements, excluding railway hospitals and
cantonment hospitals.

 Medical Attendance:

 Includes consultation and treatment in the AMA’s consulting room, government

hospitals, or the patient’s residence.
 Covers diagnostic methods (pathological, radiological, etc.) available in government
hospitals.
 Allows consultation with specialists or other medical officers as certified necessary by
the AMA.
 Applies to different categories of Government servants based on the AMA appointed.

 Additional Notes:

 No fees are charged by Government medical officers to Government servants for

medical attendance within hospital premises during hospital hours.
 For family members, fees may apply if services are rendered outside the hospital.
 Medical officers receiving a non-practicing allowance should not charge fees for
services rendered to Government servants or their families.
  Note.-In Delhi and other centrally administered areas, authorised medical attendants
are whole time employees of the Central Government and as such are not entitled to
claim their fees for medical attendance, including administration of injections from
Government servants, male or female, whether attended to at the hospital or at the
residence of the Government servants concerned.

Notes on Medical Attendance and Treatment Rules:

 Note 5:
Refunds for consultation fees are only admissible if the specialist or medical officer
consulted is in the service of the Government. Consultation with private specialists is
not reimbursable.
 Note 6:
Diagnostic tests (pathological, radiological, etc.) must be conducted only at
Government hospitals or laboratories. To claim reimbursement, a certificate from the
authorised medical attendant (AMA) confirming the necessity of the tests is required.
 Note 7:
Government medical officers attending to Central Government servants and their
families should avoid referring patients to private practitioners or labs unless
absolutely necessary due to unavailability of government facilities.
Prior approval from the Director of Health Services (or equivalent) is required for
such referrals; otherwise, fees will not be refunded.
Women’s hospitals are generally not recognized for treating male patients but may be
considered government hospitals for certain diagnostic tests with approval.
 Note 8 & 9:
Special arrangements exist for medical attendance/treatment in certain states and
domiciliary (home) treatment for families of government servants is considered
automatic for specified classes.

Additional Definitions and Provisions:

 Patient: A government servant covered by these rules who has fallen ill.
 State: The state where the patient falls ill.
 Treatment:
o Includes all medical and surgical facilities available at government hospitals.
o Covers necessary diagnostic methods as certified by the AMA.
o Massage therapy is generally not covered but may be reimbursed with special
government approval if done by a trained masseur under AMA advice and
supervision. Families can avail this but not at home unless certified no local
facility exists.
o Treatment for female government servants includes confinement care.
o Special disease treatments are separately provided for (e.g., TB, cancer,
mental diseases).
o Physiotherapy and occupational therapy costs may be reimbursed if aimed at
curing disease-related defects, not for general fitness or cosmetic reasons.
 Medicines:
o Medicines provided by the hospital are free.
 o Cost of prescribed medicines bought privately may be refunded on AMA
certification (essentiality certificate).
o No reimbursement for non-medicinal items like tonics, foods, or proprietary
preparations if equally effective cheaper alternatives exist.
o Sales tax on medicines is refundable; packing/postage costs are not.
 Hospital Accommodation:
o Patients get accommodation suited to their status; if unavailable, a higher class
can be allotted with proper certification.
o Certain charges like booking, admission, and laundry are not reimbursable;
electric/fan charges are reimbursable; air-conditioning charges are
reimbursable only in specific necessary cases.
 Nursing:
o Standard nursing care provided by the hospital is covered.
o Charges for private attendants or ayahs are not reimbursable.
 Specialist Consultation: Covered as per AMA certification.
 Medical Attendance Reimbursement:
o Government servants are entitled to free medical attendance by the AMA.
o If they pay any fees, they can claim reimbursement with AMA certification.
o Controlling officers may reject suspicious claims after giving a hearing, and
the claimant can appeal.
o In centrally administered areas (like Delhi), AMAs are full-time government
employees and cannot charge fees.

2. Contributory Health Service Scheme:

An approved scheme offering free medical treatment to government servants and their families in exchange
for a monthly contribution set by the Government.
3. Family Definition:
Includes the member's spouse, and dependent family members such as parents, sisters (including widowed),
widowed daughters, minor brothers, children, step-children, dependent divorced/separated daughters,
dependent brothers, and step-mother, all of whom must normally reside with the member.
1. Government:
 Refers to the Central Government for officers serving the Union and the State Government for
officers serving a State.
 If a State officer falls ill in another State, the government of that State (where the illness occurs) is
deemed the relevant government for medical purposes.
2. Government Hospital:
Includes military hospitals, certain notified railway hospitals, hospitals run by local authorities, and any hospital
with which the government has an arrangement for treating its officers.
3. Medical Attendance:
Covers treatment at:
 Government hospitals,
 The officer’s residence, or
 The medical attendant’s consulting room.
Also includes:
 Diagnostic tests (e.g., pathological, radiological) available in government facilities if deemed
necessary,
 Consultations with other government medical officers/specialists as certified by the authorised
medical attendant.
4. Member of the Service:
Defined as a member of the All-India Services under the All India Services Act, 1951.
5. Nurse:
A qualified or registered nurse recognized by the State's Chief Administrative Medical Officer or under
applicable state registration laws.
6. Patient:
A member of the Service who requires medical attention or treatment.
7. State:
Refers to the State where the member of the Service falls ill.

8. Treatment:
Means the use of all medical and surgical facilities available at a Government hospital, and includes:
 (i) Diagnostic methods (pathological, bacteriological, radiological, etc.) as deemed necessary by the
authorised medical attendant.
 (ii) Dental treatments like tooth extraction, scaling, gum treatment, fillings, and root canal treatment
(excluding cost of dentures).
 (iii) Supply of:
o Medicines, vaccines, and therapeutic substances ordinarily available in State Government
hospitals, but excluding:
 Items primarily used as food, tonics, toiletries, or disinfectants.
 Expensive or proprietary drugs where cheaper alternatives of equal therapeutic
value are available (as notified by the Central Government).
 (iv) Supply of medicines or therapeutic items not ordinarily available, if certified in writing as
essential by the authorised medical attendant.
 (v) Hospital accommodation suited to the patient's status, as is ordinarily provided.
 (vi) Services of hospital-employed nurses.
 (vii) Special nursing services, if certified as essential for recovery or to prevent serious deterioration.
 (viii) Medical attendance as defined in clause (f)(ii) (i.e. consultations with specialists, etc.).

Exclusions:
 Diet.
 Upgraded accommodation requested by the patient beyond what is ordinarily provided.

9. Medical Attendance by Authorised Medical Attendant:

 (3(1)) Members of the Service are entitled to free medical attendance by the authorised medical
attendant.
 (3(2)) If any payment is made for such medical attendance, it will be reimbursed by the Government
upon producing a certificate from the authorised medical attendant.
o Claims can be rejected if found not genuine, but only after giving the claimant a chance to be
heard and providing written reasons.
o Appeal against rejection can be made to the Central Government within 45 days.

10. Medical Attendance and Treatment of Family Members:

 (4(1)) Family members are entitled to:
o Free medical attendance and treatment (at a government hospital, residence, or medical
attendant’s consulting room), and
o Travelling allowance as per the rules applicable to the member.
 (4(2)) Includes hospital confinement, pre-natal, and post-natal care for the member’s wife.

11. Travelling Allowance:

 (5(1)) If the patient is not at the authorised medical attendant’s HQ:
o Patient gets travel allowance to and from the medical officer’s HQ, OR
o If too ill to travel, the medical officer gets travel allowance to visit the patient.
o Note: No allowance for visits to dentists or oculists.
 (5(2)) Application must include a certificate from the medical attendant confirming:
o Medical attendance was necessary, and
o (If applicable) the patient was too ill to travel.
12. Medical Attendance by Others (Specialist or Alternate Medical Officer):
 (6(1)) If the case requires a specialist, the authorised medical attendant (with prior approval of the
Chief Administrative Medical Officer unless urgent) may:
o (a) Send the patient to a specialist or medical officer, or
o (b) Summon the specialist to attend the patient if the patient cannot travel.
 (6(2)) Patient is entitled to travel allowance for journey to/from specialist (with certificate from
authorised medical attendant).
 (6(3)) The summoned specialist is also entitled to travel allowance (with certificate).

13. Hospital Treatment and Reimbursement

7(1) Entitlement to Treatment:
Members of the Service are entitled to free treatment in:
 (a) A Government hospital in the station/district where they fall ill, if suitable.
 (b) A non-Government hospital in the same area, if no suitable Government hospital is available.
 (c) A hospital elsewhere in the State, if neither of the above are available.
 Exceptionally, with prior approval, treatment may be taken outside the State (within India) if no
suitable hospital is available in the State.
7(2) Reimbursement:
 Any amount paid for entitled treatment is reimbursable with a certificate from the authorised medical
attendant.
 Special nursing costs are reimbursed only beyond 25% of the officer's pay for the period of special
nursing.
 Claims can be rejected if not genuine, but the claimant must be:
o Heard, and
o Given reasons for rejection, and
o Allowed to appeal to the Central Government within 45 days.
7(3) Travelling Allowance:
 If treatment requires travel to another station:
o TA is admissible for both the patient and, if certified necessary, an attendant.

14. Treatment at Residence

8(1) Allowed if no hospital is nearby or illness is too severe.
8(2) Member is reimbursed up to the amount they would have received for hospital treatment under the rules.
8(3) Claims must include a certificate from the authorised medical attendant specifying:
 The reason for residence-based treatment.
 Estimated cost of equivalent hospital treatment.

15. Charges for Additional Services

9(1) Charges for non-medical services (related to but not part of treatment) are to be:
 Determined by the medical attendant, and
 Paid by the patient.
9(2) Disputes over whether a service is included in treatment are resolved by the Government, whose decision
is final.

10. Countersignature for TA Reimbursement

The Government may require that certificates for travelling allowance reimbursement be countersigned by
the Chief Administrative Medical Officer of the State through general or special orders.
11. Transfer to Foreign Service
 A member of the Service cannot be transferred to foreign service unless the foreign employer
provides medical privileges equal to those under these rules.
 Exception: This condition does not apply if the transfer is at the officer's own request or if the officer
opts out in writing.

11A. Deputation to Government Organisations with Separate Medical Rules

  Members on deputation to such organisations (e.g., Railways) may choose to follow that
organisation’s medical rules instead of these rules.
 These organisations must be funded by the Consolidated Fund of India or the State.

12. Injuries Due to Civil Disturbances

 (12(1)) Members serving in disturbed areas are considered to be on duty continuously, and injuries
are presumed to be duty-related unless clearly proven otherwise.
 (12(2)) Such members are entitled to free medical attendance and treatment as per rules 2(f) and
2(k).
 (12(3)) Members on leave in such areas also get the same benefits if injured due to being a
Government servant.

12A. Applicability of Contributory Health Service Scheme (CHSS)

 When on deputation to the Central Government at a location where CHSS applies, these rules are
not applicable.
 Instead, the CHSS applies as per rules applicable to Class I Central Government Servants.

13. Interpretation
 Any interpretation issues regarding these rules are to be decided by the Central Government.

14. Saving Clause

These rules:
 Do not entitle a member to:
o Reimbursement or travel allowance beyond what is expressly provided.
o Costs for:
 Food-tonics, toiletries, or disinfectants.
 Expensive or proprietary drugs (if alternatives are available and notified by the
Central Government).
 Do not prevent the Government from granting additional concessions, including treatment or travel
allowances not specifically covered by these rules.

CENTRAL SERVICES (MEDICAL ATTENDANCE) RULES, 1944 PREAMBLE In

exercise of the powers conferred by sub-section (2) of section 241, read with sub-section (3)
of section 313 of the Government of India Act, 1935, the Governor General – in – Council is
pleased to make the following Rules, namely: Rule 1 SHORT TITLE AND EXTENT OF
APPLICATION Rule 1 (1). These rules may be called the Central Services (Medical
Attendance) Rules, 1944. Rule 1 (2). They shall apply to all Government servants other than
(i) those in railway service and (ii) those of non-Gazetted rank stationed in or passing through
Calcutta, whose conditions of service are prescribed by Rules made or deemed to be made by
the Central Government, when they are on duty, leave or Foreign Service in India or when
under suspension Rule 2. DEFINITIONS In these Rules, unless there is anything repugnant
in the subject or context:- Rule 2 (a) “Authorised Medical Attendant” means – (i) in respect
of a Government servant who belongs to a Central Service, Class I, or whose pay is not less
than Rs.500 per mensem, the Principal Medical Officer of the district appointed by the
Government to attend its officers in the district; (ii) in respect of Government servant not
belonging to a Central Service Class I, whose pay is less than Rs.500 but more than 150 per
mensem, an assistant surgeon grade I (Medical Graduate), or other medical officer appointed
by the Government to attend its officers in the station.; (iii) in respect of any other
government servant an Assistant Surgeon Grade II (Medical Licentiate), or other Medical
Officer, similarly appointed. Rule 2 (b) “Districts” means the district in which the
Government servant falls ill. Rule 2(c) “The Government” means – (i) in respect of a Part
“A” or Part “B” state, the State Government; and (ii) in respect of a Part “C” State, the
Lieutenant Governor or the Chief Commissioner, as the case may be. Rule 2 (d)
“Government Hospital” includes a Military Hospital, subject to the provisions of Appendix
32 to the Regulations for Medical Services of the Army in India, 1937, a hospital maintained
by a local authority and any other hospital with which arrangements have been made by the
Government for the treatment of government servants. Rule 2 (e). “Medical Attendance”
means- (i) in respect of a government servant specified in sub-clause(a), attendance in
hospital or at the residence of government servant, including such pathological,
bacteriological, radiological or other methods of examination for the purpose of diagnosis as
are available in any government hospital in the district and are considered necessary by the
authorised medical attendant and such consultation with specialist or other medical officer in
the services of the Government stationed in the state as the authorised medical attendant
certifies to be necessary, to such extent and in such manner as the specialist of medical
attendant determine; (ii) in respect of any other government servant but excluding a member
of the central service class IV, attendance at a hospital or in the case of illness which compels
the patient to be confined to his residence, at the residence of the government servant,
including such methods of examination for purposes of diagnosis as are available in the
nearest government hospital and such consultation with a specialist or other medical officer
of the government stationed in the district as the authorised medical attendant certifies to be
necessary to such extent and in such manner as the specialist for medical officer may, in
consultation with the authorised medical attendant, determine; (iii) in respect of a member of
the central service, class IV, attendance at a hospital including such methods of examination
for purposes of diagnosis as are available in the nearest government hospital and such
consultation with a specialist or other medical officer of the government stationed in the
district as the authorised medical attendant certifies to be necessary to such extent and in such
manner as the specialist or medical officer may, in consultation with the authorised medical
attendant, determine. Rule 2 (f) “Patients” means a government servant to whom these Rules
apply and who has fallen ill; Rule 2 (g) “State” means the State in which a patient has fallen
ill; Rule 2 (h) “Treatment” means the use of all medical and surgical facilities available at the
Government hospital in which the Govt. servant is treated and includes- (i) the employment
of such pathological, bacteriological, radiological, or other methods as are considered
necessary by the authorised medical attendant; (ii) the supply of such medicines, vaccines,
sera or other therapeutic substances as are ordinarily available in the hospital; (iii) the supply
of such medicines, vaccine, sera or other therapeutic substances not ordinarily so available as
the authorised medical attendant may certify in writing to be essential for the recovery or for
the prevention of serious deterioration in the condition of the Government servant; (iv) such
accommodation as is ordinarily provided in the hospital and is suited to his status;
accommodation in general or free wards in the hospital being regarded as suitable for a
member of the Central Services, Class IV; (v) such nursing as is ordinarily provided to in-
patients by the hospitals; and (vi) the specialist consultation described in clause (e) but does
not include diet or provision at the request of the Govt. servant or accommodation superior to
that described in sub-clause (iv). Rule 3 MEDICAL ATTENDANCE Rule 3 (i)- A
Government servant shall be entitled, free of charge to medical attendance by the authorised
medical attendant; Rule 3 (ii)- Where a Government servant is entitled under sub-rule (i), free
of charge, to receive medical attendance, any amount paid by him on account of such medical
attendance shall, on production of a certificate in writing by the authorised medical attendant
in this behalf be reimbursed to him by the Central Government. Rule 4 TREVELLING
ALLOWANCE FOR MEDICAL ATTENDANCE JOURNEYS Rule 4 (i)- When the place at
which a patient falls ill is more than five miles by the shortest route from the consulting room
of the authorised medical attendant- (a) the patient shall be entitled to traveling allowance for
the journey to and from such consulting room, or (b) if the patient is too ill to travel the
authorised medical attendant shall be entitled to traveling allowance for the journey to and
from the place where the patients. Rule 4(ii)- Application for traveling allowance under sub-
rule (i) shall be accompanied by a certificate in writing by the authorised medical attendant
stating that medical attendance was necessary and if the application is under clause (b) of that
sub-rule that the patient was too ill to travel. Rule 5 CONSULTATION WITH SPECIALIST
Rule 5 (1)- If the authorised medical attendant is of opinion that the case of a patient is of
such a serious or special nature as to require medical attendance by some person other than
himself, he may, with the approval of the Chief Administrative Medical Officer of the State
(which shall be obtained beforehand unless the delay involved entails danger to the health of
the patient)- (a) send the patient to the nearest specialist or other medical officer as provided
in clause (e) of Rule 2, 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 medical officer
to attend upon the patient. Rule 5(2)- A patient sent under clause (a) of sub-rule (1) shall on
production of a certificate in writing by the authorised medical journeys to and from the
headquarters of the specialist or other medical officer. Rule 5(3)- A specialist or other
medical officer summoned under clause (b) of subrule (1) shall, on production of a certificate
in writing by the authorised medical attendant in this behalf be entitled to travelling
allowance for the journey to and from the place where the patient is. Rule 6 MEDICAL
TREATMENT Rule 6 (1)- A Government servant shall be entitled, free of charge, to
treatment- (a) in such Government hospital at or near the place where he falls ill as can in the
opinion of the authorised medical attendant provide the necessary and suitable treatment; or
(b) if there is no such hospital as is referred to in sub-clause (a) in such hospital other than a
Government hospital at or near the place as can in the opinion of the authorised medical
attendant, provide the necessary and suitable treatment; Rule 6(2)- Where a Government
servant is entitled under sub-rule (1), free of charge, to treatment in a hospital, any amount
paid by him on account of such treatment shall, on production of a certificate in writing by
the authorised medical attendant in this behalf, be reimbursed to him by the Central
Government. Rule 7 TREATMENT AT RESIDENCE Rule 7 (1)- If the authorised medical
attendant is of opinion that owing to the absence or remoteness of a suitable hospital or to the
severity of the illness, a Govt. servant cannot be given treatment as provided in clause (a) of
sub-rule (1) of Rule 6, the Government servant may receive treatment at his residence. Rule
7(2)- A Government servant receiving treatment at his residence under sub-rule (1) shall be
entitled to receive towards the cost of such treatment incurred b him a sum equivalent of the
cost of such treatment as he would have been entitled, free of charge, to receive under these
rules if he had not been treated at his residence. Rule 7(3)- Claims for sums admissible under
sub-rule (2) shall be accompanied by a certificate in writing by he authorised medical
attendant stating- (a) his reasons for the opinion referred to in sub-rule (1); and (b) the cost of
similar treatment referred to in sub-rule (2). Rule 8 OTHER MEDICAL FACILITIES Rule 8
(1)- Charges for services rendered in connection with but not included in medical attendance
on, or treatment of, a patient entitled, free of charge, to medical attendance or treatment under
these Rules, shall be determined by the authorised medical attendant and paid by the patient.
Rule 8(2)- If any question arises as to whether any service is included in medical attendance
or treatment it shall be referred to the Government and the decision of the Government shall
be final. Rule 9- COUNTERSIGNATURE OF CERTIFICATES The Controlling Officer of a
patient may require that any certificate required by these Rules to be given by the authorised
medical attendant for traveling allowance purposes shall be countersigned- (a) in the case of a
certificate given by the principal medical officer of a district, by the Chief Administrative
Medical Officer of the State; and (b) in the case of a certificate given by any other medical
officer, by the principal medical officer of the district. Rule10- TRANSFER TO FOREIGN
SERVICE No Government servant shall be transferred to foreign service unless the foreign
employer undertakes to afford to him so far as may be privileges not inferior to those which
he would have enjoyed under these Rules if he had been employed in the service of the
Government of India. Rule11- TREATMENT OUTSIDE INDIA Rule 11 (1)- A Government
Servant shall be eligible to obtain medical treatment outside India or, as the case may be, to
claim reimbursement of the cost of medical treatment obtained inside or outside India in
accordance with the provisions of this rule. Rule 11 (2)- A Government Servant desirous of
availing of medical treatment outside India may make an application through the
Department/Ministry to which the Government servant is attached to the Standing Committee
established under this rule in the form specified by the Standing Committee. Rule 11 (3)- A
Government servant desiring to avail of medical treatment outside India for himself or for a
member of his family for any treatment specified in the Table below shall, subject to the
other provisions of this rule, be eligible for medical treatment outside India. Table (1)
Complex/high risk Cardio Vascular Surgery cases for treatment at Centres with extensive
experience; (2) Bone marrow Transplant; (3) Complex Medical and Oncological Disorders,
such as leukaemia and Neo-plastic conditions; (4) Complex high risk cases in Micro Vascular
and Neuro Surgery for treatment at Centres with extensive experience; (5) Treatment of
extremely complex ailments other than those mentioned above which in the opinion of
Standing Committee can only be treated abroad and fall in the high risk category. Rule 11
(4)- It shall be competent for the Central Government to review from time to time the list of
treatment facilities as specified in the Table to sub-rule (3) and make such additions or
deletions as it may deem fit by notification in the Official Gazette. Rule 11 (5)- The Central
Government may for purposes of this rule, constitute a Standing Committee consisting of :-
(a) the Director-General of Health Services in the Ministry of Health in the Central
Government, (b) the Director-General of Armed Forces Medical Services. (c) the Director-
General of the Indian Council of Medical Research, and (d) the Joint Secretary in the
Ministry of Health and Family Welfare (Convener), for purposes of considering and
recommending to the Central Government cases for medical treatment outside India. Rule 11
(6)- On receipt of an application for medical treatment outside India, the Standing Committee
may, it after due consideration, satisfied that the ailment or treatment can be treated only
outside India, issue a certificate to the concerned Department or Ministry to which the
applicant Government servant is attached conveying its approval of the application and the
concerned Department or Ministry shall, on the strength of that certificate incur necessary
expenditure in getting the Government servant concerned or the member of his family treated
outside India in accordance with the procedure laid down by the Standing Committee. Rule
11 (7)- It shall be competent for the Central Government to authorize reimbursement of
expenditure on medical treatment obtained outside India, if it is satisfied that the prior
approval could not be obtained by the Central Government servant due to circumstances
beyond control; Provided that the Government servant fulfils all other conditions relating to
medical treatment outside India under this rule. Rule 11 (8)- The Standing Committee may, if
it is satisfied that in the interest of the Government servant or the member of his family
obtaining treatment abroad it is essential so to do, recommend one attendant to accompany
the Government servant or the member of his family, as the case may be, and the expenditure
so incurred shall also be eligible for reimbursement. Rule 11 (9)- Where the Standing
Committee, on receipt of an application for medical treatment outside India consider that
adequate facility for treatment of the ailment sought to be treatment is available in any
medical institution within India, it shall record such a finding and authorize treatment of such
ailment in such medical institution within India whereupon the cost of such treatment shall be
reimbursed. Rule 11 (10)- For purposes of sub-rule(9), the Ministry of Health in consultation
with the Standing Committee shall, from time to time, notify the names of such institutions
along with the ailments and the types of treatment available in such institutions. Rule 11 (11)-
The scale of expenditure and the eligibility for treatment for which a Government servant or a
member of his family shall be entitled, shall be identical to the scale of expenditure and the
eligibility of an official of the Indian Foreign Service of the corresponding grade in the
Ministry of external Affairs under any Assisted Medical Attendance Scheme for the time
being in force.

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. Défense 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.

Exclusions:

 Railway service employees (except those deputed to Central Government offices).

 Defence Services personnel.
 Government servants on leave or deputation abroad.
 Non-Gazetted employees and some Gazetted employees in or passing through
Calcutta with special medical arrangements.
 Retired officials.
 Non-officials deputed abroad.
 Employees in Delhi/New Delhi covered under a different health scheme.
 Officers under All India Services rules.
 India-based mission staff abroad under a separate scheme.

 Special Applicability:

 Servants on leave preparatory to retirement or refused leave post-retirement.

 Officers of the General Administrative Reserve.
 Re-employed pensioners under the Central Government.
 Defence Accounts personnel and certain civilians paid from Defence estimates.
 Those on terminal leave, probationers, apprentices in full-time government service.
 Police personnel including Assam Rifles (with conditions).
 State Government servants on deputation to the Central Government.

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 : Authorised Medical Attendant
o There are three categories of Medical Officers who can be appointed as AMA
o MOs under the employ of Central Govt.
o MOs who are not employees of the Central Govt.
o MOs in the employ of the State Govt. or UTs

o 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.
o 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

o Medical P.G./Specialist- First consultation Rs. 100/- the Rs. 60/- for subsequent
consultation.
o Medical Graduates(MBBS)- First consultation Rs. 70/- the Rs. 40/- for subsequent
consultation.

Medical Attendance
o 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.
o Limits for reimbursement of consultation fees and cost of medicines :
o 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.
o 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.
o 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.
o 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
o the patient shall be entitled to TA for the journey to and from such consulting room
o 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-
o send the patient to the nearest specialist or other Medical Officer by whom in
his opinion medical attendance is required for the patient; or
o 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-
o in such Govt. hospital at or near the place where he falls ill;
o 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:-
o For Men Officers – Rs. 2,000/-
o 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:-
7. Complex Cardio Vascular Surgery.
8. Bone Marrow Transplant.
9. Complex Oncological Disorders.
10. Complex Micro Vascular and Neuro Surgery.
11. 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:-
 For outdoor treatment 90% of the total estimated expenditure subject to
the condition that the total cost is more than Rs. 10,000/-
 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:-

 Son Till he starts earning or attains the age of 25 years or gets married
whichever is earlier
 Daughters Till she starts or gets married irrespective of age limit, whichever is
earlier
 Son, Brother suffering from any permanent disability Irrespective of age limit
 Dependent divorced/widowed daughters Irrespective of age limit
 Dependent unmarried/divorced/widowed sisters Irrespective of age limit
 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 nonCGHS
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.