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Central Government personnel, pensioners, and their families are eligible for comprehensive healthcare services under the Central Government Health Scheme (CGHS). One key benefit of CGHS is the ability to seek treatment at empaneled dental clinics, which offer specialized dental care. Below are frequently asked questions (FAQs) related to CGHS empaneled dental clinics to help you understand the services available and how to access them.
A dental clinic that has received formal approval from the Central Government Health Scheme to offer dental services to its clients is known as a CGHS empaneled clinic. These clinics offer a range of dental treatments that are covered under CGHS, allowing eligible patients to receive high-quality care at subsidized rates or without out-of-pocket expenses, depending on the treatment and eligibility
Eligibility to receive treatment at CGHS empaneled dental clinics includes:
Dependents, including spouses, children, and sometimes parents, can also receive care if they are included under the beneficiary’s CGHS card.
CGHS empaneled dental clinics provide a wide range of dental services, including:
Preventive care: Oral hygiene guidelines, routine cleanings, and examinations are all part of preventive care.
Restorative care: Fillings, root canal treatments, and dental crowns.
Prosthodontics: Dentures and bridges.
Surgical procedures: Tooth extractions, gum surgery, and other minor oral surgeries.
Periodontal treatments: Treatment for gum diseases.
Orthodontics (for dependent children): Braces and related treatments
Certain treatments may require prior approval, so it is always advisable to consult with your dentist and the CGHS office regarding coverage.
To find a CGHS empaneled dental clinic:
For some treatments, particularly major dental procedures, prior approval from the CGHS authorities is required. This includes treatments like dental implants, bridges, and advanced prosthodontics work. Routine procedures such as dental cleanings, fillings, and extractions usually do not require prior approval.
It is advisable to check with the empaneled clinic and the CGHS Wellness Center to determine whether the treatment you need requires pre-authorization.
The beneficiary's status and the particular treatment plan determine the co-payment amount. Serving government employees and pensioners generally do not need to make any payments for approved treatments covered under CGHS. However, for treatments that exceed CGHS-approved limits or involve procedures not fully covered, patients may be required to make co-payments. The clinic will inform you about any co-payments before starting the treatment.
To receive treatment at a CGHS empaneled dental clinic, you will need the following documents:
For treatments covered under CGHS but taken at a non-empaneled clinic or for out-of-pocket expenses, you may file for reimbursement. The process involves:
1.Obtaining the necessary approvals for treatments requiring prior authorization.
2. Submitting the reimbursement claim along with bills, receipts, and relevant treatment documents to your local CGHS office.
The reimbursement amount will be based on CGHS-approved rates, and any amount exceeding the standard rates may not be covered.
Dental implants are typically covered under CGHS with prior approval. Since dental implants are considered a specialized and more expensive treatment option, you will need to obtain approval from CGHS authorities before proceeding. The clinic can help you with the approval process by providing the necessary treatment plan and cost estimate.
There is no restriction on routine dental visits under CGHS, so beneficiaries can visit an empaneled clinic for regular check-ups as often as needed. It is recommended that you have a dental check-up every six months to maintain optimal oral health, but the frequency can vary depending on individual needs.
Yes, you can switch between different CGHS empaneled dental clinics as long as they are listed under CGHS in your area. However, it is advisable to stick to one clinic for continuity of care, especially for ongoing treatments, so your dentist has a complete understanding of your dental history
Dental clinics with CGHS endorsements are carefully chosen and have to adhere to strict government requirements. These clinics are subject to periodic inspections to ensure they maintain the required quality of care, hygiene, and infrastructure. Clinics that do not meet CGHS standards may lose their empanelment.
Choosing a CGHS empaneled dental clinic offers several advantages, from access to affordable dental care to peace of mind knowing you’re receiving treatment at a government-approved facility. Whether you need routine dental maintenance or more complex treatments, the CGHS network ensures that you have access to quality dental services. Always check with your local CGHS Wellness Center for up-to-date information on empaneled clinics and the latest guidelines on dental treatments covered under the scheme.
