Is a Referral Required for Treatment Under the Ayushman CAPF Scheme?

Hello,

No, a referral is not required for every treatment under the CAPF Ayushman scheme. It depends on the patient's medical condition, type of treatment, age and hospital.

When is a referral not required?

• Medical Emergency: If the patient has a sudden or serious medical emergency, they can go directly to the hospital without waiting for a referral. The hospital will guide them about the emergency certificate and other scheme formalities.
• Patients aged 70 years or above: As per the referral guidelines shared, these patients are exempt from the referral requirement.
• Government Hospitals: A referral is not required for treatment at a government hospital, as per the shared guidelines.
• Follow-up Treatment: For some serious or long-term illnesses, such as cancer treatment, a new referral may not be needed for every follow-up visit after the initial approval. This depends on the approved treatment plan.

When is a referral required?

For planned treatment, such as a regular doctor consultation, hospital admission or surgery at a private hospital empanelled under the CAPF scheme, a referral is generally required before taking treatment.

Where can you get a referral?

You can get a referral from:

• A CAPF Medical Officer or Composite Hospital.
• A doctor at a Government Hospital.
• A doctor at a CGHS Wellness Centre.

The shared guidelines mention that a referral slip is generally valid for 3 months or up to 3 specialist consultations. Please confirm its current validity with the authority issuing the referral.

Documents required for treatment

• CAPF Ayushman card.
• Aadhaar card or another valid ID proof.
• CAPF service or beneficiary details, if applicable.
• Referral letter, if required.
• Doctor's prescription and admission advice.
• Medical reports, scan reports and blood test reports.
• Previous treatment records and discharge summary, if available.

Important: Before visiting the hospital, check whether it is empanelled under the CAPF scheme and whether your required treatment is covered. Cashless treatment depends on the scheme rules and approval.

Please share these details:

1. What is the patient's age?
2. Which treatment or surgery is required?
3. Do you want treatment at a government hospital or a private empanelled hospital?

With these details, we can guide you about whether a referral is needed and what steps to follow.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth