Central Government Health Scheme (CGHS)

• Enjoy options to cover yourself, your spouse, kids and even your parents
• Enjoy access to 10,000+ hospitals for cashless treatment
• Reduce your taxable income by up to Rs. 50,000 deduction under section 80D**

Central Government Health Scheme (CGHS) is one of the oldest health insurance schemes launched by the government of India that is currently in effect. The scheme was introduced in the year 1954, and it provides health insurance coverage to Central Government employees and pensioners. The large volume of beneficiaries associated with this scheme makes it a unique one. This scheme comes with a range of benefits to provide comprehensive coverage to government employees/pensioners and their families.

Eligibility for Central Government Health Scheme

This scheme is available for the following groups:

• Central Government employees who draw a salary from Central Civil Estimates and their dependent family members
• Pensioners who draw a pension from Central Civil Estimates and their eligible dependent family members
• Members of Parliament (Sitting and Ex)
• Governors and Lt.Governors (Ex)
• Ex-Vice Presidents
• Freedom Fighters
• Retired High Court Judges
• Delhi police personnel
• Journalists accredited with Press Information Bureau
• Supreme Court Judges (Sitting and Retired)
• Employees and pensioners of certain autonomous/statutory bodies that have been extended to CGHS facilities in Delhi

Enrollment Process for Central Government Health Scheme

The enrollment process under CGHS can be listed as follows:

• Eligible employees and pensioners must apply for this cover in order to get enrolled.
• The application can be made in the official websites (www.cghs.nic.in and www.cghs.gov.in) or by visiting the wellness centers.
• The provision of uploading supporting documents is currently not available on the website portals. After online enrollment, the applicant must get a printout of that application and submit it along with the supporting documents.
• Official CGHS wellness centers are open from 7.30 AM to 2.00 PM from Monday to Saturday. These centers will remain closed on all Central Government holidays.
• The filled up enrollment form must contain an individual photograph along with personal details such as proof of residence, proof of stay of dependents, age proof of dependents, etc.
• In addition to these documents, pensioners must also provide attested copies of their Pension Payment Order (PPO). If PPO is not available, provision PPO or last pay certificate must be submitted during enrollment.
• For availing medical benefits, the government has deemed parents, parents-in-law (in case of female employees), unmarried son till the age of 25 years, unmarried/divorced/separated daughters, and minor siblings are deemed as dependents if their overall income from all sources is less than Rs.9,000 + DA per month.
• Following the enrollment, CGHS beneficiaries will be issued a photo ID plastic card that contains all the relevant policy details including a unique beneficiary number.
• The card obtained after the enrollment process is valid till the date of retirement of the primary insured.
• In case of the death of the primary insured, the card will become invalid. Dependent family members have to apply for a fresh card upon drawing a pension.
• In case of the transfer of the employee to another department or another CGHS-covered area, the same card will continue. The department may inform the CGHS to make the necessary changes.

Benefits of Central Government Health Scheme

Some of the benefits available for enrolled members under this scheme can be listed as follows:

• Inpatient treatment for all enrolled members at government and empanelled facilities
• Cashless treatment at empanelled hospitals and diagnostic centers
• Medical investigations conducted at government or empanelled diagnostic centers
• Specialist consultations at polyclinic or government hospitals
• Outpatient treatment (OPD) including expenses for medications
• Reimbursement for emergency medical treatments undertaken at government or private hospitals
• Expenses related to maternity, child health services, and family welfare
• Expenses incurred for external medical accessories such as hearing aids, appliances, artificial limbs, etc.
• Alternative treatment procedures such as Ayurveda, Homeopathy, Siddha, and Unani

Member Contribution and Ward Allocation Under CGHS

Obtaining a CGHS health insurance card is mandatory for all Central Government employees residing in CGHS covered areas. The following salary deductions in monthly salary will be applicable to employees enrolled in this scheme:

Entitlement of ward based on pay band:

Claim Procedure

Cashless treatment can be obtained in CGHS-empanelled hospitals across the country. These hospitals cannot deny admission to a CGHS beneficiary during the times of emergency. Treatment provided in these empanelled hospitals also include pre-operative investigations, two pre-operative consultations, two post-operative consultations, room charges, medicines, cost of implants (if required), etc. as per the CGHS package rates. The package rates for treatment and implants will remain standard as per the rates approved under the CGHS.

Reimbursement can be obtained for treatments undertaken in non-empanelled hospitals and diagnostic centers. The claim has to be submitted to the concerned department of the employee and to the CMO of the CGHS Wellness Centre within a maximum of 6 months from the date of discharge from the hospital. For reimbursement claims, the beneficiary must submit relevant documents and proofs including policy certificate copy, discharge summary, medical bills and receipts, ambulance usage bills, etc. Once these documents are submitted, the Wellness Center will verify the details and provide the reimbursement. Status of a claim can be viewed in the CGHS computer module with the help of the claim number.

FAQs on Central Government Health Scheme

1. Are emergency services available in any of the wellness centres?

Yes, emergency services are available in four wellness centres located in Delhi. They are:

• Zakir Hussain Road
• North Avenue
• South Avenue
• Kingsway Camp

The regular timings are 7:30 a.m. to 1:30 p.m. The limited emergency services are available between 1:30 p.m. and 7:30 a.m.

2. Are wellness centres open on all days?

The wellness centres are open on all working days and will be closed on Central Government holidays. If, however, there are three consecutive holidays, the centres will be closed only for two days.

3. Is CGHS operational in all cities in the country?

The cities in which CGHS is currently operational are:

1	Visakhapatnam
2	Thiruvananthapuram
3	Shimla
4	Shillong
5	Ranchi
6	Raipur
7	Pune
8	Puducherry
9	Patna
10	Nagpur
11	Mumbai
12	Meerut
13	Lucknow
14	Kolkata
15	Kohima
16	Kanpur
17	Jammu
18	Jaipur
19	Jabalpur
20	Indore
21	Imphal
22	Hyderabad
23	Guwahati
24	Goa
25	Gangtok
26	Gandhinagar
27	Delhi & NCR
28	Dehradun
29	Chennai
30	Chandigarh
31	Bhubaneshwar
32	Bhopal
33	Bengaluru
34	Allahabad
35	Aizawl
36	Ahmedabad
37	Agartala

4. Can sons and daughters be included under the scheme?

Yes, sons and daughters can be included under the scheme until they get married, start earning, or reach the age of 25, whichever is earlier. However, a son who suffers from a physical or mental disability can be covered under the policy even after he crosses the age of 25 years.

5. Can step-children avail facilities under CGHS?

Yes, step-children can also be covered under the policy if they are dependents of the beneficiary. As in the case of sons and daughters, step-children, too, can be covered only until the age of 25 years, when they start earning, or when they get married, whichever is earlier.

6. Can parents-in-law be included in the scheme?

Female government employees will be given the option to include their in-laws under the scheme if they are dependent on her.

7. Can both, parents and parents-in-law, be covered under the same CGHS card?

No, either parents or parents-in-law can be included in a single CGHS card.

8. If the husband and wife are eligible to avail facilities under the scheme, can they make separate

cards and include their respective parents and dependent brothers/sisters?

Yes, if both, the husband and the wife, are government employees and are eligible for the scheme, they may get separate cards and include their dependents.

9. Is it necessary to get separate CGHS cards in case both, the husband and the wife, are

government employees?

No, it is not necessary. The spouse who receives the higher pay can get a CGHS card and his/her spouse can avail services under the same card as a member of the family.

10. Can CGHS cards be applied for online?

Yes, eligible members can apply for the CGHS card online through the CGHS website or the CGHS portal. To apply for the card, one has to upload the required documents and pay the CGHS contribution online.

11. How long does the beneficiary have to wait for the CGHS card to be issued?

The day the beneficiary applies for the CGHS card, he/she is provided with a printout of the index card which he/she can use to avail facilities. The plastic card will be made and sent to the wellness centre in 3 to 4 weeks. The beneficiary will have to collect it from the wellness centre.

Alternatively, the beneficiary can also take a colour printout of the card from the CGHS portal. He/she can then laminate the card and use it as a plastic card and avail services.

12. What should the beneficiary do if the CGHS card is not issued in time?

The individual should contact the Additional Director of the city regarding the issue.

13. What should be done in case the CGHS card is lost?

An application for a duplicate CGHS card has to be submitted to the Additional Director of the city. Two photographs, a copy of the FIR, and an IPO for Rs.50 has to be submitted along with the application.

14. What should be done in case the details on the card are wrong?

The issue should be brought to the notice of the Additional Director of the city. The individual will have to submit the necessary documents for the necessary changes to be made.

15. Is there a colour scheme for the plastic cards?

The colour scheme for the CGHS cards is as given below:

Member of Parliament	Red
Serving government employees	Blue
Journalists and beneficiaries of autonomous bodies	Yellow
Pensioners, freedom fighters, ex-MPs, etc.	Green

16. Can government employees residing in non-CGHS cities avail CGHS facilities?

No, currently, only employees residing in CGHS cities are allowed to be included under the CGHS scheme. Other employees are covered under the CS(MA) Rules, 1944.

17. Can pensioners avail CGHS facilities in no-CGHS cities?

Yes, pensioners can avail CGHS facilities in non-CGHS cities. They can get the CGHS card from the nearest CGHS city.

18. Can pensioners apply for the CGHS card?

Yes, pensioners can apply for the CGHS card by submitting the relevant documents. The current rates of the subscription have to be paid to avail the services.

19. Can the CGHS card be switched between wellness centres within the same city?

If the beneficiary is still an employee, the office or department has to forward the request to transfer the card to the new wellness centre. In the case of a pensioner, the person will have to approach the CMO and submit the proof of residence.

20. Can the CGHS card be transferred in the name of the spouse in case the beneficiary expires?

Should the widow/widower pay for the lifetime subscription of the card?

Yes, the ownership of the card will be transferred in the database once the Additional Director of the city is informed of the same. The card, however, can be used with the same beneficiary ID. For lifetime subscription of the card, one has to pay the subscription amount for 10 years. So, in case the deceased person had paid the subscription amount for 6 years, the spouse is required to pay the amount for 4 years to get the lifetime subscription of the CGHS facilities.

21. Can CGHS facilities be availed temporarily in a different CGHS location from that of the city of

work?

Yes, the facilities can be availed from any wellness centre located in several CGHS cities across the country.

22. Are domiciliary visits provided to patients in need?

Yes, in case a person is not in the physical state to visit the dispensary, a medical officer will visit the patient after the dispensary working hours. In case of emergencies, the officer will visit the person during dispensary hours too. Female medical officers will not pay visits between 8:00 p.m. and 6:00 a.m.

23. Do beneficiaries equal to and above the age of 80 have any special facilities?

Yes, beneficiaries aged 80 and above can enjoy the following facilities:

• Doctor consultation services can be availed at a wellness centre without having to stand in a queue.
• Medical claims will be settled on priority.
• Follow-up treatments will be provided by the same specialist who provided treatments earlier in a non-empanelled hospital.
24. Can a non-CGHS beneficiary avail first aid treatment at a wellness centre?

During working hours in the wellness centre, services will be provided to all emergency cases. First OPD treatment for symptoms of dengue, chikungunya, etc., suffered by any public individual is provided.

25. Who should be informed in case doctors are not present at a wellness centre?

One can inform the CMO of the wellness centre if no doctor is present at the wellness centre. In case a CMO is not available, the Additional Director of the CGHS city/zone should be contacted. For further escalation, the person can get in touch with the Director of CGHS.

26. What are the guidelines with regard to the issue of medicines under the scheme?
• Medicines are required to be issued only according to the formulary available on the CGHS website and portal.
• If a medicine that is not present in the formulary needs to be issued, the same can be done supported by a valid prescription by the doctor at a wellness centre. The medicine, however, cannot be a food supplement, a banned drug, or a food item.
• In case a medicine of a brand other than the one prescribed has to be issued, the beneficiary will have to be educated about the same so that there are no confusions.
• In case the person suffers from a chronic disease, medicines required for up to 3 months may be provided.
• If a life-saving drug or an anti-cancer drug not approved by the DCGI for use in India has to be issued, the case is required to be dealt with by the Expert Committee chaired by the Special DG.
• If the beneficiary himself/herself cannot collect the medicine, a person with a valid ID card or an authorization letter can collect it on the beneficiary’s behalf.
27. Can a beneficiary avail services in any hospital during an emergency beyond the working hours of the wellness centres?

Yes, the beneficiary can go to any government hospital, an empanelled private hospital or any other private hospital. No deposits will be demanded from CGHS employees, pensioner beneficiaries, DGHS employees, and employees of the Ministry of Health and Family Welfare from such hospitals.

28. Are CGHS beneficiaries eligible for cashless treatment in private empanelled hospitals?

Yes, certain categories of beneficiaries such as MPs, Central Government pensioners, former PMs, serving employees, etc., can avail the cashless facility at a private empanelled hospital.

29. Can the expenses incurred on treatment in a private non-empanelled hospital be reimbursed?

Yes, in case of an emergency, a beneficiary can avail treatment in a non-empanelled private hospital and claim reimbursement of the same. When filing the claim, the person is required to submit all necessary documents and a letter explaining the nature of the emergency.

30. Can appointments be taken online?

Yes, beneficiaries can take appointments online to consult a doctor available at a wellness centre or a certain specialist who visits a particular wellness centre. The person can book the appointment through the CGHS portal by accessing the link ‘Book Appointment’.