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.
This scheme is available for the following groups:
The enrollment process under CGHS can be listed as follows:
Some of the benefits available for enrolled members under this scheme can be listed as follows:
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:
|Levels in pay matrix (as per 7th Central Pay Commission)||Contribution per month|
|Level 1 to 5||Rs.250|
|Level 7 to 11||Rs.650|
|Level 12 and above||Rs.1,000|
Entitlement of ward based on pay band:
|Type of ward||Corresponding basic pay drawn by the officer (as per 7th CPC)|
|General ward||Up to Rs.47,600 per month|
|Semi private ward||Rs.47,601 to Rs.63,100 per month|
|Private ward||Rs.63,101 and above|
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.
Yes, emergency services are available in four wellness centres located in Delhi. They are:
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.
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.
The cities in which CGHS is currently operational are:
|27||Delhi & NCR|
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.
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.
Female government employees will be given the option to include their in-laws under the scheme if they are dependent on her.
No, either parents or parents-in-law can be included in a single CGHS card.
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.
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.
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.
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.
The individual should contact the Additional Director of the city regarding the issue.
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.
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.
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|
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.
Yes, pensioners can avail CGHS facilities in non-CGHS cities. They can get the CGHS card from the nearest CGHS city.
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.
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.
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.
Yes, the facilities can be availed from any wellness centre located in several CGHS cities across the country.
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.
Yes, beneficiaries aged 80 and above can enjoy the following facilities:
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.
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.
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.
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.
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.
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’.
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