Central Government Health Scheme (CGHS) gives healthcare facilities to registered employees and pensioners of the Central Government of India. The enrolled members are provided reimbursement and cashless facilities under this scheme.

The Central Government Health Scheme aims at giving CGHS beneficiaries in India with comprehensive health care. CGHS works towards fulfilling health care needs of beneficiaries from Legislature, Judiciary, Executive and Press. The CGHS is unique in its own way as it possesses a massive beneficiary base. In addition, the aim is to provide healthcare on an open-ended generous approach.

At the present time, approximately 35 lakh beneficiaries are covered by CGHS in 71 cities all across the country. CGHS aims to include more cities to work on the accessibility of the services. It must be noted that the Central Govt Health Scheme covers health care under different systems of medicine, such as Allopathy, Homeopathy, Ayurveda and Unani.

List of Beneficiaries of the Central Government Health Scheme

The beneficiaries of the CGHS Health Insurance Policy include:

• Central government’s present employees as well as dependent family members living in CGHS covered areas.
• Former and existing members of the Indian Parliament
• Former Vice Presidents of India
• Freedom Fighters of India
• Former governors & Lieutenant governors of India
• Former and existing Judges of Supreme Court & High Courts of India
• Journalists qualified with PIB (only Delhi)
• Police Personnel (only Delhi)
• Railway Board workers
• Workers and Pensioners of Delhi’s selected autonomous organizations

Facilities Available Under Central Government Health Scheme

The CGHS takes care of the healthcare facilities by providing cover for:

• Cashless facility treatment in empanelled hospitals and diagnostic centers
• Out-patient treatment including issue of medicines
• Indoor treatment at government and empanelled hospitals
• Specialist consultation at polyclinic/govt. Hospitals
• Family welfare service
• Maternity and child health services
• Investigations done at government and empanelled diagnostic centers
• Reimbursement of expenses for treatment availed in govt./private hospitals in case of emergency
• Reimbursement of expenses incurred due to artificial limbs, hearing aids, appliances and more
• Medical consultation and dispensing of medicines in AYUSH (Ayurveda, Homeopathy, Unani and Siddha) system of medicines

Cost of Central Government Health Scheme (CGHS) Facilities

CGHS facilities cost different to serving employees as well as pensioners of the central government of India.

• In Case of Pensioners

If a pensioner wants to undergo the facilities provided by CGHS, they will be required to make a contribution as per their grade pay (entitled at the time of service). Please note that the contribution can be done as on an yearly basis or as a one-time contribution. In case of yearly contribution, every year a specific amount of money (as per grade pay) is contributed towards CGHS. In case of one time contribution, the pensioner pays a one-time contribution amount towards CGHS for a period of 10 years. It is considered as a lifetime contribution.

• In Case of Serving Government Employees

A central government employee, serving in CGHS covered area at present, has to take the CGHS card. Depending on the grade pay of the serving employee, a deduction is made from the salary by their department every month.

Time Required to Get CGHS Card

A printed index card of the Central Government Health Scheme is issued on the day of application for CGHS. Thereafter, the plastic cards are issued and sent to the concerned cardholders within a span of 3 weeks. The government employees receive their CGHS cards at their residence.

CGHS - Treatment in Private Hospitals

CGHS beneficiaries can undergo treatment at any empanelled private hospital of their choice. It must be noted that the CGHS beneficiaries are not required to provide a referral letter.

As per an order issued by the Health Ministry, private hospitals (empanelled) can carry out cashless treatment for ex-MPs, pensioners, freedom fighters, regular employees of Ministry of Health & Family Welfare in addition to other CGHS beneficiary categories, eligible for credit facility at present. According to the order, CGHS beneficiaries have to enclose a prescription issued by Government Specialist or a CGHS Medical Officer, in original (or a self-attested photocopy) as well as the hospital bill submitted to the competent authorities.

Treatments That Central Government Health Scheme Do Not Cover

In-patient treatments and follow-ups are not addressed in case of:

• A Declared Emergency: In case of a declared emergency, the treatment can be carried out at any hospital. However, submission of the reimbursement claim can only be done to the Additional General having the registry of the CGHS card.
• Reimbursement of Medical Bills: In case of reimbursement of the medical bills, the treatment of the beneficiary can be carried out at any hospital. Take note that in this case, the claim amount is limited to the rates according to the CGHS. The submission of the reimbursement claim can only be done to the Additional General where the CGHS card is registered.