CGHS - Central Government Health Scheme

What is CGHS

The Central Government Health Scheme (CGHS) is a health-care benefit programme for current and retired Central Government of India employees.

CGHS provides healthcare to eligible beneficiaries and covers the four pillars of India’s democratic system: legislature, judiciary, executive, and press. CGHS is a model health-care institution for Central Government employees and retirees, and it is one of a kind due to its enormous beneficiary base and open-ended generous approach to health-care provision.

CGHS currently covers roughly 38.5 lakh people in 74 cities across India, with plans to expand to more locations in the future to improve service accessibility.

Components of the Central Government Health Scheme – CGHS

The dispensary services including domiciliary care.
F. W. & M.C.H. Services.
Specialists’ consultation facilities both at dispensary, polyclinic and hospital.
Level including X-Ray, ECG and Laboratory Examinations.
Hospitalization.
Organization for the purchase, storage, distribution and supply of medicines and other requirements.
Health Education to beneficiaries.

Medical Systems Covered under CGHS

Allopathic
Homoeopathic
Ayurveda
Unani
Siddha and
Yoga

Eligibility for joining CGHS

All the following persons are eligible for CGHS facilities

All Central Government employees paid from the Central Civil Estimates (except Railways and Delhi Administration), including their dependant family members residing in CGHS covered areas.
Pensioners of Central Government (except pensioners belonging to Railways and the Armed Forces) and their families.
Central Government Pensioners retiring with Contributory Provident Fund benefits and their families.
Widows of Central Government pensioners, in receipt of family pension.
Delhi Police personnel and their families, in Delhi only.
Railway Board employees.
Civilian employees of Defence paid from Defence Service Estimates.
Child drawing pension on death of a Central Government employee including minor brothers and sisters of such child.
Ex-Governors and Lt. Governors and their families.
Ex-Vice Presidents and their families.
Central Government servants who are deputed to semi-government and autonomous bodies receiving substantial grant from, or financed by the Central Government.
Central Govt. employees on deputation to statutory or autonomous during the period of deputation.
Military Officers while on deputation to civil departments and getting their emoluments from Central Civil Estimates.
Families of Governments servants transferred to a non-CGHS area, for a maximum period of six months on deposit of CGHS contribution (for the period of 6 months) in advance.
Families of IAS Officers on North-Eastern Cadre, who continue to stay back in Delhi even after repatriation of the IAS Officer to the North-Eastern Cadre, provided that they continue to occupy Government accommodation in Delhi or New Delhi, on deposit of CGHS contribution in advance (one to three years). The same also applies to families of IAS Officers of J&K Cadre.
Parliamentary Secretaries of the Central Government and their families.
Members of Parliament and their families.
Ex-Members of Parliament.
Sitting Judges of Supreme Court and High Court of Delhi and former Judges of Supreme Court and High Courts.
Work Charged and Industrial Staff working in establishments run by various Ministries or Departments of Central Government, immediately from the date of their joining the service.
Employees of Kendriya Vidyalays Sangathan stationed at Delhi and NCR, Kolkata, Chennai, Hyderabad, Mumbai and Bengaluru.
Employees of Ordnance Factory Board Headquarters, Kolkata and Ordnance Equipment Factories Headquarters, Kanpur.
All India Service pensioners who retire while serving under the State at their option.
Freedom Fighters and members of their family receiving Central Pension under the Swatantrata Sainik Samman Pension Scheme.
Family members of the Deceased Ex-Members of Parliament.
Pensioners of Ordnance factories.
Members of Staff Side of the National Council of the Joint Consultative Machinery, even though not serving as Central Government employees.
Persons employed in semi-government and autonomous bodies who are permitted to join the CGH Scheme.
An Accredited Journalist who produces a certificate from the Press Council of India stating that he is a member of the Press Association, New Delhi (for OPD and at RML Hospital).
Retired Divisional Accountants of the Indian Audit and Accounts Department and those whose pay and pension are entirely borne by the State governments.
PSU absorbees who had commuted 100 percent of their pension and have been restored one third portion of their pension after 15 years.
Absorbees of Statutory Bodies or Autonomous Bodies of Central Govt. (including those who proceeded on deputation initially or were on deemed deputation and then absorbed), who are in receipt of Central Civil Pension.
Serving and retired Railway Audit Staff.
Serving and retired Divisional Accounts Officers and Divisional Accountants posted in the Office of Accountant Generals in States.
CISF personnel (and their families) and CAPF (Central Armed Police Forces) personnel posted in CGHS cities.
Employees of Supreme Court Legal Services Committee.
Employees of India Pharmacopoeia Commission, and their families.
Family and dependent members of a Central Govt. employee (a CGHS beneficiary) who stay back in CGHS covered area after posting of the employee to N.E. region (including Sikkim), Andaman and Nicobar Lakshadweep or Ladakh region and CAPF personnel posted in Left Wing Extremist areas, on payment of annual CGHS contribution in advance.
Defence Industrial Employees of Naval Dockyard Central Ordnance Depot and AFMSD, in Mumbai.

Eligibility Criterion

Residence alone (and not the Headquarters) is the criterion for determining eligibility of a Central Government servant for availing medical facilities under the Central Government Health Scheme. Thus, Central Government employees and their family members etc. residing in any of the notified cities are covered under the Scheme.

Facilities available under CGHS

OPD Treatment including issue of medicines.
Specialist Consultation at Polyclinic/Govt. Hospitals.
Indoor Treatment at Government and Empanelled Hospitals.
Investigations at Government and Empanelled Diagnostic centers.
Cashless facility available for treatment in empanelled hospitals and diagnostic centers for Pensioners and other identified beneficiaries.
Reimbursement of expenses for treatment availed in Govt. /Private Hospitals under emergency.
Reimbursement of expenses incurred for purchase of hearing aids, artificial limbs, appliances etc. as specified.
Family Welfare, Maternity and Child Health Services.
Medical consultation and dispensing of medicines in Ayurveda, Homeopathy, Unani and Siddha system of medicines (AYUSH)

Cost of Central Government Health Scheme (CGHS) Facilities

The cost of CGHS benefits varies for serving and retired central government employees in India.

For Pensioners

If a pensioner wishes to use the CGHS’s facilities, he or she must also make a contribution equal to the grade pay to which they were entitled during their service.

Contributions can be made on a yearly or one-time basis:

Annual Contribution: Each year, a certain amount of money (calculated on the basis of grade pay) is to be contributed to CGHS.

One Time Contribution: A pensioner makes a one-time contribution to the CGHS for a period of ten years. It will be considered a contribution for life.

For Serving Government Employees

A central government employee serving in a CGHS-covered area is obligated to obtain a CGHS card. Each month, their department deducts a certain amount from their salary based on the grade pay of the serving employee.

Time required to obtain a CGHS card

On the day of application for CGHS, a printed index card is issued. Following that, plastic cards are issued and mailed to cardholders within three weeks. The cards are delivered to government employees’ homes.

CGHS – Treatment in Private Hospitals

CGHS beneficiaries are not required to provide a referral letter for treatment at any empanelled private hospital. According to a Health Ministry order, private empanelled hospitals shall provide cashless treatment to ex-MPs, pensioners, Freedom Fighters, regular employees of the Ministry of Health & Family Welfare (both CGHS and CS (MA) beneficiaries), and other categories of CGHS beneficiaries who are currently eligible for credit. They “shall enclose the prescription issued by a Government Specialist or a CGHS Medical Officer, in original (or a self-attested photocopy), along with the hospital bill submitted to the competent authorities,” the order states.

How to book an Appointment Online

Navigate to the CGHS portal.
Enter the beneficiary’s identification number and click “Generate OTP.”
An OTP will be sent to the beneficiary’s registered mobile number or to the primary cardholder’s mobile number, if that is the only registered number. Enter your OTP and click “Proceed”.
The screen will display the beneficiary’s information. If the information displayed on the screen is accurate, click “Proceed,” otherwise click “Not You.” In this case, the user must re-login and continue.
Select a specialty, a dispensary, and a physician, then click the “Proceed” button. A beneficiary may schedule an appointment with a GDMO or a Specialist at any of the CGHS Wellness Centers.
A calendar is displayed, and the user must select a date that the selected doctor is available for an appointment. Appointment dates can be selected.
After selecting a date, the top of the screen will display the slot times and available appointments. A beneficiary may select his or her preferred slot.
Select “Proceed to Book Appointment”. The ‘Change the Specialty’ button allows the user to return and make changes.
After clicking “Proceed to Book Appointment,” the beneficiary’s information and the appointment are displayed for confirmation.
Click on “Confirm to Book Appointment,” which will bring up a confirmation status page. The confirmation slip may be printed or an additional appointment may be scheduled. Additionally, the system would send an SMS to the registered mobile phone number.

Treatments Not Covered Under Central Government Health Scheme (CGHS)

Follow-up and In-patient Treatments are not addressed in case of the following:

While treatment can be provided at any hospital during a declared emergency, reimbursement claims must be submitted to the Additional General where the CGHS card is registered.

When medical bills are reimbursed, the beneficiary may be treated at any hospital and the claim amount is limited to the rates specified in the CGHS. The reimbursement claim must be submitted to the Additional General located at the address on the CGHS card.