Central Government Health Scheme (CGHS) | CGHS Cities | CGHS Card | CGHS Hospital List | Procedures of Registration for CGHS | Cost of CGHS |Rules of CGHS | Test/ Investigation Process under CGHS | Age Limitations in CGHS | Medicines under CGHS | Abroad Treatment under CGHS | Emergency under CGHS | Cashless Treatment under CGHS
The Central Government Health Scheme (CGHS) of India aims to provide health care facilities to the existing and former employees of the Central Government of India. CGHS only provides medical care facilities in some particular areas which are covered by CGHS. This scheme is a noble scheme and is a very important scheme in India which aims to help the Government employees.
Beneficiaries of CGHS
- The Central Government employees of India living in CGHS covered areas.
- The family members/dependents of the Central Government employees of India residing in CGHS covered areas.
- Existing and Former members of the Indian Parliament.
- Former governors & Lieutenant governors of India.
- Freedom Fighters of India.
- Former Vice Presidents of India.
- Existing and Former Judges of Supreme Court & High Courts of India.
- Workers and Pensioners of selected autonomous organizations in the Delhi state.
- Journalists qualified with PIB (In Delhi Only).
- Police Personnel (In Delhi Only).
- Workers of Railway Board.
Selected Cities under CGHS
CGHS is not available in all the cities of India. Currently, the facilities of CGHS is available in 25 cities of India. Mainly, the major cities of India are covered under CGHS along with other important cities.
Meaning of Family in CGHS Card
CGHS allows the family members of a Central Government Employee to avail the facilities of the health scheme. But the term family has a certain meaning in the CGHS cards. Here the term family means and includes:
- Husband or Wife of the eligible person.
- Reliant Family Members: If the Parents, Children, Sisters, Minor brothers and Sisters of a government employee is reliant on them and if they are residing with the government employee, they will be considered as the family members of the government employee.
- The widowed sisters and widowed daughters of a government employee will also be considered as family if they are living with the employee. Also the reliant step-children will be considered as the family members of the government employee.
- If a government employee has a step mother and if she is reliant on the government employee, she will also be considered as a family member of them.
- If a government employee has divorced/separated daughters including minor children of the daughter, they will be conspired as a family member of the government employee.
- In terms of spouse, no clause such as dependency is noted.
A person will only be considered as a reliant member if their income from all sources including Pension is lower than RS 3500 plus amount of DA on basic pension of Rs 3500 per month.
Procedures of Registration for CGHS
The registration process for CGHS is different for a pensioner and an existing employee and below we will know about it.
- A pensioner will be able to get a CGHS card from the office of AD/JD of their city.
- A pensioner will be able to download an application form from the official website of CGHS to apply for CGHS. Otherwise, they will also be able to contact the AD/JD of CGHS of their city to get the form.
- An application in a prescribed format.
- Proof of residence of the pensioner.
- Proof of residence of the dependents of the pensioner.
- Proof of age of son of the pensioner.
- Disability Certificate. (If any)
- Pictures of the beneficiary family members.
- Surrender Certificate(If a pensioner has an active CGHS card)
- Attested copies of PPO
- Attest Copies of Last Pay Certificate
- A draft for required amount towards CGHS contribution.
- Provisional Card.(If PPO isn’t provided)
A pensioner is issued a printout copy of their CGHS card for emergency use on the day they apply for CGHS. Also, the plastic card of CGHS is sent to the card holder pensioner by post.
- Current Employees
If an existing employee wants to apply for CGHS, they will have to submit an application form in a prescribed format along with required photos and documents of their family members to the Ministry/Department/Office where they are currently working. The contacted office will forward the application form of the existing Central Government employee to the additional director of CGHS of that city. A printout will be issued to the employee on the very day and a plastic card will also be sent to them.
Cost of CGHS facilities
The cost of CGHS facilities is different for the serving employees and the pensioners of the central government of India.
For Serving Government Employees
If a central government employee is currently serving in CGHS covered area, they are bound to take the CGHS card. A deduction is made from the salary of the serving central government employees by their department every month. This deduction depends upon the grade pay of the serving employee.
Below we will know about the contribution of each employee towards CGHS according to their grade pay. This rate has been fixed on 1 June, 2009.
|Grade Pay (Rs.)||Contribution (Rs. Per Month)|
|Up To 1650||50|
|7600 and more than 7600||500|
If an individual wants to avail the facilities of CGHS, they are bound to make a contribution towards CGHS. In case a pensioner wants to avail the facilities of CGHS they will also have to make a contribution. They can make a contribution of two types stated below.
- Yearly Contribution: A pensioner will be able to contribute a certain amount of money every year towards CGHS.
- One Time Contribution: A pensioner will be able to make a onetime contribution with the money of 10 years in one go towards CGHS. It will be considered as a life time contribution.
A pensioner will be able to contribute through a demand draft.
A pensioner will be obliged to contributed according to the grade pay they were entitled at the time of their service.
System of the services of Specialists in Dispensaries under CGHS
An individual will be obliged to do their registration prior to their appointment with a specialist in the CGHS Wellness Center. Specialist services are always available in the CGHS Wellness Centre but an individual will be obliged to do their registration firstly. But if an individual has an emergency case they will have to contact CMO i/c dispensary of the CGHS Centre for consultation purposes. An individual will not need prior registration in case of emergency.
Local Dispensary Issues under CGHS
The local dispensary issues under CGHS is handled by a committee which is named Local Advisory Committee. The Local Advisory Committee often fixes several meetings with CMO i/c for discussing the issues of Local Dispensary.
Required time to get CGHS Card
Whether serving or pensioner, a government employee is issued a printed index card of CGHS on the very day they apply for CGHS. The plastic cards are sent to the concerned card holders within 3 weeks. The cards are sent to the residence of the government employees.
In case, an individual haven’t received their card within the required time, they will be obliged to contact the additional director of their City (except Delhi). The citizens of Delhi will need to contact with the Joint Director of CGHS if their card isn’t issued within the required time.
Things to do if CGHS card is lost
If an individual has lost their CGHS card, they will be obliged to submit an application to the AD/JD of their respective city. They will also need to provide two photographs and an IPO for Rs. 50 to issue a duplicate card.
An individual will be able to pay IPO to P.A.O. CGHS.
Things to do if CGHS card has wrong information
In case the details of an individual is not proper in their CGHS card, they will have to go to the Joint Director of CGHS with their card and they will have to tell the Joint Director about the abnormalities of their card if they reside in Delhi. If they don’t live in Delhi, then the individual will have to go to the additional director of their city.
Different Colors of CGHS Card
The color of the top part of a CGHS Plastic card isn’t always the same. The CGHS plastic cards have different colors and it varies according to the designation of the card holder and below we will know about them.
|Color||Designation of Card Holder|
|Blue||Current Government Employee|
|Green||Pensioners. Former Members of Parliament, Freedom Fighters|
|Red||Member of Parliament|
Can a retired Government Employee get the facilities of CGHS?
A retired government employee/a pensioner will be able to get a CGHS card by submitting the form for CGHS with relevant documents. But, the retired employee will be obliged to pay the subscription rates as per the current rate.
Rules of CGHS for married couple
- If the husband is working under Central Government, the wife will also be able to get health care as a member of the husband’s family.
- If the wife is working under Central Government, the husband will also be able to get health care as a member of the wife’s family.
- If both the husband and wife are working under Central Government, then the higher earning spouse will have to make the card and the other spouse will be eligible to get health care as a member of their spouse’s family.
- If the husband and wife both have dependent brother/sisters in their family, they will be able to make two separate cards and they will be able to include their respective family members as dependents in their card.
Transfer of Ownership of CGHS Card (To Spouse Name)
The ownership of a CGHS card is transferable. After the death of their spouse, a husband/wife will be able to transfer the CGHS card on their name. In this case, an individual will have to provide required documents and the Additional Director of their concerned city will transfer the card in their name.
The required documents are:
- An Application in a prescribed format.
- Proof of family pension.
- Prescribed Contribution. (In case the card is not for life time)
The additional director will edit the data base on the computer and will transfer the ownership of the card.
No extra charges will be taken from the husband/wife in case their spouse had a life time card. But in case the dead spouse hadn’t issued a life time card, the new owner of the card will have to pay the subscription fees of 10 years for getting a life time card. In case, the dead spouse had paid the contribution fees of some years, the new owner of the card or the husband/wife of the dead spouse will have to pay the contribution of the remaining years.
Transferring CGHS card from one Wellness Centre to another in the same City
If an individual wants to transfer their CGHS card from one CGHS Wellness Centre to another, they will be obliged to provide the proof of their changed residence to the CMO i/c in case their residential address is changed. After an individual has contacted CMO i/c, they will take the necessary steps in changing the Wellness Centre of an individual.
But a CGHS card is mainly a computerized information and thus no separate permission will be required from an individual if they use the card in another city. An individual will be able to get the facilities of CGHS from any of the WC Centre’s in India. In case an individual faces any problem, they will be able to contact the additional director of the respective city.
Test/ Investigation Process under CGHS
If an individual is advised by a Government Specialist/ Medical Officer in a CGHS Wellness Centre to go through several tests, they will not need any further permission letter to go through those tests. An individual will be able to perform these tests from any CGHS empanelled laboratories on the basis of that advice. An individual will need to provide the original/photo copy of their prescription along with their CGHS card.
If an empanelled diagnostic center has urged an individual to go through some tests, they will need to provide the original/self–attested copy of their prescription given by the specialist and the copy of their CGHS card.
Deleting Name of Sons of the Government Employees under CGHS
CMO i/c will be competent to delete the name of the sons of the government employees. If a son of a government employee is aged 25 or above, CMO i/c will delete their name. The computer system of CGHS doesn’t allow sons aged 25 or above to avail health care facilities under CGHS.
Transfer of Card for Pensioners (From one city to another) under CGHS
If a pensioner is shifting from one CGHS covered city to another, they will have to apply for the transfer of their CGHS card. A pensioner will be obliged to contact the additional director of their concerned city for the transfer of their card. After a pensioner has contacted their additional director, their card will be transferred online and a receipt will be provided to the pensioner. The pensioner will have to show their receipt to the additional director of their new city and thus they will be able to transfer their card. In case a pensioner has a life time card, they will not be obliged to pay any additional contributions for their card.
Age Limitations for Sons/Daughters as dependant under CGHS
- If a son of a government employee reaches the age of 25 he will not be eligible for health facilities under CGHS. Also, he will be ineligible for CGHS if he is married or has started earning.
- But in case a son of a government employee is physically disable and suffering from a permanent disability, he will be able to avail the facilities of CGHS. The disabilities can be physical/mental such as blindness, low vision, leprosy-cured, hearing impairment, locomotor disability, mental retardation, mental illness, etc. In this case a government employee will require a disability certificate from the medical board.
- A daughter of a government employee is eligible to get health facilities under CGHS until she starts earning or gets married whichever is earlier irrespective of her age.
Rules for Step–Children under CGHS
If the step–children of the government employee is included as a dependent on the card of the government employee, the step–children will be able to get health facilities under CGHS. They will also have to bear the age limitation rules.
Rules for including in–laws under family members for CGHS
- If the government employee is a man, he will not be allowed to include his in–laws as his family members for CGHS.
- If the government employee is a women, she will be allowed to include either her parents or her in–laws as her family members for CGHS.
Medicines under CGHS
CGHS has a certain formulary named CGHS Formulary. A specialist/ pharmacist will only be allowed to provide those medicines which are included in the formulary of CGHS.
Life Saving Drugs under CGHS
An individual will be able to get lifesaving drugs from CGHS Medical Store if they are in Delhi. In other cities, an individual will have to submit their request to the additional director of their city.
Required Documents for Life Saving Drug
- Firstly an individual will be requiring a medicament from a specialist of a Government Hospital or CGHS empanelled private hospital.
- Then an individual will need a photocopy of their token card.
- If an individual has taken prescription from a private hospital, they will need a copy of permission.
- An individual will require the original copy of their utilization certificate.
Also, an individual will be able submit their indent online through CHS WC.
Guidelines for Anti–Cancer related Medicines under CGHS
The supply of Anti-Cancer and related medicines varies from case to case and the guidelines are different from case to case.
Guidelines for Issue of Medicine under CGHS
- CGHS will be obliged to supply the medicines as per the existing brand/generic name.
- In case an advised medicine by a specialist is not available, they must be dented by the same brand name by the Local Authorized Chemist.
- The medicines for Anti–Cancer are provided on a case to case basis.
- For treatment of Chronic Illnesses, the medicines should be supplied for a maximum time of three months.
- Issue of medicines should be restricted for a period of six months in case a beneficiary is going abroad.
- Dietary supplements will not be provided by CGHS. Also, insulin pens are not supplied by CGHS but insulin pen catridges are supplied.
In case a dispensary isn’t providing the medicines to an individual they will be able to take the following steps.
- Contact the CMO i/c of their CGHS Wellness Centre
- Contact the additional director of CGHS of their city.
In case some medicines are not available in the CGHS Wellness Centre and an individual needs them urgently, CMO i/c will issue an authorization form which will allow the individual to buy medicines for 3/5 days directly from local chemists. But if the medicine is not even supplied by the local chemists, an individual will still be able to use the authorization form provided by CMO i/c and they will be able purchase their required medicines from open market and they will also be able to claim compensation from the Local Authorized Chemists.
Also, if an individual notices something abnormal about the medicines, or finds out that the quality of the medicines are poor, they will be able to replace it from the Wellness Centers.
Required time for getting medicines under CGHS
The issues medicines are provided to an individual immediately. In case, the medicines are not available and needs to be dented through Local Authorized Chemist, the medicines are usually provided the next day.
Usually, medicines are issued on basis of the prescriptions provided by the Government Doctors. But in some permitted cases the medicine is issued by the prescriptions of empanelled hospitals. But the empanelled hospitals are also obliged to provide available brand/generic name of the medicine.
Providing Medicines in one go under CGHS
- If an individual has a valid prescription, they will be able to get issued medicines up to three months in one go.
- If an individual is travelling a foreign country, they will be able to get issued medicines up to 6 months in one go in respect of chronic illness. But in this case an individual will need to provide the following documentaries.
- An application for obtaining permission from AD/JD of their city.
- Copy of Valid CGHS card.
- Valid prescription for six months.
- Proof of station leaving.
Abroad Treatment under CGHS
If an individual is required to go through an emergency treatment while they are on an abroad tour, they will have to bear the expenses of their treatment. An individual will also be unable to claim for any reimbursement for a treatment taken in a foreign soil.
Odd Hour Emergency under CGHS
If an individual is unwell in the odd hours like late at night, they will have the option to go to their nearby 24 hour functional dispensaries or a nearby Government hospital or an empanelled private hospital or any of the private hospitals in case of emergency.
If the doctor are not available in the CGHS Wellness Centre, an individual will be able to contact CMO i/c of the respective Wellness Centre. Also, an individual will be able to contact the Additional Director of CGHS of their concerned city. All the beneficiaries having a Valid CGHS card will be able to get treatment in case of emergency in the Empanelled Hospitals.
Different Ward facilities under CGHS
All the CGHS card holders are not endorsed with the same Ward facilities. It differs as per the basic pension/basic pay of a government employee. Below we will know about it.
|Basic Pay (Rs. Per Month)||Ward Facility Type|
|Up to 13, 950||General Ward|
|13, 960– 19, 530||Semi–Private Ward|
|19, 540 and above||Private Ward|
Cashless Treatment under CGHS
Hospitals must provide credit facility or cashless treatment to certain categories of personnel including their dependent family members. Cashless treatment must be provided to the Parliament Members, Pensioners, Former Vice-Presidents, Former Governors, Former Prime Ministers, Former MP’s, Freedom Fighters of the Central Government. Also the Current employees of Ministry of Health & Family Welfare including subordinate offices under the ministry should be provided cashless treatment in case of emergency.
Step–Motherly Treatment under CGHS
Under CGHS, all the private and empanelled hospitals are urged to provide step-motherly treatment. In case any empanelled hospital refuses to provide step–motherly treatment, an individual will be able to do the following things.
- Contact CMO i/c of the CGHS Wellness Centre
- Contact the additional director of CGHS of their city.
Permission for treatment for the employees of Autonomous Bodies under CGHS
If an employee of an autonomous body has a CGHS card, they will be obliged to consult a Government Specialist. If the government specialist advises the individual to go through treatment procedures, they will have to get the permission for getting treatment from the Head of their Autonomous Body. The rule is same for the pensioners of Autonomous bodies with a CGHS card.
Medical Claim Clarification under CGHS
If the documents of a pensioners are complete and valid the medical claims of the pensioners are usually cleared within 45 days.
But if the documentation is complete but the claim hasn’t been cleared, a pensioner will be able to contact the additional director of their concerned city on any Wednesday between 11 A.M. and 1 P.M to complaint about the unnecessary delay of their Medical Claim Clarification.
Reimbursement of money in case of emergency under CGHS
If a pensioner or a family member of an individual is admitted into a private hospital in state of emergency, they will be able to apply for reimbursement of money. They will need to follow the procedures mentioned below.
- Firstly, an individual will need to apply to CMO i/c.
- An individual will have to provide the filled MRC forms as per Check list.
- An individual will also need to provide a copy of their discharge summary.
- An individual will also need to provide their hospital bills with break–up.
- An individual will also need to provide their original receipts.
- An individual will also need to provide the copy of their valid CGHS card.
- An individual will also need to provide the documents issued by the hospital.
- All these documents should be provided with the application made to CMO i/c.
The MRC forms are available with CMO i/c and alternatively an individual will also be able to download it from the official website of CGHS. The serving employees will have to submit the documents to their department.
Also, if an individual takes health care facilities from a private hospital due to medical emergency in another city, they will be provided a reimbursement as per the existing CGHS rate.
An individual will be obliged to claim for duplicate papers of their bills and receipts in case their original ones are lost. They will be able to claim through an affidavit. Details of draft for affidavit is available in CMO i/c in a medical claim form. Alternatively, an individual will be able to download the form and know the details.
Procedures of getting MRC for the dead CGHS card holder
The spouse of a dead CGHS card holder will be able to get MRC, if their spouse lost their lives in a hospital. For that the spouse of the card holder will have to apply to CMO i/c with following things.
- MRC Forms duly filled as per Check List
- Copy of Death Summary
- Hospital Bills with Break–Up
- Original Vouchers
- Copy of CGH Card
- Death Certificate
- Affidavit on Stamp Paper with the card holder’s spouse being the legal heir and NOC from other legal heirs
- Copies of other documents issued by hospital.
The spouse of a card holder will be able to get the details of the Medical Claim form from the CMO i/c or from the website.
Rule for reimbursement without CGHS card for pensioner
A pensioner is given a time period of three months after their retirement for acquiring the facilities of CGHS. If a pensioner takes treatment or makes expenses due to health care in the grace period, a reimbursement will be provided to them if they have applied for CGHS or obtained CGHS Card with all the required documents within one month of expiry of the grace period of 3 months.
If a pensioner doesn’t apply for CGHS Card in their grace period, no reimbursement will be given to them.
If an individual pensioner applies for CGHS before taking a treatment within their grace period, they will be provided reimbursement for that treatment.
IVF Treatment under CGHS
CGHS has approved IVF treatment. An individual willing to take IVF treatment will be able to gather the details of IVF treatment from the official website of CGHS.
Compensation of Ambulance Charges under CGHS
Ambulance charges are compensable within the city. If the treating doctor issues a certificate that conveyance by any other mode would have endangered the patient’s life or would have exaggerated the condition of the patient, then the ambulance charges will be compensated under CGHS.
CGHS & Mediclaim Insurance Policy
If an individual has a Mediclaim Insurance Policy and they receive an emergency treatment in a private hospital and some of the bills are paid by the insurance, an individual will still be able to get balance from CGHS. Firstly, bills will be submitted to the insurance company and the duplicate bills with certificate from Insurance Company will be claimed from CGHS by the pensioner. CGHS will provide reimbursement at CGHS rates. The serving employees will have to contact their concerned departments for getting the balance from CGHS.
CGHS in Private Hospitals
CGHS is only provided on the Government hospitals and the empanelled private hospitals under CGHS but the non-empanelled private hospitals aren’t bound to provide CGHS to an individual. But if an individual faces an emergency and takes treatment from a private non–empanelled hospitals, they will be given reimbursements as per normal CGHS rates.
But it is often seen that the private hospitals charge the individual at different rates and sometimes it may be higher than the actual rate of CGHS and in these cases, an individual will only be able to get the money from CGHS according to the actual rate of CGHS and the whole amount of money will not always be provided in these cases.
Surgeries at Private Empanelled Hospitals under CGHS
An individual will have to obtain advice from a Government Specialist/ CMO i/c before doing a surgery. Pensioners will have to apply to CMO i/c of Wellness Center for getting the permission/advice before doing the surgery. Existing Government employees will have contact their respective department/office.
The Government specialist will only advise for the surgery/specific treatment procedure and they will not refer it to any empanelled hospital for further procedures. After taking permission/advice from the Government specialist, an individual will be able to go through their surgery from any of their favorite empanelled hospital.
But no Government specialist/ CMO in charge will have the power/ability to refer any patient to private empanelled hospitals.
Treatment Facilities for Accredited Journalist under CGHS
An accredited journalist will be able to opt for OPD treatment from dispensaries and treatment from DR.RML Hospital. But they will not be able to seek medical care from the Private Hospitals (Empanelled). Journalists will also be unable to get cashless treatment and they will also not be allowed for reimbursement for treatment from empanelled hospitals.
Facilities for Pensioners in a Non–CGHS area
- If a pensioner is living in an area which is not covered by CGHS, they will be able to get covered under CGHS from their nearest CGHS covered area.
- If a pensioner is residing in a Non–CGHS area, they will be able to get a Fixed Medical Allowance of Rs 500 per month and they will not be forced to opt for CGHS.
- If a pensioner is residing in a Non–CGHS area, they will be able to get a Fixed Medical Allowance of Rs 500 per month for OPD treatment and they will also be able to get CGHS card from their nearest CGHS covered city. No OPD medicines will be provided to the pensioner in this case
- Although a pensioner may be residing in a non-CGHS area, they and their family members will be able to get treatment from Government Hospitals under CGHS if they have opted for a CGHS card from their nearest area. They will also be able to claim for reimbursement by applying to the Additional Director of the concerned city from where they have issued their card.
- A pensioner will be able to get emergency treatment from any hospitals and they will be able to claim for the reimbursement to the AD/JD of the concerned city from where they have issued the card. The compensation will be provided as per the existing rates of CGHS in that city.
An existing employee of the Central government will be obliged to take a CGHS card from the city where they are currently working but a pensioner will have the luxury to get the CGHS card from any of the cities covered under CGHS.
CGHS Wellness Centers for General People
If anybody doesn’t have any CGHS card or they are also not included as the dependent members of their family members, they will still be able to get free consultation if they are aged 60 and above. This free consultation is provided at 26 CGHS Wellness Centers in the capital of India. The free consultation is usually provided from 1 P.M. to 2 P.M.
Emergency Treatment under CGHS
The following treatments will be considered as an emergency treatment.
- Acute Coronary Syndromes
- Unstable Angina
- Ventricular Arrhythmias
- Paroxysmal Supra Ventricular Tachycardia
- Cardiac Temponade
- Acute Left Ventricular Failure
- Severe Congestive Cardiac Failure
- Accelerated Hypertension
- Complete Heart Block and Stoke Adam attack
- Acute Aortic Dissection.
- Acute Limb Ischemia
- Rupture of Aneurysm
- Medical and Surgical shock and peripheral circulatory failure
- Cerebro-Vascular attack-Stokes
- Sudden unconsciousness
- Head injury
- Respiratory failure
- decompensated lung disease
- Cerebro-Meningeal infections
- Acute Paralysis
- Acute Visual loss
- Acute Abdomen pain
- Electric Shock
- Road Traffic Accidents with injuries including fall.
- Severe Hemorrhage due to any cause,
- Acute poisoning
- Acute Renal Failure.
- Acute abdomen pain in female including acute Obstetrical and Gynecological emergencies.
- Any other life threatening condition
In case a patient is identified with a serious problem, the hospital will not be able to demand any advance payment from the beneficiary or their family and will provide cashless treatment and credit facilities to the patient regardless they are a serving/retired employee of Central Government. In case of emergency, the hospitals will provide the reimbursement bills to concerned Department/CGHS.
If a hospital refuses to provide cashless treatment, they will be disqualified from the list of empanelled hospitals under CGHS. A hospital will be liable to identify the injuries/seriousness of the patient and they will be liable to take emergency actions for saving the life of the patient. The hospitals will also be liable to take required facilities for saving the life of the patient and they will be forced to begin the treatment of the concerned patients without taking a pre–permission from CGHS board.
- Stents are not included in this scheme