Central Government Health Scheme (CGHS) For Government Employees in India
India has a dynamic healthcare industry that will only progress further in the coming years. However, like most healthcare systems worldwide, India’s healthcare has its fair share of shortcomings and tremendous scope for improvement.
Moreover, a considerable proportion of its populace remains alienated from the system, and equal access to healthcare for all citizens remains a major concern for the country. The government, therefore, aims to combat this issue through a number of programmes and schemes, one of which is the CGHS. The CGHS full form is Central Government Health Scheme.
Allow us to offer you a clearer picture of this scheme so that you can understand its ins and outs.
What is the Central Government Health Scheme?
The Government of India in 1954 introduced the Central Govt Health Scheme or CGHS as a healthcare facility for the former and current employees of the central government.
This scheme was explicitly mapped out for the betterment of individuals by rendering comprehensive medical care to its eligible beneficiaries.
Let’s take a closer look at the components of the Central Government Health Scheme:
- Dispensary services, including domiciliary care
- Consultation facilities by specialist doctors
- Laboratory examinations such as ECG and X-ray
- Hospitalisation
- Purchase, supply, and storage of medicines and other medical requirements
- Health education to the beneficiaries
- Maternity and child care
- Family welfare services
Furthermore, CGHS extends health care by way of several systems of medicine, namely:
- Homeopathy
- Allopathy
- Indian system of medicine
- Ayurveda
- Yoga
- Unani
- Siddha
Eligibility Criteria to Apply for CGHS
Wondering if you can avail the benefits of this scheme?
As aforementioned, CGHS is offered to central government employees only. Moreover, this scheme covers the following persons:
| Central Government Pensioners and their families who benefit from Contributory Provident Fund |
| Central Government employees residing in CGHS covered areas, and their family members |
| Employees of the Railway Board |
| Pensioners of Central Government and their families |
| Post and telegraph department employees |
| Journalists who are members of the Press Association |
| Civilian employees of Defence |
| Freedom Fighters and their family members receiving a pension under the Sainik Samman Scheme |
| Widows of Central Government pensioners, in receipt of family pension |
| Delhi Police personnel and their families |
| Central Government employees deputed to semi-government or autonomous bodies receive significant finance by or grant from the Central Government |
| Ex-Vice Presidents of India and their families |
| Ex-Lt. Governors and Governors, as well as their families |
| Families of Governments employees transferred to a non-CGHS area |
| Members of Parliament, including their families |
| Former members of Parliament |
| Kendriya Vidyalayas Sangathan’s employees stationed at Delhi and NCR, Chennai Kolkata, Bengaluru, Mumbai, and Hyderabad |
| Judges of the Supreme Court and High Court of Delhi |
| Former Judges of High Courts and the Supreme Court |
| IAS Officer's family members on the North-Eastern Cadre are staying back in Delhi even after the officer's repatriation to the North-Eastern Cadre. This is also applicable to the family members of IAS Officers of J&K Cadre |
| Family of a Central Govt. employee and CGHS beneficiary who stay back in CGHS covered area after the employee’s posting to North Eastern region |
| Industrial Staff working in establishments run by Ministries or Departments of the Central Government |
| Central Government’s Parliamentary secretaries and their families |
| Family members of deceased Ex-Members of Parliament |
| Pensioners of Ordnance factories |
| Indian Pharmacopoeia Commission’s employees and their families |
| Retired Divisional Accountants of the Indian Audit and Accounts Department whose pay and pension are borne by state governments |
| Members of the Staff Side of the National Council of the Joint Consultative Machinery, even though not serving as Central Government employees |
| Serving and retired Railway Audit Staff |
| CISF and CAPF personnel posted in CGHS-covered areas and their families |
| Serving and retired Divisional Accountants and Divisional Accounts Officers |
| Supreme Court Legal Services Committee’s employees |
What are the Advantages of CGHS?
The Central Government Health Scheme comes with the following advantages for beneficiaries:
Now, let’s get into the monetary aspect of this scheme.
What is the Cost of Central Government Health Scheme?
The cost of availing of the Central Government Health Scheme varies depending on one’s employment status. Here is how it is classified:
- For serving employees - A central government employee residing in a CGHS covered region must possess a CGHS card. The department of this employee makes monthly deductions from his/her salary depending upon the pay grade. This amount is contributed to the CGHS facilities.
- For pensioners - If pensioners wish to avail the facilities of CGHS, they shall make a contribution based on the pay grade they were entitled to at the time of service. Moreover, this contribution can be made as a yearly or one-time/lifetime contribution.
The table below summarises the CGHS rate list:
Furthermore, private hospital wards empanelled under the Central Government Health Scheme are available based on one’s pay grade. This ward entitlement under the scheme is as follows:
- Private ward: Rs.63,101 and above
- Semi-private ward: Rs.47,601-Rs.63,100
- General ward: Up to Rs.47,600
Moreover, when it comes to a revised monthly subscription for the CGHS facility, the corresponding levels in the matrix as per the 7th CPS and their respective contribution per month are as follows:
- Level 12 and above: Rs.1000
- Level 7-11: Rs.650
- Level 6: Rs.Rs.450
- Level 1-5: Rs.250
Referral from a medical practitioner is necessary for CGHS beneficiaries aged under 75 years seeking OPD consultation. However, those over 75 years, old do not need any referrals to acquire the said medical consultation.
Benefits of the Central Government Health Scheme (CGHS)
The Central Government Health Scheme (CGHS) offers several advantages to its beneficiaries. The following services are the benefits of CGHS:
What is a CGHS card?
The Government of India provides all CGHS beneficiaries and their dependents with a photo ID plastic card called a CGHS card. It contains a unique beneficiary identity number, which an individual must produce to CGHS facilities at any point.
This card is white with a varying-coloured stripe at the top that depicts the cardholder’s status. Therefore, this strip can be any of the following colours:
- Yellow: A journalist of an autonomous company
- Blue: A serving government employee
- Red: A member of the Parliament
- Green: A pensioner, ex-MP, retired personnel, or a freedom fighter
CGHS cards remain valid until a beneficiary’s retirement date. To extend its validity post-retirement, one must make his/her contribution a year before the completion.
Additionally, after the expiration of this card, the cardholder must surrender the card to the concerned department.
In case you want to renew your CGHS card, you must submit a form and the necessary details.
Under no circumstance can this card be transferred from one employee to another. Furthermore, missing this card will attract penalties, and in extreme cases, strict disciplinary actions.
How to Apply for Central Government Health Scheme (CGHS) Card?
If eligible to be a CGHS beneficiary, you can apply for a CGHS card either from an authorised wellness centre or through online registration. If taking the online route, simply visit the CGHS portal and submit an application form. The Central Government Health Scheme is available to current and retired Central Government employees. The application process steps to follow are as follows:
- Step 1: To start enjoying the plan's benefits, register first.
- Step 2: Open the CGHS official website on your PC or phone.
- Step 3: Download the application form by selecting the "Downloads" option.
- Step 4: A page requesting your personal information will be sent to you. Fill that out appropriately.
- Step 5: Send the application to the Additional Director's office in any of the CGHS-covered cities, along with your most recent photo and the required paperwork.
So, You can easily procure a CGHS card online if you reside in any of its applicable cities. Some of these cities include:
| Agartala | Agra | Imphal | Raipur |
| Kozhikode | Aligarh | Allahabad (Prayagraj) | Ambala |
| Amritsar | Ranchi | Rajahmundry | Baghpat |
| Bengaluru | Bareilly | Berhampur | Jaipur |
| Kannur | Lucknow | Kanpur | Vishakhapatnam |
| Dehradun | Delhi and NCR | Hyderabad (Trichy) | Mumbai |
| Ahmedabad | Srinagar | Guwahati | Dibrugarh |
Documents required for CGHS card
Premised upon your status, procuring a CGHS card calls for you to furnish the following documents:
- Pensioners
- Demand draft
- Copies of Provisional PPO/PPO/Last Pay Certificate
- For serving employees
- Residential proof
- Age proof of dependent(s)
- Dependent’s proof of stay
- In case a dependent is differently-abled, a certificate of disablement from a valid authority
Presently, this scheme covers 74 cities all across the country and comprises 38.5 lakh beneficiaries.
The Central Government Health Scheme, through an array of healthcare benefits, extends a helping hand to a sizable chunk of the Indian populace.
Medical Packages Under CGHS
The CGHS has various packages under it. Follow the list below to see the detailed number of packages per procedure or condition:
How to Find a Hospital List Under CGHS Scheme?
To find a list of hospitals under the Central Government Health Scheme (CGHS), follow these steps:
- Step 1: Visit the Official CGHS Website: Go to the official CGHS website.
- Step 2: Navigate to the Empanelled Hospitals Section: Look for the section related to "Empanelled Hospitals" or "Hospital's List" on the homepage or under the "Services" or "Beneficiaries" tab.
- Step 3: Select Your City or Region: Choose your city or region from the dropdown menu or search box to get a list of hospitals in your area.
- Step 4: Download or View the List: The website usually provides options to download the list in PDF format or view it online.
- Step 5: Contact the Local CGHS Office: For additional assistance or specific queries, you can contact the local CGHS office or wellness centre.
- Step 6: Check Updates: The list of empanelled hospitals can be updated regularly, so check the latest information periodically.
The CGHS helpline or local office can provide guidance and additional support if you encounter difficulties.
Hospitalisation Process Under CGHS Scheme
Under the Central Government Health Scheme (CGHS), the hospitalisation process begins with verifying eligibility and obtaining a referral from a CGHS empanelled doctor, if applicable. Upon selecting a CGHS-empanelled hospital, you must inform the hospital about your CGHS coverage for verification and pre-authorization if required.
During hospitalisation, ensure that the treatment aligns with CGHS guidelines. After discharge, collect all relevant documents, including the discharge summary and bills. For treatments in non-empanelled hospitals or additional expenses, submit a reimbursement claim to the local CGHS office with the necessary documents for processing.
How to Book a Doctor’s Appointment Under the Central Government Health Scheme?
To schedule a medical consultation, you must make an online appointment with the centre by following the instructions provided:
- Step 1: Go to CGHS's official webpage.
- Step 2: Enter your beneficiary ID and the supplied OTP to log in. Your details will be displayed to you.
- Step 3: If your information is accurately shown, click "Agreed." The "Not me" choice, instead, is another alternative.
- Step 4: After turning to the following page, you must fill in the CGHS dispensary, doctor, and specialism.
- Step 5: Depending on the availability of the doctor you have chosen, choose the day of your appointment.
- Step 6: Choose the time slot that you like.
- Step 7: Select the option labelled "Proceed to Book Appointment."
- Step 8: Examine the provided information, then select "Confirm.”
The system will generate the confirmation receipt. You can print it off and bring it to the centre on the day of the appointment.
How to Link CGHS with ABHA for Central Government Employees?
According to new instructions from the Ministry of Health and Family Welfare, beginning on April 1, 2024, linking CGHS beneficiary ID with ABHA with the Ayushman Bharat Digital Mission is required.
Here are the steps to connect CGHS with ABHA ID:
Step 1: Navigate to Beneficiaries, and then the Beneficiary login is at https://cghs.nic.in.
Step 2: Log in using your beneficiary ID after entering your password and captcha information.
Step 3: Update and create/link your ABHA ID now. bIf you don't have an ABHA ID, choose "I don't have an ABHA ID."
Step 5: Select 'Link Using ABHA Number' if you already have an ABHA ID number.
Step 6: Enter your Aadhaar number and use an OTP to finish the verification procedure. You can print your ABHA card if the linking process is successful and all the information is correct.
The ABHA system provides a seamless digital platform that revolutionises health records management. With the help of the 14-digit ABHA ID, users may easily record health data, manage insurance information, and even grant access to preferred healthcare providers. This development is a significant step forward for India's healthcare sector's digital revolution.
CGHS Toll-Free Number and Address
Toll Free No.: 1800-208-8900
Address: H5FJ+HM2, MS Flats Rd, Sector 13 R K Puram, Sector 13, Rama Krishna Puram, New Delhi, Delhi 110022
One of the critical programs that can quicken India's healthcare ecosystem's development is CGHS. You can view information on different licensed medical professionals. By giving Indian individuals a CGHS health card, the program seeks to enhance their access to healthcare. The Central Government Health Scheme, through an array of healthcare benefits, extends a helping hand to a sizable chunk of the Indian populace.
FAQs about Central Government Health Scheme
Is the CGHS card valid all over India?
CGHS card is valid in all CGHS Wellness Centers (WCs) in the applicable cities across India. Therefore, a cardholder can avail CGHS benefits at any of these facilities and regions.
Is CGHS contribution taxable?
The amount of contribution made to the CGHS qualifies for deduction under section 80D of the Indian Income Tax Act. The maximum deductible amount stands at Rs.25,000 in a financial year.
Is there any age limit for daughters/sons as dependent on CGHS cards?
Both sons and daughters are eligible to avail CGHS facilities till he/she starts earning, attains the age of 25 years, or gets married, whichever is earlier.
How can I monitor my refund from CGHS?
Using the claim number, users can access the claim's status in the CGHS computer module. At every level of the MRC processing, recipients will also receive SMS messages. The CGHS website now shows details about claims over a month.
What is the CGHS maximum limit?
The Central Government Health Scheme, or CGHS, is a health insurance program that covers medical expenses up to Rs. 5 lakhs for central government employees.
What does a CGHS card look like?
The CGHS card is white with a coloured stripe at the top. The four colours of the strips are yellow, green, blue, and red.
For whom is a CGHS card appropriate?
The program is open to Central Government employees and their families and to Central Government pensioners and their families. Participants must live in cities with accessible CGHS amenities and have a current CGHS card.
How can I obtain a CGHS plastic card?
For a plastic card under the Central Government Health Scheme (CGHS), new hires and retirees of the central government may apply online. To apply for CGHS plastic cards, government employees and pensioners must fill out an online form.
What is the duration of a refund claim?
Reimbursement claim processing times can differ. The claim settlement process can take up to 21 days on average.
What is the CGHS rule for those who are older than 75?
This ministry was considering elderly CGHS beneficiaries, and it has been decided that going forward, CGHS Pensioner beneficiaries (Primary Card holders) who are 75 years of age or older will be able to have an "Annual Health Check-up" at CGHS impanelled hospitals.
Does CGHS offer “plans”?
CGHS does not provide different "plans" in the conventional sense. Nonetheless, the program covers many medical needs, such as out-of-pocket visits, tests, and medications, inpatient hospitalisation fees, AYUSH therapies, and maternity and paediatric healthcare.
How do seniors use the CGHS?
To utilise CGHS services, retirees may pay yearly contributions or a single, ten-year commitment for lifetime validity.
What is a CGHS card's beneficiary ID?
The Beneficiary Identification System (BIS) can identify, verify, and validate the CGHS beneficiaries, who are pensioners and dependents. Application Program Interfaces (APIs) integrate the BIS with the CGHS NIC database.
Does the Central Government Health Scheme provide coverage for maternity?
Yes, the Central Government Health Scheme (CGHS) provides coverage for maternity periods.
Can I use my CGHS Card outside of CGHS cities?
Yes, you can use your CGHS (Central Government Health Scheme) card outside CGHS-covered cities, but the facilities might be limited. You can avail yourself of treatment at private hospitals and diagnostic centres that are part of the CGHS network, even if they are not in a CGHS city.
How do I obtain my misplaced CGHS card?
Upon losing the card, the beneficiary must notify the police and the CGHS officials. To get a duplicate copy of the card, you must provide a copy of the FIR, an application to the Additional Director, and a penalty cost of Rs 50.