Central Government
Health Scheme
  • Ayush Benefit
  • Benefits to Central Govt. Employees
  • Benefits to Dependents
Central Government Health Scheme
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Central Government Health Scheme

The Central Government Health Scheme introduced by the Indian government, ensures that citizens have access to affordable and quality healthcare services. It is a comprehensive healthcare program providing medical care, especially to central Government employees, pensioners, and their families for over six decades.

With approximately 42 lakh beneficiaries covered in 79 cities across India, Central Govt Health Scheme offers healthcare services in various systems of medicine, including Indian systems of treatment, and Ayush Treatment.

The CGHS scheme is essential for shielding people and families from the cost of medical costs. It typically functions as a welfare programme which offers a family health benefit of up to Rs. 5 lakhs per year. This plan also pays for hospitalization expenses, medical treatments, operations, and prescription drugs, promoting improved healthcare results and easing financial burdens on individuals.

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Treatments Covered under the Central Govt Health Scheme

CGHS Scheme provides healthcare services through multiple systems of medicine, ensuring a holistic approach to patient care:

  • Allopathic medicine
  • Homeopathic medicine
  • Traditional Indian Medicine (TIM)
  • Ayurveda Unani
  • Siddha
  • Yoga

Key Points About Central Government Health Scheme

Here are some important points about the Central Government Health Schemes (CGHS):

  • The CGHS Scheme was launched in 1954 to provide comprehensive medical facilities to Central Government employees, pensioners, and their dependents.
  • The scheme has expanded over the years and now covers over 79 cities in India.
  • The official CGHS wellness centers are open from Monday through Saturday, 7.30 AM to 2 PM. On all holidays observed by the Central Government, these centers are closed.
  • After enrolling, CGHS recipients will receive a plastic photo ID card with all the necessary policy information, including a special beneficiary number.
  • Pensioners and eligible employees must enroll in this coverage by submitting an application, online as well as offline.
  • For Offline enrollment, visit the nearest wellness center, with the required documents.
  • For online enrollment, both the official websites (www.cghs.nic.in and www.cghs.gov.in) and the wellness centers accept applications.
  • The government considers parents, parents-in-law (in the case of female employees), unmarried sons under the age of 25, unmarried, divorced, and separated daughters, and minor siblings to be dependents for the purposes of receiving medical benefits if their combined monthly income is less than Rs. 9,000 + DA. To avail of CGHS benefits, eligible individuals must enroll in the scheme and pay a nominal monthly contribution. The contribution amount is based on the individual's pay scale or pension, and it ranges from Rs. 250 to Rs. 1,000 per month.
  • The programme offers a family health benefit of up to Rs. 5 lakhs per year for secondary and tertiary medical care.
  • The scheme covers more than 10 lakh families, making it one of the oldest government-funded healthcare programs.

Benefits/Inclusions of the CGHS Scheme

The following benefits are covered under the scheme:

  • OPD treatment is provided at wellness centers (WCs), which includes the expenses of medicines.
  • Specialist consultation is available at polyclinics, government hospitals, and CGHS-listed hospitals.
  • Both OPD and indoor treatments are provided at government and private hospitals under the CGHS. Health checkups can be conducted at Government and listed diagnostic centers.
  • Pensioners and other designated beneficiaries have access to a cashless facility at government-listed hospitals and diagnostic facilities.
  • Expenses for treatment availed in government or private hospitals in emergency situations are reimbursed, as are those for specific treatments advised by government specialists or specialists from private healthcare organizations, duly signed by the Chief Medical Officer/Medical Officer of Wellness Centers.
  • Expenses for treatment availed in government or private hospitals in emergency situations are reimbursed, as are those for specific treatments advised by government specialists or specialists from private healthcare organizations, duly signed by the Chief Medical Officer/Medical Officer of Wellness Centers.
  • Expenses incurred for the purchase of hearing aids, artificial limbs, appliances, etc., are reimbursed after obtaining permission.
  • Family Welfare, Maternity, and Child Health Services are provided under CGHS.
  • The AYUSH treatment includes access to medical advice and medication distribution.
  • Customer Care service is available 24*7.

Individuals eligible for the Central Govt Health Scheme

As a reliable and trusted healthcare provider, CGHS plays a crucial role in ensuring the well-being and health of the Central Government community. Here is the list of individuals who get the CGHS benefit:

  • All employees of the central government who receive wages from the Central Civil Estimates are entitled tovarious benefits and facilities of the policy.
  • Central Government employees dependent on family members.
  • Pensioners and families of the pensioners of the Central Government.
  • Members of Parliament.
  • Ex-vice presidents.
  • Ex-Governors and Lt. Governors.
  • Retired and sitting judges of high courts and the Supreme Court.
  • Freedom fighters.
  • Journalists accredited with the Press Information Bureau.
  • Employees of the Railway Board
  • Delhi Police personnel serving in the capital city.
  • Pensioners and employees of certain statutory/autonomous organizations.
  • Post and Telegraph Department Employees.

Limitations of the Central Health Scheme

To prevent any discrepancies, thoroughly read the policy statement to understand the terms and conditions. Here are a few exclusions of policy:

  • In the case of an emergency, treatment can be sought at any hospital. But claims can only be received by the "Additional General" where the CGHS card is registered.
  • For reimbursement of medical bills, the beneficiary can receive treatment at any hospital. However, the claim amount will be limited to the rates specified under CGHS. The "Additional General" where the CGHS card is registered is the only place the reimbursement claim can be sent.

Premium Paid Under CGHS Scheme

The Central Government has made the CGHS scheme compulsory for their employees. So the enrolled employees will be subject to the following salary deductions from their monthly salaries and the deduction will be based on their level of income:

Level of Pay Premium Paid 
Level 1- 5 Rs 250
Level 6 Rs 450
Level 7-11 Rs 650
Level 12 and above Rs 1000

Before enrolling in the plan, determine your income level and where you fall on the income scale.

Claim Procedure of Central Government Health Scheme

In situations of emergency, the listed hospitals are not permitted to refuse entry to a CGHS beneficiary. These schemes have a simple claim procedure, the claims can be made online as well as offline. Let's go through the CGHS Claim procedure step by step:

Step 1: The person must visit CGHS-listed hospitals across the nation.

Step 2: Pre-operative investigations, two preoperative consultations, two post-operative consultations, room costs, medications, the cost of implants (if necessary), etc. are all included in the treatment.

Step 3: After the treatments are completed in hospitals, within a maximum of six months from the date of discharge, the claim must be submitted along with the required documents to the employee's concerned department and the CMO of the CGHS Wellness Centre.

Step 4: The Wellness Centre will check the information and issue the reimbursement after receiving these documents. The payment will be given to the policyholder in the bank account or via offline mode on the wellness center.

Colour Scheme of the card provided by Central Health Scheme

According to the designation, wellness center provided by the beneficiary, the central govt health scheme cards have the following colour scheme:

Designation Colour of the card
Member of Parliament Red
Serving government employees Blue
Journalists and other beneficiaries of autonomous bodies Yellow
Pensioners, freedom fighters, ex-MPs, and many others. Green

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Central Government Health Scheme: FAQs

1. Who is eligible for the Central Government Health Scheme (CGHS)?

CGHS is available to Central Government employees, pensioners, and their dependent family members.

2. What are the benefits of CGHS?

CGHS provides comprehensive healthcare services, including OPD treatments, specialist consultations, indoor treatments, investigations, and cashless facilities in empanelled hospitals and diagnostic centers.

3. Name the cities in which the operations of this scheme take place.

Agartala, Agra, Ahmedabad, Aizawl, Ajmer, Aligarh, Allahabad, Ambala, Amritsar, Baghpat, Bengaluru, Bhopal, Bhubaneswar, Chandigarh, Chennai, Dehradun, Delhi & NCR, Gandhinagar, Guwahati, Hyderabad, Jabalpur, Jaipur, Jammu, Kanpur, Kolkata, Lucknow, Meerut, Mumbai, Nagpur, Patna, Pune, Ranchi, Shillong, Shimla, Thiruvananthapuram.

4. How do I schedule a health examination under the CGHS Scheme?

CGHS beneficiaries can book appointments online through the CGHS portal by following a simple step-by-step process and they are:

  • Visit the CGHS Official Website.
  • Enter "Beneficiary ID" and then next select the "Generate OTP" option.
  • An OTP will be issued. Enter the OTP and click "Proceed."
  • Beneficiary details will be displayed on the screen. Confirm the details or select "Not You" if they are inaccurate.
  • Choose the options such as Speciality, Dispensary, and Doctor and click "Proceed."
  • A calendar will be displayed with available appointment dates. Select a suitable date.
  • The available time slots will be shown. Choose the desired slot.
  • Click "Proceed to Book an Appointment." Use the "Change the Specialty" button if you need to make any changes.
  • Review the beneficiary and appointment details for confirmation.
  • Simply select "Confirm to Book Appointment." There will be a confirmation status page.
  • You can schedule a different appointment or print the confirmation receipt. An SMS will be sent to the registered mobile number as well.

5. How long would the beneficiaries have to wait before receiving their Central govt health scheme card?

A temporary printout of the card, which the beneficiary can use to access facilities, is given to him/her on the day the beneficiary applies for the CGHS card. In three to four weeks, the plastic card will be created and mailed to the wellness center. The beneficiary can pick up the card from the wellness center.

6. Can stepchildren use the CGHS Scheme?

Yes, if they are the beneficiary's dependents, stepchildren may also be covered by the policy, until they turn 25 years old, when they begin working, or they get married.

7. What will happen to the card if the personnel gets a transfer?

The same card will remain valid in the event that the employee is transferred to another department or another area covered by the CGHS.

8. What documents are needed to submit claims for central health system reimbursement?

The beneficiary is required to provide supporting documentation when filing reimbursement claims, such as a copy of the policy certificate, a discharge summary, medical bills and receipts, ambulance usage invoices, etc.

9. What are the documents required for the enrollment under the Central govt health scheme?

The documents required are:

  • Photo of the Enrollee
  • Enrollee's proofs of residency
  • The presence of dependents, the dependents' ages, etc.
  • Pensioners have to submit attested copies of their Pension Payment Order (PPO), along with other papers. If PPO is not an option, enrollment requires the submission of a provisional PPO or last pay certificate.
  • The completed enrollment form must be signed by the chief medical officer of the wellness center.

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Reviewed By: Naval Goel

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.