Central Govt. Health Scheme

Central Government Health Scheme (CGHS)

The Central Government Health Scheme (CGHS) is a government-funded healthcare scheme that provides cashless medical treatment and reimbursement facilities to eligible Central Government employees, pensioners, and their dependent family members. It offers OPD consultations, hospitalization, medicines, diagnostic tests, maternity care, and AYUSH treatments through a network of CGHS Wellness Centres and empanelled hospitals across India.

With approximately 42 lakh beneficiaries covered in 79 cities across India, the CGHS offers healthcare services in various systems of medicine, including Indian systems of treatment and AYUSH.

The CGHS scheme is essential for shielding individuals and families from high medical expenses. It functions as a welfare programme, providing cashless treatment and medical reimbursement as per approved CGHS package rates. Unlike regular health insurance, it does not offer a fixed sum insured. This plan also covers hospitalization expenses, medical treatments, operations, and prescription drugs, promoting improved healthcare outcomes and easing financial burdens.

Treatments Covered Under the Central Government Health Scheme

The 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 the Central Government Health Scheme

Here are some important points about the Central Government Health Scheme (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 2:00 PM. These centers are closed on all holidays observed by the Central Government.
• After enrolling, CGHS recipients receive a plastic photo ID card with all necessary policy information, including a special beneficiary number.
• Pensioners and eligible employees must enroll in this coverage by submitting an application, both online and offline.
• For offline enrollment, visit the nearest wellness center with the required documents.
• For online enrollment, applications are accepted on the official websites (www.cghs.nic.in and www.cghs.gov.in) and at wellness centers.
• The program offers a family health benefit of up to ₹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.

Who Is Considered a Dependent Under CGHS?

Under the Central Government Health Scheme (CGHS), certain family members can be covered as dependents if they meet the eligibility conditions prescribed by the government. Eligible dependents include:

• Spouse
• Dependent children (including unmarried sons up to the prescribed age limit and unmarried, divorced, or widowed daughters, as per CGHS rules)
• Dependent parents
• Dependent parents-in-law (for eligible female beneficiaries, where applicable)
• Dependent siblings (in eligible cases)
• Family members with disabilities who fulfill CGHS dependency criteria
• Other family members eligible under CGHS guidelines

Income Criteria for Dependents

To qualify as a dependent under CGHS, eligible family members must satisfy the income criteria notified by the Central Government. At present, parents, parents-in-law, siblings, and other eligible dependents are generally considered dependent if their monthly income is less than ₹9,000 plus the applicable Dearness Allowance (DA), subject to the latest CGHS guidelines. Always refer to the latest government notifications, as dependency conditions and income limits may be revised from time to time.

Benefits and Inclusions of the CGHS Scheme

The Central Government Health Scheme (CGHS) covers OPD care, hospitalization, medicines, diagnostic services, maternity care, and AYUSH treatments, making it one of the most comprehensive healthcare schemes for government employees and their families.

• OPD treatment is provided at wellness centers (WCs), including 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 received in government or private hospitals in emergency situations are reimbursed. This also applies to 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.
• AYUSH treatment includes access to medical advice and medication distribution.
• Customer care service is available 24/7.

How to Enroll in the Central Government Health Scheme

Enrolling in the Central Government Health Scheme is simple. Follow these steps:

1. Visit the official CGHS website or the nearest Wellness Center.
2. Fill out the enrollment form (online or offline).
3. Submit required documents (ID, address proof, photos, etc.).
4. Pay the applicable monthly contribution.
5. Receive your CGHS plastic card with beneficiary details.

Individuals Eligible for the Central Government Health Scheme

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

• All Central Government employees who receive wages from the Central Civil Estimates are entitled to various benefits and facilities of the policy.
• Dependent family members of Central Government employees.
• Central Government pensioners and their families.
• Members of Parliament.
• Former Vice Presidents.
• Former Governors and Lieutenant 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.
• Pensioners and employees of certain statutory/autonomous organizations.
• Post and Telegraph Department employees.

Limitations of the Central Government Health Scheme

To prevent any discrepancies, beneficiaries should thoroughly read the policy statement to understand the terms and conditions. Here are some limitations of the policy:

• In case of an emergency, treatment can be sought at any hospital. However, claims for reimbursement must be submitted to the "Additional General" office where the CGHS card is registered.
• For reimbursement of medical bills, while treatment can be received at any hospital, the claim amount will be limited to the rates specified under CGHS. The reimbursement claim must be sent to the "Additional General" office where the CGHS card is registered.

Monthly Contribution Under the CGHS Scheme

The Central Government has made the CGHS scheme compulsory for its employees. Enrolled employees will be subject to the following monthly salary deductions, based on their income level:

Before enrolling in the plan, determine your income level to identify the applicable monthly contribution.

Claim Procedure for the Central Government Health Scheme

In emergency situations, listed hospitals are not permitted to refuse entry to a CGHS beneficiary. The scheme has a simple claim procedure, and claims can be made both online and offline. Here’s a step-by-step guide to the CGHS claim procedure:

1. The beneficiary must visit CGHS-listed hospitals across the nation.
2. The treatment typically includes pre-operative investigations, two pre-operative consultations, two post-operative consultations, room costs, medications, and the cost of implants (if necessary).
3. After treatments are completed, the claim, along with required documents, must be submitted within a maximum of six months from the date of discharge to the employee’s concerned department and the CMO of the CGHS Wellness Center.
4. The Wellness Center will verify the information and issue the reimbursement. Payment will be credited to the policyholder’s bank account or disbursed via offline mode at the wellness center.

Color Scheme of CGHS Cards

CGHS cards are issued with different color schemes based on the beneficiary’s designation and the wellness center: