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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.
CGHS Scheme provides healthcare services through multiple systems of medicine, ensuring a holistic approach to patient care:
Here are some important points about the Central Government Health Schemes (CGHS):
The following benefits are covered under the 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:
To prevent any discrepancies, thoroughly read the policy statement to understand the terms and conditions. Here are a few exclusions of policy:
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.
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.
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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CGHS is available to Central Government employees, pensioners, and their dependent family members.
CGHS provides comprehensive healthcare services, including OPD treatments, specialist consultations, indoor treatments, investigations, and cashless facilities in empanelled hospitals and diagnostic centers.
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CGHS beneficiaries can book appointments online through the CGHS portal by following a simple step-by-step process and they are:
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.
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.
The same card will remain valid in the event that the employee is transferred to another department or another area covered by the CGHS.
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.
The documents required are:
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