Central Government Health Scheme

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 central govt health insurance program 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.

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:

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: