Central Government Health Scheme (CGHS)

​Imagine a world where you and your health are well-protected from unforeseen circumstances. An ideal world in which you do not have to bear the burden of increasing healthcare costs and do not compromise on quality healthcare.

This is exactly what is promised under the Central Government Health Scheme (CGHS). It is a financial safety net that protects Indian government employees and their family members during medical emergencies.

With this government-backed health scheme, government employees can benefit from comprehensive medical support and increased accessibility to healthcare facilities.

Central Government Health Scheme (CGHS): Ke​​y Insights

Key Insights	Details
Eligibility	Central government employees, their family members and pensioners.
Commencement Year	1954
Main Objective	Offer extensive medical facilities to government employees and their dependents.
Key Benefits/ Inclusions	Expenses include hospitalisation, preventive care, AYUSH treatments, emergency care, and more.
Covered Cities	It offers coverage for 80 cities in India.
Network Hospitals	Multiple CGHS Empanelled Hospitals in India
Cashless Hospitalisation	Beneficiaries under this scheme can get cashless treatments.
Number of Doctors	1471
Appointments	Both walk-ins and online appointments are available.

What is the Central Government​​ Health Scheme (CGHS)?

The Central Government Health Scheme is an extensive healthcare scheme initiated by the Indian government. Under this scheme, Indian government employees, pensioners, and employees’ family members can benefit from comprehensive medical solutions at affordable rates.

The type of medical support available includes coverage for OPD treatments, domiciliary treatments, diagnostic tests, child health services, AYUSH medicines, etc.

With an extensive network of empanelled hospitals and clinics around India, the CGHS initiative has increased the accessibility of healthcare support for central government employees.

How Does the Central Government Medical Insurance Scheme Work?

It works on a subscription fee model that is dependent on each employee's pay range, making it affordable for government employees to cover expenses during medical emergencies.

In addition, a health card is issued to every beneficiary who enrols in this scheme to receive CGHS benefits. This health card acts as proof of identity and authorisation and includes information about the beneficiary, such as eligibility, name, registration number, etc.

What is Covered Under CG​​HS?

Healthcare Services

• In-Patient Treatment - Pre- and post-hospitalisation expenses, ICU treatments, surgery-related expenses, etc.
• Outpatient Department - Medicine supplies, check-ups, etc.
• Diagnostic Tests - Lab tests, X-rays, blood tests, urine tests, etc.
• Hospitalisation Expenses - Room rent, consumables (if applicable), etc.
• Consultation Costs - Doctor’s fees and other consultation-related expenses.
• Preventive Healthcare - Medical tests, vaccinations, screenings, etc.
• Ambulance Services - Emergency ambulance charges for transportation to and from the empanelled hospitals or clinics.
• Home Healthcare Support - Physical therapy, home treatments, nursing care, etc.

Types of Medical Systems

• Allopathy - Western medicines backed with scientific reports and evidence using surgery, medicinal drugs, etc.
• Ayurveda - Traditional Indian medicines that work towards a balanced diet and lifestyle changes for holistic health benefits.
• Homoeopathy - Using simple medicines to activate the healing process while increasing the recovery speed.
• Naturopathy - Healing with a combination of diet and natural medicines.
• Unani - Recovery or treatment with the use of ancient herbs and other natural remedies.
• Siddha - Recovery or treatment with the use of ancient herbs and other natural remedies.

Types of Medical Treatments

• Paediatrics - For child care support and services to improve the worsened health conditions.
• ENT - Treatments related to ears, nose, and throat issues.
• General Surgeries - All surgical procedures to improve the health condition of the beneficiary.
• Medicine - The availability of dedicated and authorised medical stores under the CGHS.
• Orthopaedics - Treatments related to joint, muscle or bone issues and disorders.
• Obstetrics and Gynaecology - For treatments related to a woman’s reproductive health.
• Ophthalmology - Treatments required for eye issues and disorders.

What is Not Covered Under C​​GHS?

• Cosmetic treatments and surgeries
• Genetic testing-related services
• Alternative medicines
• Fertility treatments
• Non-allopathic treatments
• Dental treatments
• Medical bills from treatments outside India
• Vision-related treatments

Benefits of Central Government He​​alth Scheme (CGHS)

Comprehensive Medical Coverage

Under the CGHS, you can access a wide range of medical services, giving you complete access to quality healthcare. This includes inpatient and outpatient services, medicine supplies, hospitalisation expenses, room rent and AYUSH treatments.

Cashless Hospitalisation

One of the most significant benefits of the Central Govt Health Scheme is the convenience of cashless hospitalisation. With this option, you can get the necessary medical treatments without the burden of expensive bills. Once you get the treatment, your bills will be settled by the insurer with the hospital on your behalf.

Affordable Healthcare

The Central Govt Health Scheme offers an affordable subscription model to help manage rising medical costs. The fee is deducted directly from the beneficiary's salary or pension, making it a hassle-free and affordable healthcare solution.

Emergency Support

Under the Central Govt Health Scheme, you can get immediate medical support in case of unfortunate accidents or medical emergencies. This includes ambulance support to take the beneficiary to the nearest hospital, emergency care and services, and more.

Preventive Care

The Central Govt Health Scheme offers preventive health services to ensure good health for all beneficiaries. These include check-ups, vaccinations, screenings and much more to help detect health issues in the early stages and get the right treatment on time.

Eligibility Criteria for the Centra​​l Govt Health Scheme?

● Individuals with a valid Central Government Health Scheme card. ● All central government employees and their dependents. ● Central government pensioners and their families. ● Individuals who live in cities where CGHS facilities are available.

● Employees of the Railway Board. ● Delhi Police personnelle. ● Employees of the Postal Department. ● Ex-Governonrs and L.T. government employees. ● Ex-vice presidents of the Central Government. ● Freedom fighters.

In case of ineligibility, you can always buy a health insurance place from a private insurer like us at Reliance General Insurance. We offer several types of health insurance policies with premiums startin​g at ₹243 per month*.

With us, you also have the convenience of buying, claiming and renewing your plans online.

How to Apply for the Central Gover​​nment Health Scheme (CGHS) Card?

• Step 1 - Go to the CGHS Login portal.
• Step 2 - Add your mobile number and captcha code, and then select “Generate OTP”. Add the OPT and then select “Apply Here” for either of the two options available on the screen.
• Step 3 - Complete the application form with the necessary details. The required information includes personal details, address, and other relevant information.
• Step 4- You must also collect all the necessary documents for a complete application submission. The list includes an Aadhaar card, rental agreement, PAN card, etc.
• Step 5- Once you have completed the form and documents, print out the form and submit it to the Head of the Department or Office (if you are a serving central government employee) or the Additional Director’s office in other cities.

Documents Required to Apply for the CGHS Card

• A completed CGHS application form
• Proof of residence
• Recent photographs of all eligible members of the family
• A relevant disability certificate (if your son is over 25 years old and has a disability)
• Draft letter for the required CGHS contribution amount.
• Attested copies of the PPO (Pension Payment Order) and your last pay certificate.

How to Book an Appointment Under ​the Central Health Scheme?

• Step 1 - Visit the official CGHS website.
• Step 2- From the top tab, select “Beneficiary Corner” and click on “Book an Appointment”.
• Step 3 - On the next page, enter your beneficiary details and click on “Generate OTP.” Once you get the OPT, add it to the space provided and click on “Proceed.”
• Step 4- Confirm your details on the screen by clicking “Proceed” again. Then select your city, dispensary, speciality required, and doctor before clicking on “Proceed” again.
• Step 5- On the next page, select a date and time that works best for you and then click on “Proceed to Book Appointment.”
• Step 6 - For the final step, review your appointment details on the screen and select “Confirm to Book Appointment”. You will receive the confirmation details on your registered mobile number.

Source - Process to Book Appointment

How to Claim Benefits Unde​r the CGHS Health Scheme?

• Step 1 - Get the desired medical treatment at any of the CGHS-empanelled clinics or hospitals for cashless claims or any other hospital for reimbursement claims.
• Step 2- Collect all the medical reports, bills, etc., and submit them with a claim form at the nearest CGHS wellness centre where your registration was done.
• Step 3 - Upon submission, you will receive a claim number from the wellness centre’s computer system.
• Step 4- Once we receive the documentation, we will begin our verification process.
• Step 5- When approved, you will receive the claim amount in your bank account for a reimbursement claim, or it will be settled between the hospital and us for a cashless claim.

Frequently Asked Questions about Central Government Health Scheme

1. What is a CGHS card?

A CGHS card is an identity card issued to all beneficiaries under the Central Government Health Scheme. It contains all the necessary information about the beneficiary, including the registration number, name, eligibility details and more. It acts as valid proof of eligibility to receive the necessary benefits under the scheme.

2. Is the Central Government Health Scheme available free of cost?

No, the Central Government Health Scheme is not free. You will need to pay a subscription fee, which is deducted from the beneficiaries’ salaries or pension amounts. The fee is calculated based on the employee's pay grade.

3. How do I find CGHS empanelled hospitals near me?

To find CGHS-empanelled hospitals near you, you can visit the official CGHS website or contact the local office.

4. Does the CGHS offer cashless hospitalisation benefits?

Yes, you can enjoy cashless hospitalisation under the Central Government Health Scheme. With this facility, you do not have to pay hefty upfront medical expenses after treatment, as the bills are settled directly between CGHS and the hospital.

5. Can I apply for the Central Govt Health Insurance Scheme online?

Yes, you can apply for the Central Govt Health Insurance Scheme online. However, the process may be limited to certain cities and regions. Thus, you must check with the local CGHS for availability before applying.

6. How can I transfer the CGHS card from one Wellness Centre to another within the same city?

You can transfer your CGHS card from one wellness centre to another by contacting the new wellness centre’s authorities and informing them about your requirement to shift your card to their centre. Once you do so, they will guide you through the entire process.

7. What is the contribution of CGHS?

It is the subscription fee every beneficiary needs to pay to claim services under this initiative. The contribution amount is decided based on the employee's pay grade.

8. What is the colour scheme for CGHS cards?

The colour of the CGHS card is white with a top strip of a different colour. The different colour of the top strip highlights the status of the cardholder within the central government. The colour scheme is as follows -

• Red - Parliament members
• Blue - Existing government employees
• Green - Freedom fighters, ex-MPs and retired employees
• Yellow - Journalists and other beneficiaries from authorised organisations.
9. What are the medical benefits to retirees under CGHS?

The medical benefits of retired employees are the same as those of existing employees. This includes diagnostic tests, emergency care, hospitalisation expenses, medicine supplies, etc.

10. What is the maximum coverage limit under the CGHS?

The maximum coverage limit under the Central Government Health Scheme depends on the employee's title and pay scale.

11. Which family members are eligible for coverage under the CGHS?

Spouses, dependent or unmarried children, and parents are among the family members eligible for coverage under the Central Government Health Scheme.

12. What is the age limit for dependents who can be covered under the CGHS?

The standard age limit for dependents is typically up to 25 years. However, there is no age limit for a girl child. She is covered until she is married or employed.

13. How can pensioners avail of healthcare services under the CGHS?

Pensioners need to submit their CGHS card at any of the authorised hospitals or clinics to receive the required healthcare services.

14. What is the time limit for submitting bills under the CGHS?

Yes, you need to submit and claim your medical bills under the Central Government Health Scheme within a maximum of 3 months. Failure to do so will result in no coverage, as you will not be eligible.

15. Can dependent in-laws be included under family members for the CGHS?

In most cases, dependent in-laws cannot be included under family members for the CGHS. However, for exceptions, you must get in touch with the authorities. However, female government officials have a choice to choose either their parents or in-laws to cover under this scheme.

16. How long does it take to get the CGHS card?

The physical plastic CGHS card takes approximately 3 weeks to arrive at your residential address. However, you can get the online card almost instantly. Log in to your beneficiary account and select “Print CGHS Card” to download a copy.

17. What should I do if I have lost my CGHS card?

If you have lost your card, you must first report it to the police station by filing an FIR and then inform the CGHS authorities. Next, you need to fill out an application form and submit it along with ₹50 fine to the AD’s office to get a duplicate card.

18. How can I change the details present on my CGHS card?

    If your CGHS card contains incorrect information, you must bring the incorrect and correct details to the attention of the –

    • Director/Joint Director of the concerned CGHS City or
    • Joint Directorat CGHS building, RK Puram Sector-12, New Delhi​
19. Whom should I contact in case of a grievance?

You can complain online by logging on to the Grievance Portal. Once you log in, you can file a complaint and wait for a response. To file a grievance, you must ensure your mobile number and email address are registered with your CGHS account.

20. Can the medical bills be reimbursed if the CGHS card holder ​​dies while in the hospital?

Yes, in case the CGHS card holder dies in the hospital, the cardholder's main claimant (living s​pouse) is eligible for reimbursement of the medical bills. However, it is advised to get the family pensioner card issued beforehand for faster settlements.

21. Are ambulance charges covered under the CGHS scheme?

Yes, ambulance charges are covered under the Central Government Health Scheme. However, coverage might be limited to only the CGHS-approved hospitals and clinics, so check before filing any claims.​

Disclaimers:

*T&C Apply. For more details on risk factors, terms conditions, brochure, and exclusions, please read the policy wording and CIS carefully before concluding a sale.

Premium: The premium mentioned is excluding taxes for single person aged between 5 years to 20 years with individual health policy for Sum Insured of ₹3 lakhs considering no adverse health conditions/pre-existing disease/medical conditions with waiting period of 3 years. For more details, please refer to the policy wordings. Premium used is 2,919/year converted into a month which gives us Rs.243/month (2,919/12).