Central Government Health Scheme (CGHS)

The Central Govt Health Scheme (CGHS) is a healthcare program designed to offer affordable medical services to central government employees, pensioners and their family members.

This initiative began in 1954, and now it covers services like doctor consultations, treatments, medications, diagnostics, surgery, hospitalisation, deliveries, pre- and postnatal care and even immunisations.

The CGHS model works on a subscription basis that is decided depending on a central government employee’s pay range. Additionally, a health card is offered to every beneficiary who registers under the program. It holds a unique registration number, name and eligibility status of the beneficiary and acts as a vital document while claiming benefits under the scheme.

With a wide network of empanelled hospitals and medical facilities across India, the Central Health Scheme has remarkably improved the accessibility of healthcare for central government employees.

Central Government Health Scheme (CGHS): Key Highlights

Key Highlights	Details
Eligibility	Central government employees, pensioners and their family members
Launched in	1954
Primary Objective	Ensure that government employees and their families receive extensive medical facilities
Key Features/ Benefits	Covered expenses include preventive care, hospitalisation, AYUSH treatments, emergency treatments, and more
Cities Covered	80+ cities are covered across India
Network Hospitals	Numerous CGHS empanelled hospitals, diagnostic centres and wellness establishments across India
Cashless Hospitalisation	Beneficiaries are eligible for cashless hospitalisation
Number of Doctors	1471
Appointments	Both online appointments and walk-ins are accepted

What Facilities are Offered by CGHS?

Cashless Treatment

With the CGHS card, you and your family members can get cashless treatment at any empanelled hospital or clinic. It eases the financial burden, especially in times of emergencies or unplanned hospitalisations.

Wide Range of Services

Under CGHS, beneficiaries can schedule routine blood test appointments, avail of advanced medical imaging tests, and undergo elaborate treatments at both government and empanelled private hospitals.

Comprehensive Maternity and Welfare Services

The Central Govt Health Scheme ensures reimbursement of expenses related to maternity, child healthcare, pre- and postnatal care, paediatric services, and general welfare services.

Easy Access to Highest-level Healthcare Support

You can get compensation for medical appliances, hearing aids and other types of assistive devices if you are registered under the Central Health scheme. Additionally, you have full access to indoor treatment facilities at both government and private hospitals.

Coverage for Alternative Treatment Methods

With a CGHS card, you can fix medical consultations and collect medications under the Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) system of medicine.

Specialised Care for Critical Illnesses

CGHS provides specialist consultations in polyclinics and government hospitals for chronic or complex medical needs. This guarantees access to expert medical opinions and care when you need this type of facility the most.

Reimbursement for Emergency Treatment

Beneficiaries can seek compensation for their emergency bills raised at a hospital. Pensioners must submit a Medical Reimbursement Claim (MRC) within 6 months of discharge to the CMO I/C of the CGHS Wellness Centre where their card is registered. Whereas, serving employees can submit this form to their respective departments.

Coverage for Outpatient Treatment

Outpatient care, such as doctor visits, diagnostic tests and medicine, is available to beneficiaries at affordable rates across all CGHS hospitals, diagnostic centres and clinics.

Exclusions of CGHS

Under the Central Govt Health Scheme, you cannot seek reimbursement for treatment costs if you take admission at a non-empanelled hospital. Additionally, if the claim amount is not as per the rates specified by CGHS, your request for compensation will be rejected. Reimbursement claims must be submitted only to the Additional General where the CGHS card is registered, in both situations.

Therefore, you can consider adding an extra layer of protection by opting for our health insurance plan. At IndusInd General Insurance, health insurance premiums start at just ₹243 per month*, and beneficiaries can get up to ₹5 Crores as coverage. The best part is that our renewal process is very easy and can be completed in a few taps via the IndusInd Insurance app.

Who is Eligible to Get Healthcare Services Under CGHS?

CGHS eligibility depends on where a Central Government employee presently lives, covering them and their family in specific cities. The following entities are eligible to get medical coverage under the Central Govt Health Scheme:

Individuals with a valid CGHS card
All Central Government employees and their dependents
Central Government pensioners and their family members
Individuals living in cities where CGHS hospitals, diagnostic centres or clinics are present
Delhi Police Personnel
Employees of the Railway Board
Ex-governors and L.T. government employees
Employees of the Postal Department
Freedom fighters
Ex-Vice Presidents

What are the Benefits of the Central Government Health Scheme?

Comprehensive Medical Coverage

If you have the CGHS card, you can access numerous medical services at affordable rates. It gives you easy access to quality healthcare. This encompasses both inpatient and outpatient medical services, medicines, hospitalisation costs, AYUSH treatments and room rent.

Cashless Treatment

Like any comprehensive medical insurance, the CGHS scheme also offers the convenience of cashless hospitalisation. Therefore, if you own the card, you can receive the necessary medical care without feeling pressured by the bills. After your treatment is over, the insurer will settle the due amount on your behalf.

Affordable Services

The subscription system of the CGHS scheme has been designed with affordability as the top priority. Therefore, by availing it, eligible individuals can manage the ever-rising medical costs. Moreover, the fee is deducted automatically from a person’s pension or salary, making the process smooth.

Preventive Care

Preventive health services are also available through the Central Govt Health Scheme to promote every beneficiaries' long life. Under this, you can avail vaccinations, check-ups, routine screenings, and much more. It helps detect critical illnesses at an early stage so that you can take necessary actions on time.

Emergency Support

The CGHS program enables you and your family members to seek emergency medical support if there is an accident or other health-related emergency. This covers first-aid, ambulance support to the nearest hospital, and other immediate services.

How to Register Under the Central Government Health Scheme?

Registration Process for CGHS Card

Visit the CGHS Portal

Open the official CGHS website and click on “Apply for CGHS Card” on the top tab. Click Proceed.

Fill Out the Application Form

Enter your details and click next. You can also download the form to apply for a plastic card and fill out the necessary details.

Submit the Document

You must submit the filled-out form with documents like ID proof, residence proof, photographs, etc., to the CGHS office in your location.

Get the CGHS Card

After the employment verification is successfully completed, you get a photo ID with a unique beneficiary number.

Book an Appointment Online

As you are already enrolled, now you can fix appointments with CGHS-registered doctors and medical establishments.

Key Details of the CGHS Card

Documents needed

A completely filled-out CGHS application form

Proof of residence

Recent photographs of the applicant and their family members

A disability certificate (if anyone in the family is disabled and above 25 years of age)

Draft letter indicating the CGHS contribution amount

Attested copies of the Pension Payment Order (PPO) and the last pay certificate

Validity

When a serving employee is transferred to an area not covered under CGHS, the CGHS service card will continue to remain valid for their family members for up to six months, as long as the advance contribution for six months has been paid.

To keep pensioner CGHS cards valid, you should make yearly contributions before the year's end.

A CGHS card is valid across all CGHS cities for any kind of treatment or hospitalisation.

If you are a serving Central Government employee, your card will remain valid till the date of your retirement.

Key Takeaways

The Central Govt Health Scheme symbolises the Indian Government’s commitment to promoting the well-being of its employees and their dependents. With this program, eligible people can avail cashless treatment options and emergency medical care at a large network of empanelled hospitals.

For Central Government employees, the CGHS insurance is like a lifeline, protecting them from the financial burden of growing medical costs. However, if you are already registered under the scheme, you can still consider purchasing our comprehensive health insurance, as it would ensure seamless coverage across over 10,000 network hospitals* pan-India.

Additionally, issues such as administrative delays, waiting for prior referrals, and navigating red tape to receive treatment can be frustrating. So, buying a private health insurance plan from us can help cover these pitfalls.

With IndusInd General Insurance (formerly Reliance General Insurance), you get quick cashless claims via the IndusInd Insurance app at all our network hospitals. You can also enhance your health insurance coverage by adding various add-ons, such as unlimited SI restoration, consumables cover, and an OPD add-on, among others. These riders can be highly beneficial for individuals who need frequent doctor visits or for those who wish to stay on top of their health.

By pairing your Central Government Health Insurance scheme with our health insurance policy, you ensure all-around medical coverage.

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From Hospital to Home, We’ve Got You Covered!

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Frequently Asked Questions (FAQs)

How much time is required to get a CGHS card?

Normally, you receive the computerised version of the CGHS card as soon as your application is verified. However, the plastic card is sent within 3-4 weeks. Sometimes, it can take more than a month.

Is there any maximum limit for CGHS?

The maximum medical coverage under CGHS depends on the entitlement and pay scale of a government employee or beneficiary. However, it should not exceed ₹5 lakh per year for a family.

Are critical illnesses covered under CGHS?

Yes, critical illnesses that require immediate medical attention, like kidney diseases, cancer, heart attack, etc., are covered under the CGHS program. Beneficiaries get reimbursement as per the CGHS rates upon taking admission in an empanelled hospital. Admission to a non-empanelled hospital will be subject to policy limits.

Can pensioners raise a claim for medical bill reimbursements?

Yes, based on their eligibility, Central Government pensioners can raise a claim for medical bill reimbursement by visiting the official website of CGHS. However, the claim must be filed within 6 months of discharge and should accompany essential documents like original medical bills, discharge summary, CGHS card details, etc.

Are CGHS facilities free of cost?

No, healthcare services are not free of cost under CGHS. This is because it runs on a subscription system where Central Government employees and pensioners have to pay a fixed amount every year to keep their card’s validity active.

How many cities in India are covered under the CGHS scheme?

At present, 80 different cities in India are covered under the Central Government Health Scheme.

What should you do when facing problems while availing CGHS services?

If you experience CGHS-related problems, contact the CMO-in-Charge of the hospital or get in touch with their customer support by calling 1800-208-8900. After following this, if your issue is still not resolved, you can write a complaint via email to the Additional Director of CGHS in your city.

Is treatment under CGHS cashless?

Yes, pensioners and other eligible government employees can avail treatment under the Central Govt Health Scheme on a cashless basis at empanelled hospitals and diagnostic centres across India.