What is the Central Government Health Scheme (CGHS)?

Central Government Health Scheme (CGHS)

The Central Government Health Scheme, or CGHS as it is known in its abbreviated form, has been offering comprehensive medical care to pensioners and employees of the Central Government, provided they have enrolled under the scheme. Individuals are required to meet certain eligibility criteria to enrol under CGHS.

Eligibility Criteria for Availing Central Government Health Scheme:

  • All employees of the Central Government who draw their salary from central civil estimates
  • Freedom fighters
  • Retired as well as sitting judges of Supreme Court
  • Journalists accredited with Press Information Bureau
  • Employees of the Railway Board
  • Delhi Police Personnel
  • Pensioners and employees of certain statutory/autonomous bodies that have been extended CGHS facilities in Delhi
  • Ex-vice presidents
  • The dependent family members of the Central Government employees who draw their salary from Central Civil Estimates and reside in areas covered under the CGHS
  • Pensioners and family pensioners of the Central Government, who receive a pension from central civil estimates
  • The eligible dependent family members of pensioners and family pensioners of the Central Government who receive a pension from central civil estimates
  • Members of parliament, both ex- and sitting
  • Retired judges of high courts

Treatment of CGHS Beneficiaries in areas that do not cover CGHS:

Inpatient treatment or follow up treatment of CGHS health insurance beneficiaries in the areas that do not cover CGHS is as follows:

  • During times of emergencies, treatment of beneficiaries is allowed in any hospital, but the medical claim has to be submitted to the additional director of the city in which the individual’s CGHS card is registered.
  • During times of follow up treatment in case of knee/hip replacement, cardiac/neurosurgery, renal transplant or cancer, the beneficiary of a CGHS is allowed to receive follow up treatment in the approved hospitals provided he/she has received prior permission from the CMO I/C.
  • In case of reimbursement for medical expenses, the amounts that can be claimed will be limited to the rates according to CGHS, and the beneficiary can be treated in any hospital. The medical claim, however, has to be submitted to the additional director of the city in which the CGHS card is registered.
  • During times of non-emergency, the beneficiary of CGHS will be allowed to avail treatment from local/state/central government hospitals. However, prior approval has to be obtained from the CMO I/C of CGHS WC (in the city where the individual’s’ CGHS card is registered). The hospitals from which treatment can be availed must be approved and should fall in the list of CSMA/Empanelled hospitals under ECHS.

Facilities Offered by Central Government Health Scheme:

  • OPD treatment (inclusive of the issue of medicines)
  • Reimbursement of costs incurred for buying appliances, artificial limbs, hearing aids, etc., as specified
  • Cashless facility for treatment in diagnostic centres and empanelled hospitals for identified beneficiaries and pensioners
  • Medical consultation as well as dispensing of medicines in homoeopathy, Siddha, Ayurveda and Unani systems of medicines
  • Investigations at empanelled and government hospitals
  • Maternity, family welfare, and child health services
  • Indoor treatment at impanelled and government hospitals
  • Reimbursement of costs for treatment in private or government hospitals in case of emergencies
  • Specialist consultation at government or polyclinic hospitals
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