Central Government Health Scheme (CGHS) For Government Employees in India

India has a dynamic healthcare industry that will only progress further in the coming years. However, like most healthcare systems worldwide, India’s healthcare has its fair share of shortcomings and tremendous scope for improvement.

Moreover, a considerable proportion of its populace remains alienated from the system, and equal access to healthcare for all citizens remains a major concern for the country. The government, therefore, aims to combat this issue through a number of programmes and schemes, one of which is the CGHS. The CGHS full form is Central Government Health Scheme.

Allow us to offer you a clearer picture of this scheme so that you can understand its ins and outs.

Team Digit

What is CGHS?
Eligibility Criteria
Benefits Offered by CGHS
What is CGHS Card?
Application & Documents Required
Medical Packages Under CGHS
Find a Hospital List
Link CGHS with ABHA Card
Frequently Asked Questions

What is the Central Government Health Scheme?

The Government of India in 1954 introduced the Central Govt Health Scheme or CGHS as a healthcare facility for the former and current employees of the central government.

This scheme was explicitly mapped out for the betterment of individuals by rendering comprehensive medical care to its eligible beneficiaries.

Let’s take a closer look at the components of the Central Government Health Scheme:

Dispensary services, including domiciliary care
Consultation facilities by specialist doctors
Laboratory examinations such as ECG and X-ray
Hospitalisation
Purchase, supply, and storage of medicines and other medical requirements
Health education to the beneficiaries
Maternity and childcare
Family welfare services

Furthermore, CGHS extends health care by way of several systems of medicine, namely:

Homeopathy
Allopathy
Indian system of medicine
- Ayurveda
- Yoga
- Unani
- Siddha

Eligibility Criteria to Apply for CGHS

Wondering if you can avail the benefits of this scheme?

As aforementioned, CGHS is offered to central government employees only. Moreover, this scheme covers the following persons:

SL. NO	Eligibility Criteria
1	Central Government Pensioners and their families who benefit from Contributory Provident Fund.
2	Pensioners of Central Government and their families
3	Civilian employees of Defence
4	Delhi Police personnel and their families
5	Ex-Lt. Governors and Governors, as well as their families
6	Former members of Parliament
7	Former Judges of High Courts and the Supreme Court
8	Industrial Staff working in establishments run by Ministries or Departments of the Central Government
9	Pensioners of Ordnance factories
10	Members of the Staff Side of the National Council of the Joint Consultative Machinery, even though not serving as Central Government employees
11	Serving and retired Divisional Accountants and Divisional Accounts Officers
12	Absorbees of Statutary Bodies or Autonomous Bodies of Central Govt., who are in receipt of Central Civil Pension
13	Employees of Ordnance Factory Board Headquarters, Kolkata and Ordnance Equipment Fcatories Headquarter, Kanpur
14	Central Government employees residing in CGHS covered areas, and their family members.
15	Post and telegraph department employees
16	Freedom Fighters and their family members receiving a pension under the Sainik Samman Scheme
17	Central Government employees deputed to semi-government or autonomous bodies receive significant finance by or grant from the Central Government
18	Families of Governments employees transferred to a non-CGHS area
19	Kendriya Vidyalayas Sangathan’s employees stationed at Delhi and NCR, Chennai Kolkata, Bengaluru, Mumbai, and Hyderabad
20	IAS Officer's family members on the North-Eastern Cadre are staying back in Delhi even after the officer's repatriation to the North-Eastern Cadre. This is also applicable to the family members of IAS Officers of J&K Cadre
21	Central Government’s Parliamentary secretaries and their families
22	Indian Pharmacopoeia Commission’s employees and their families
23	Serving and retired Railway Audit Staff
24	Supreme Court Legal Services Committee’s employees
25	Defence Industrial Employees of Naval Dockyard Central OrdnanceDepot and AFMSD, in Mumbai
26	Persons employed in semi-governmental and autonomous bodies who are allowed to join the CGH Scheme
27	Employees of the Railway Board
28	Journalists who are members of the Press Association
29	Widows of Central Government pensioners, in receipt of family pension
30	Ex-Vice Presidents of India and their families
31	Members of Parliament, including their families
32	Judges of the Supreme Court and High Court of Delhi
33	Family of a Central Govt. employee and CGHS beneficiary who stay back in CGHS covered area after the employee’s posting to North Eastern region
34	Family members of deceased Ex-Members of Parliament
35	Retired Divisional Accountants of the Indian Audit and Accounts Department whose pay and pension are borne by state governments
36	CISF and CAPF personnel posted in CGHS-covered areas and their families
37	PSU absorbees who commuted 100 per cent of their pension and have been restored one third portion of their pension after 15 years
38	All India Service Pensioners who retire while serving under the State at their option.
39	An Accredited Journalist who produces a certificate from the Press Council of India stating that he is a member of the Press Association, New Delhi (for OPD and at RML Hospital.

What is the Cost of Central Government Health Scheme?

The cost of availing of the Central Government Health Scheme varies depending on one’s employment status. Here is how it is classified:

For serving employees - A central government employee residing in a CGHS covered region must possess a CGHS card. The department of this employee makes monthly deductions from his/her salary depending upon the pay grade. This amount is contributed to the CGHS facilities.

For pensioners - If pensioners wish to avail the facilities of CGHS, they shall make a contribution based on the pay grade they were entitled to at the time of service. Moreover, this contribution can be made as a yearly or one-time/lifetime contribution.

The table below summarises the CGHS rate list:

CGHS Treatment Procedure	Rate for NABH	Rate for Non-NABH
OPD consultation	135	135
Dressings of wounds	52	45
Inpatient consultancy	270	270
Suturing of wounds with local anaesthesia	124	108
Aspiration pleural effusion- Therapeutic	200	174
Aspiration pleural effusion- Therapeutic	138	120
Joints aspiration	329	285
Stitch removal	41	36
Biopsy skin	239	207
Abdominal aspiration-Therapeutic	476	414
Abdominal aspiration- Diagnostic	380	330
Sternal puncture	199	173
Venesection	143	124
Dilation of Urethra	518	450
Phimosis under LA	1357	1180
Intercostal drainage	144	125
Varicose veins injection	363	315
Haemorrhoids’ injection	428	373
Incision and Drainage	435	378
Peritoneal dialysis	1517	1319
Intercostal drainage	144	125

Furthermore, private hospital wards empanelled under the Central Government Health Scheme are available based on one’s pay grade. This ward entitlement under the scheme is as follows:

Private ward: Rs.63,101 and above
Semi-private ward: Rs.47,601-Rs.63,100
General ward: Up to Rs.47,600

Moreover, when it comes to a revised monthly subscription for the CGHS facility, the corresponding levels in the matrix as per the 7th CPS and their respective contribution per month are as follows:

Level 12 and above: Rs.1000
Level 7-11: Rs.650
Level 6: Rs.Rs.450
Level 1-5: Rs.250

Referral from a medical practitioner is necessary for CGHS beneficiaries aged under 75 years seeking OPD consultation. However, those over 75 years, old do not need any referrals to acquire the said medical consultation.

Benefits of the Central Government Health Scheme (CGHS)

The Central Government Health Scheme (CGHS) offers several advantages to its beneficiaries. The following services are the benefits of CGHS:

Benefit	Description
Comprehensive Medical Care	Through the scheme, individuals will receive comprehensive medical care, including diagnostic tests for any ailments that may require hospitalisation or necessary consultations with medical professionals.
Financial Protection	The scheme's beneficiaries can receive medical treatments at reasonable rates in state government and private hospitals. In certain cases, they can opt for free healthcare services, a severe form of financial protection. Under certain conditions, beneficiaries can also receive daily allowances.
Cashless Facility	CGHS offers a cashless system that covers medical expenses for its members. Beneficiaries can receive treatment at no cost or reduced rates at participating healthcare providers and submit bills to the scheme for reimbursement.
Preventive Medical Benefits	People participating in the Central Government Health Scheme can also receive preventive medical benefits, such as timely health checkups, dental care, immunisations, and many other things that improve quality of life.
Emergency Healthcare services	The Central Government Health Scheme offers its beneficiaries a cashless facility that allows them to receive medical treatments at no cost or a reasonable cost. Additionally, people can get financial coverage for the medical treatments of insured members and submit the medical bills to the relevant department of the scheme for settlement.

What is a CGHS Card?

The government of India provides all CGHS beneficiaries and their dependents with a plastic card with a photo ID called a CGHS card. It contains a unique beneficiary identity number, which an individual must produce to CGHS facilities at any point.

This card is white with a varying-coloured stripe at the top that depicts the cardholder’s status. Therefore, this strip can be any of the following colours:

Yellow: A journalist of an autonomous company
Blue: A serving government employee
Red: A member of the Parliament
Green: A pensioner, ex-MP, retired personnel, or a freedom fighter

CGHS cards remain valid until a beneficiary’s retirement date. To extend its validity post-retirement, one must make his/her contribution a year before the completion.

Additionally, after the expiration of this card, the cardholder must surrender the card to the concerned department. In case you want to renew your CGHS card, you must submit a form and the necessary details.

Under no circumstance can this card be transferred from one employee to another. Furthermore, missing this card will attract penalties, and in extreme cases, strict disciplinary actions.

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How to Apply for Central Government Health Scheme (CGHS) Card?

If eligible to be a CGHS beneficiary, you can apply for a CGHS card either from an authorised wellness centre or through online registration. If taking the online route, simply visit the CGHS portal and submit an application form. The Central Government Health Scheme is available to current and retired Central Government employees. The application process steps to follow are as follows:

Step 1: To start enjoying the plan's benefits, register first.
Step 2: Open the CGHS official website on your PC or phone.
Step 3: Download the application form by selecting the "Downloads" option.
Step 4: A page requesting your personal information will be sent to you. Fill that out appropriately.
Step 5: Send the application to the Additional Director's office in any of the CGHS-covered cities, along with your most recent photo and the required paperwork.

You can easily procure a CGHS card online if you reside in any of its applicable cities. These cities include:

Agartala	Agra	Imphal
Kozhikode	Aligarh	Allahabad (Prayagraj)
Amritsar	Ranchi	Rajahmundry
Bengaluru	Bareilly	Berhampur
Kannur	Lucknow	Kanpur
Dehradun	Delhi and NCR	Hyderabad (Trichy)
Ahmedabad	Srinagar	Guwahati
Shimla	Silchar	Puducherry
Panaji	Siliguri	Nashik
Thiruvananthapuram	Nagpur	Sonepat
Moradabad	Panchkula	Shillong
Varanasi (Banaras)	Tirunelveli	Mysuru
Saharanpur	Kota	Vijayawada
Kolkata	Nellore	Kohima
Muzaffarpur	Jammu	Jabalpur
Darbhanga	Indore	Dhanbad
Gorakhpur	Guntur	Gwalior
Gangtok	Chanderpur	Cuttack
Chennai	Chhapra	Bhopal
Ajmer	Chandigarh	Aizwal
Raipur	Jalandhar	Dibrugarh
Ambala	Gandhinagar	Patna
Baghpat	Gaya	Vadodara
Jaipur	Coimbatore	Meerut
Vishakhapatnam	Bhubaneshwar	Tiruchirapalli (Trichy)
Mumbai	Chhatrapati Sambhaji Nagar	Kochi
Jodhpur	Pune

Documents required for CGHS card

Premised upon your status, procuring a CGHS card calls for you to furnish the following documents:

Pensioners
- Demand draft
- Copies of Provisional PPO/PPO/Last Pay Certificate
For serving employees
- Residential proof
- Age proof of dependent(s)
- Dependent’s proof of stay
- In case a dependent is differently-abled, a certificate of disablement from a valid authority

Presently, this scheme covers 80 cities nationwide and comprises 46.4 lakh beneficiaries.

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Medical Packages Under CGHS

The CGHS has various packages under it. Follow the list below to see the detailed number of packages per procedure or condition:

S.No.	Facility	Number of Packages
1	OUT PATIENT	39
2	SKIN	9
3	E.N.T.	16
4	EYE	16
5	ORTHOPAEDIC AND PLASTER WORK	29
6	PHYSIOTHERAPY	18
7	DENTAL	10
8	OTHERS	9
9	X-RAY	30
10	ULTRASOUND INVESTIGATIONS	9
11	CLINICAL PATHOLOGY	16
12	HAEMATOLOGY	23
13	BLOOD BANK	8
14	BIOCHEMISTRY	30
15	HISTOPATHOLOGY	7
16	BACTERIOLOGY & SEROLOGY	13
17	ICU/CCU CHARGES Special Care Cases	16
18	OXYGEN CHARGES	4
19	BURN DRESSING	6
20	OBSTETRIC CASES	37
21	GENERAL SURGERY	37
22	HEAD & NECK	47
23	BREAST	6
24	CHEST	19
25	ABDOMEN	55
26	GENITOURINARY	37
27	OESOPHAGUS	9
28	PLASTIC SURGERY	35
29	CARDIAC SURGERY	2
30	ORTHOPAEDIC SURGERY PROCEDURE	53
31	NEURO - SURGERY	11
32	VASCULAR SURGERY	27
33	PAEDIATRIC SURGERY	34
34	GYNAE, OPERATION CHARGES	22
35	INVESTIGATIONS	38
36	CARDIOLOGY	21
37	CHEST MEDICINE	6
38	ONCOLOGY (NEW CLEAR MEDICINE)	9
39	CARDIO THORACIC SURGERY (CTS)	72
40	NEPHROLOGY	12
41	UROLOGY	73
42	ORTHO	6
43	NEURO SURGERY	66
44	COBALT 60 THERAPY	4
45	LINEAR ACCELERATORS	3
46	BRACHYTHERAPY	4
47	CHEMOTHERAPY CHARGES	3
48	LAPAROSCOPIC PROCEDURE	41
49	OPHTHALMOLOGY	56
50	CARDIO RESPIRATORY PROCEDURES	26
51	CHEST	18
52	EAR	17
53	NOSE	20
54	THROAT	9
55	NECK	7
56	LARYNX	6
57	HEAD AND NECK CANCER	13
58	GYNAE OPERATIONS	8
59	HYSTEROSCOPY	11

How to Find a Hospital List Under CGHS Scheme?

To find a list of hospitals under the Central Government Health Scheme (CGHS), follow these steps:

Step 1: Visit the Official CGHS Website: Go to the official CGHS website.
Step 2: Navigate to the Empanelled Hospitals Section: Look for the section related to "Empanelled Hospitals" or "Hospital's List" on the homepage or under the "Services" or "Beneficiaries" tab.
Step 3: Select Your City or Region: Choose your city or region from the dropdown menu or search box to get a list of hospitals in your area.
Step 4: Download or View the List: The website usually provides options to download the list in PDF format or view it online.
Step 5: Contact the Local CGHS Office: For additional assistance or specific queries, you can contact the local CGHS office or wellness centre.
Step 6: Check Updates: The list of empanelled hospitals can be updated regularly, so check the latest information periodically.

The CGHS helpline or local office can provide guidance and additional support if you encounter difficulties.

Hospitalisation Process Under CGHS Scheme

Under the Central Government Health Scheme (CGHS), the hospitalisation process begins with verifying eligibility and obtaining a referral from a CGHS empanelled doctor, if applicable. Upon selecting a CGHS-empanelled hospital, you must inform the hospital about your CGHS coverage for verification and pre-authorization if required.

During hospitalisation, ensure that the treatment aligns with CGHS guidelines. After discharge, collect all relevant documents, including the discharge summary and bills. For treatments in non-empanelled hospitals or additional expenses, submit a reimbursement claim to the local CGHS office with the necessary documents for processing.

Know about: What are Pre-Post Hospitalization Expenses in Health Insurance?

How to Book a Doctor’s Appointment Under the Central Government Health Scheme?

To schedule a medical consultation, you must make an online appointment with the centre by following the instructions provided:

Step 1: Go to CGHS's official webpage.
Step 2: Enter your beneficiary ID and the supplied OTP to log in. Your details will be displayed to you.
Step 3: If your information is accurately shown, click "Agreed." The "Not me" choice, instead, is another alternative.
Step 4: After turning to the following page, you must fill in the CGHS dispensary, doctor, and specialism.
Step 5: Depending on the availability of the doctor you have chosen, choose the day of your appointment.
Step 6: Choose the time slot that you like.
Step 7: Select the option labelled "Proceed to Book Appointment."
Step 8: Examine the provided information, then select "Confirm.”

The system will generate the confirmation receipt. You can print it off and bring it to the centre on the day of the appointment.

How to Link CGHS with ABHA for Central Government Employees?

According to new instructions from the Ministry of Health and Family Welfare, beginning on April 1, 2024, linking CGHS beneficiary ID with ABHA with the Ayushman Bharat Digital Mission is required.

Here are the steps to connect CGHS with ABHA ID:

Step 1: Navigate to Beneficiaries, and then the Beneficiary login is at https://cghs.nic.in.
Step 2: Log in using your beneficiary ID after entering your password and captcha information.
Step 3: Update and create/link your ABHA ID now.
Step 4: If you don't have an ABHA ID, choose "I don't have an ABHA ID."
Step 5: Select 'Link Using ABHA Number' if you already have an ABHA ID number.
Step 6: Enter your Aadhaar number and use an OTP to finish the verification procedure. You can print your ABHA card if the linking process is successful and all the information is correct.

The ABHA system provides a seamless digital platform that revolutionises health records management. With the help of the 14-digit ABHA ID, users may easily record health data, manage insurance information, and even grant access to preferred healthcare providers. This development is a significant step forward for India's healthcare sector's digital revolution.

CGHS Toll-Free Number and Address

Toll Free No.: 1800-208-8900

Address: H5FJ+HM2, MS Flats Rd, Sector 13 R K Puram, Sector 13, Rama Krishna Puram, New Delhi, Delhi 110022.

One of the critical programs that can quicken India's healthcare ecosystem's development is CGHS. You can view information on different licensed medical professionals. By giving Indian individuals a CGHS health card, the program seeks to enhance their access to healthcare. The Central Government Health Scheme, through an array of healthcare benefits, extends a helping hand to a sizable chunk of the Indian populace.

FAQs about Central Government Health Scheme

All

Is the CGHS card valid all over India?

CGHS card is valid in all CGHS Wellness Centers (WCs) in the applicable cities across India. Therefore, a cardholder can avail of CGHS benefits at any of these facilities and regions.

Is CGHS contribution taxable?

The amount of contribution made to the CGHS qualifies for deduction under section 80D of the Indian Income Tax Act. The maximum deductible amount is Rs.25,000 in a financial year.

Is there any age limit for daughters/sons as dependent on CGHS cards?

Both sons and daughters are eligible to avail of CGHS facilities till he/she start earning, attain the age of 25 years, or get married, whichever is earlier.

How can I monitor my refund from CGHS?

Using the claim number, users can access the claim's status in the CGHS computer module. At every level of the MRC processing, recipients will also receive SMS messages. The CGHS website now shows details about claims over a month.

What is the CGHS maximum limit?

The Central Government Health Scheme, or CGHS, is a health insurance program that covers medical expenses up to Rs. 5 lakhs for central government employees.

What does a CGHS card look like?

The CGHS card is white with a coloured stripe at the top. The four colours of the strips are yellow, green, blue, and red.

For whom is a CGHS card appropriate?

The program is open to Central Government employees and their families and to Central Government pensioners and their families. Participants must live in cities with accessible CGHS amenities and have a current CGHS card.

How can I obtain a CGHS plastic card?

For a plastic card under the Central Government Health Scheme (CGHS), new hires and retirees of the central government may apply online. To apply for CGHS plastic cards, government employees and pensioners must fill out an online form.

What is the duration of a refund claim?

Reimbursement claim processing times can differ. The claim settlement process can take up to 21 days on average.

What is the CGHS rule for those who are older than 75?

This ministry was considering elderly CGHS beneficiaries, and it has been decided that going forward, CGHS Pensioner beneficiaries (Primary Card holders) who are 75 years of age or older will be able to have an "Annual Health Check-up" at CGHS impanelled hospitals.

Does CGHS offer “plans”?

CGHS does not provide different "plans" in the conventional sense. Nonetheless, the program covers many medical needs, such as out-of-pocket visits, tests, and medications, inpatient hospitalisation fees, AYUSH therapies, and maternity and paediatric healthcare.

How do seniors use the CGHS?

To utilise CGHS services, retirees may pay yearly contributions or a single, ten-year commitment for lifetime validity.

What is a CGHS card's beneficiary ID?

The Beneficiary Identification System (BIS) can identify, verify, and validate the CGHS beneficiaries, who are pensioners and dependents. Application Program Interfaces (APIs) integrate the BIS with the CGHS NIC database.

Does the Central Government Health Scheme provide coverage for maternity?

Yes, the Central Government Health Scheme (CGHS) provides coverage for maternity periods.

Can I use my CGHS Card outside of CGHS cities?

Yes, you can use your CGHS (Central Government Health Scheme) card outside CGHS-covered cities, but the facilities might be limited. You can avail yourself of treatment at private hospitals and diagnostic centres that are part of the CGHS network, even if they are not in a CGHS city.

How do I obtain my misplaced CGHS card?

Upon losing the card, the beneficiary must notify the police and the CGHS officials. To get a duplicate copy of the card, you must provide a copy of the FIR, an application to the Additional Director, and a penalty cost of Rs 50.