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  1. Digit Insurance
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  3. Government Insurance Schemes
  4. Central Government Health Scheme (CGHS)
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    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.

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    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.

    Know more about:

    • Arogya Sanjeevani Health Insurance
    • Buy Health Insurance Plan

    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.

    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

    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.

    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.

    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.

    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.

    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.

    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.

    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.

    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.

    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.

    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.

    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.

    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.

    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.

    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.

    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.

    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.

    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.

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