All about the Central Government Health Scheme CGHS

India has a dynamic healthcare industry that will only make further progress in the coming years. However, like most healthcare systems across the globe, 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 Central Government Health Scheme.

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

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 child care
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

What is the Eligibility Criteria 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:

Central Government Pensioners and their families who benefit from Contributory Provident Fund
Central Government employees residing in CGHS covered areas, and their family members
Employees of the Railway Board
Pensioners of Central Government and their families
Post and telegraph department employees
Journalists who are members of the Press Association
Civilian employees of Defence
Freedom Fighters and their family members receiving a pension under the Sainik Samman Scheme
Widows of Central Government pensioners, in receipt of family pension
Delhi Police personnel and their families
Central Government employees deputed to semi-government or autonomous bodies receive significant finance by or grant from the Central Government
Ex-Vice Presidents of India and their families
Ex-Lt. Governors and Governors, as well as their families
Families of Governments employees transferred to a non-CGHS area
Members of Parliament, including their families
Former members of Parliament
Kendriya Vidyalayas Sangathan’s employees stationed at Delhi and NCR, Chennai Kolkata, Bengaluru, Mumbai, and Hyderabad
Judges of Supreme Court and High Court of Delhi
Former Judges of High Courts and the Supreme Court
IAS Officer's family members on 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
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
Industrial Staff working in establishments run by Ministries or Departments of the Central Government
Central Government’s Parliamentary secretaries and their families
Family members of deceased Ex-Members of Parliament
Pensioners of Ordnance factories
Indian Pharmacopoeia Commission’s employees and their families
Retired Divisional Accountants of the Indian Audit and Accounts Department whose pay and pension are borne by state governments
Members of the Staff Side of the National Council of the Joint Consultative Machinery, even though not serving as Central Government employees
Serving and retired Railway Audit Staff
CISF and CAPF personnel posted in CGHS-covered areas, and their families
Serving and retired Divisional Accountants and Divisional Accounts Officers
Supreme Court Legal Services Committee’s employees

Wht are the Facilities under CGHS and their cost?

The Central Government Health Scheme comes with the following advantage for beneficiaries:

1) Reimbursement of expenses for treatment availed under emergency either in private or government hospitals

2) OPD treatment (includes an issue of medicines)

3) Treatment at Empanelled and Government hospitals

4) Specialist consultations at Polyclinic/Govt. Hospitals

5) Cashless facility for treatment in diagnostic centers and empanelled hospitals for pensioners and other eligible beneficiaries

6) Reimbursement of expenses incurred in purchasing hearing aids, appliances, artificial limbs, etc.

7) Medical consultation and purchase of medicines in Homeopathy, Unani, Ayurveda, and Siddha systems of medicine (AYUSH)

8) Maternity and child healthcare services and family welfare

Now, let’s get into the monetary aspect of this 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 anesthesia	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 7th CPS and their respective contribution per month is 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, do not need any referrals to acquire the said medical consultation.

What is a CGHS card?

The Government of India provides all CGHS beneficiaries and their dependents with a photo ID plastic card 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.

How to register for a CGHS card?

If eligible to be a CGHS beneficiary, you can apply for a CGHS card either from an authorised wellness center or through online registration. If taking the online route, simply visit the CGHS portal and submit an application form.

So, you can easily procure a CGHS card online if you reside in any of its applicable cities. Some of these cities include:

Agartala
Agra
Imphal
Raipur
Kozhikode
Aligarh
Allahabad (Prayagraj)
Ambala
Amritsar
Ranchi
Rajahmundry
Baghpat
Bengaluru
Bareilly
Berhampur
Jaipur
Kannur
Lucknow
Kanpur
Visakhapatnam
Dehradun
Delhi & NCR
Hyderabad (Trichy)
Mumbai
Ahmedabad
Srinagar

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 74 cities all across the country and comprises 38.5 lakh beneficiaries.

The Central Government Health Scheme, through an array of healthcare benefits, extends a helping hand to a sizable chunk of the Indian populace.

Frequently Asked Questions

✓ 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 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 stands at 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 CGHS facilities till he/she starts earning, attains the age of 25 years, or gets married, whichever is earlier.