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.

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

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:

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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• Arogya Sanjeevani Health Insurance
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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.

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.

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?

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.

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.

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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.