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CGHS (Central Government Health Scheme)

  • Author :
  • TATA AIG Team
  • Published on :
  • 17/04/2024
  • 2 min read

The Indian government is renowned for playing a crucial role in providing state-of-the-art healthcare services to its citizens. India's healthcare landscape is diverse, complex, and often challenging, with a vast population spread across urban and rural areas.

One such notable initiative is the Central Government Health Scheme (CGHS full form), which is deeply interconnected with the broader Indian healthcare system. Read this blog till the end to learn more about the Central Government Health Scheme dispensary & health scheme.

What is CGHS (Central Government Health Scheme)?

Established in 1954, the Central Government Health Scheme (CGHS) stands as a cornerstone of healthcare provision for central government employees, pensioners, and their dependents within India. Its core objective is to furnish comprehensive medical coverage, ensuring access to high-quality healthcare services across the nation.

Initially designed for central government employees and pensioners, it now extends its benefits to a broad spectrum of beneficiaries, leveraging contributions from the beneficiaries' salaries to sustain its operations.

A distinguishing aspect of the Central Government Health Scheme is its inclusive approach, covering the healthcare needs of individuals associated with various pillars of India's democratic structure, including the Legislature, Executive, Judiciary, and Press.

Through an extensive network comprising dispensaries, polyclinics, and empanelled private hospitals, the Central Government Health Scheme endeavours to deliver timely and effective medical care to its beneficiaries. Operated under the purview of the Ministry of Health and Family Welfare, CGHS operates in 37 cities nationwide, including major urban centres such as Delhi, Mumbai, Chennai, and Kolkata.

Initiated by the Government of India, CGHS continues to operate as one of the oldest and most enduring health insurance schemes in the country.

Facility Offered by CGHS (Central Government Health Scheme)

The Central Government Health Scheme (CGHS) extends a wide array of healthcare facilities to its beneficiaries; below is a comprehensive list of the same:

  • CGHS facilitates cashless treatment at empanelled hospitals and diagnostic centres, easing the financial burden on beneficiaries during medical emergencies or planned hospitalisations.

  • Right from routine blood tests to medically advanced imaging studies, beneficiaries can undergo diagnostic tests at both government and empanelled diagnostic centres under CGHS.

  • CGHS provides comprehensive maternity, child health, and family welfare services, encompassing prenatal care, childbirth, postnatal care, and paediatric services.

  • CGHS offers compensation for expenses related to the purchase of medical appliances, artificial limbs, hearing aids, and other assistive devices.

  • Beneficiaries have access to indoor treatment services at both government hospitals and empanelled private hospitals.

  • CGHS extends medical consultation and medicines under the AYUSH system of medicine, encompassing Ayurveda, Homeopathy, Unani, and Siddha.

  • Whether for chronic conditions or complex medical issues, CGHS offers specialist consultations at polyclinics and government hospitals, ensuring access to expert medical opinion and specialised care.

  • In the event of a medical emergency, beneficiaries are eligible for compensation for expenses incurred for treatment in both government and private hospitals.

  • Beneficiaries can avail themselves of outpatient treatment, including medical consultations and the issuance of prescribed medicines, at CGHS dispensaries, polyclinics, and empanelled hospitals.

Exclusions of CGHS (Central Government Health Scheme)

Services not included within the scope of the Central Government Health Scheme (CGHS) include:

Reimbursement of Medical Bills: In instances where beneficiaries opt for treatment at a non-empanelled hospital and subsequently seek reimbursement, the claim amount will be restricted to the rates specified under CGHS.

In both scenarios, reimbursement claims must be directed solely to the Additional General, where the CGHS card is registered.

Eligibility Criteria of CGHS (Central Government Health Scheme)

Eligibility for the Central Government Health Scheme (CGHS) is contingent upon the residence of the Central Government employee, with coverage extending to the employee and their family members residing in designated cities under the scheme. The following individuals are eligible under the Central Government Health Scheme:

  • Pensioners of the Central Government (excluding pensioners from Railways and the Armed Forces) and their families.

  • Widows of Central Government pensioners receiving family pension.

  • Employees of the Railway Board

  • Former Governors, Lieutenant Governors, Vice Presidents, and their families

  • Members of Parliament and their families, including ex-Members of Parliament.

  • Serving and retired Railway Audit Staff

  • All Central Government employees remunerated from the Central Civil Estimates (excluding those from Railways and Delhi Administration), their families, and dependent family members residing in areas covered by CGHS.

  • Central Government pensioners who retire with Contributory Provident Fund benefits and their families.

  • Personnel of the Delhi Police and their families (limited to Delhi only).

  • Children receiving pensions upon the demise of a Central Government employee, including minor siblings of such children.

  • Parliamentary Secretaries of the Central Government and their families.

  • Sitting Judges of the High Court and Supreme Court of Delhi, as well as former Judges of these courts.

  • Central Industrial Security Force (CISF) Personnel and Central Armed Police Forces (CAPF) stationed in CGHS cities, along with their families.

  • For a detailed list of beneficiaries, read more.

Cost of Facilities Under CGHS (Central Government Health Scheme)

The pricing structure for health schemes available to Central Government employees varies based on their employment status. Below is a comprehensive breakdown of the costs:

For Pensioners:

Pensioners are required to contribute in accordance with their former pay grade received during their service tenure to avail of CGHS insurance benefits. They have the option to either make an annual contribution or opt for a one-time payment.

One-time Contribution: Pensioners can choose to make a lump-sum payment towards CGHS insurance once every ten years.

Annual Contribution: Pensioners are obligated to pay a specified amount annually, determined by their previous pay grade.

For Eligible Serving Employees:

Central Government employees currently stationed in a city covered by CGHS can apply for a Central Government Health Scheme (CGHS full form) card to qualify for benefits.

All beneficiaries are eligible to obtain a CGHS photo ID card either through the CGHS web portal or at a nearby wellness centre.

A deduction is made from the beneficiary's salary every month, the amount of which is contingent upon their pay grade.

Furthermore, the following provides a glimpse into the rate list for various common treatments under the central government medical scheme.

CGHS Treatment Procedure Rates for NABL/NABH Accredited Hospitals Rates for NABL/NABH Non-Accredited Hospitals
Consultations- Inpatients ₹270 ₹270
Removing Stitches ₹41 ₹36
Aspiration Plural Effusion- Therapeutic ₹200 ₹174
Aspiration Pleural Effusion- Diagnostic ₹138 ₹120
Joints Aspiration ₹329 ₹285
Biopsy Skin ₹239 ₹207
Sternal Puncture ₹199 ₹173
Injection For Haemorrhoids ₹428 ₹373
Incision And Drainage ₹435 ₹378
Peritoneal Dialysis ₹1517 ₹1319
OPD Consultations ₹135 ₹135
Suturing Wounds With Local Anaesthesia ₹124 ₹108
Dressing Wounds ₹52 ₹45
Abdominal Aspiration- Therapeutic ₹476 ₹414
Abdominal Aspiration- Diagnostic ₹380 ₹330
Pericardial Aspiration ₹393 ₹342
Venesection ₹143 ₹124
7 Injections For Varicose Veins ₹363 ₹315
Intercostal Drainage ₹144 ₹125
Dilatation of Urethra ₹518 ₹450

Booking CGHS Appointment Online

Here are the Steps to book a doctor's consultation appointment at a CGHS centre:

Step 01: Begin by visiting the official website of CGHS.

Step 02: Log in to the portal using your beneficiary ID and the OTP (One-Time Password) received on your registered mobile number.

Step 03: Review your personal details displayed on the screen. If everything is correct, click on "Agreed". If any details are incorrect, click on "Not me" to rectify them.

Step 04: Choose the CGHS dispensary, doctor, and speciality for your consultation.

Step 05: Pick the date for your appointment based on the availability of the selected doctor.

Step 06: Now select your preferred time slot for the appointment.

Step 07: Once you've chosen the date and time, click on the "Proceed to Book Appointment" button and review all the details provided, including the date, time, doctor, and dispensary.

Step 08: After confirming that all details are accurate, click on the "Confirm" button to finalise your appointment booking.

Step 09: Upon successful booking, the system will generate a confirmation receipt. You can either save it digitally or take a printout. Make sure to carry it with you on the day of your appointment at the CGHS centre.

What is CGHS Contribution

The availability of private hospital wards affiliated with CGHS depends on the beneficiary's specific pay grade. The ward entitlements under CGHS are as follows:

Corresponding tiers within the pay matrix in accordance with the 7th Central Pay Commission (CPC) Contribution (₹ per month)
Up to ₹47,600 General ward
Above ₹47,601 to ₹63,000 Semi-private ward
₹63,101 and above Private ward

The monthly subscription fees required from CGHS beneficiaries to access CGHS facilities are outlined below:

Corresponding tiers within the pay matrix in accordance with the 7th Central Pay Commission (CPC) Contribution (₹ per month)
For levels 1 to 5 ₹250
For level 6 ₹450
For levels 7 to 11 ₹650
For levels 12 and above ₹1000

What is a CGHS Card?

The CGHS card, issued by the Indian government to eligible beneficiaries, is a plastic card featuring a beneficiary ID number and a photo ID. It functions as proof of identification for beneficiaries accessing medical treatment or claims under the CGHS scheme.

Within the card are the individual's personal and health details, along with specifics regarding the medical benefits they qualify for within the CGHS program. Notably, the card is non-transferrable and is valid solely for the individual named on it. Therefore, beneficiaries must carry their CGHS card alongside a valid government ID when availing of medical services under this scheme.

In the event of card loss, beneficiaries are required to report the incident to both the police station and CGHS authorities. To obtain a duplicate card, beneficiaries must submit a copy of the FIR application form and pay a penalty of ₹50.

Application Process for CGHS Card Online

Step 01: Complete the application form from the official website of CGHS with accurate details and upload photos as instructed.

Step 02: Once the form is filled out, submit it through the online portal and retain a printed copy for your records.

Step 03: Gather supporting documents, ensuring they are endorsed by the Head of the Department or Office for serving employees.

Step 04: Submit the application form and accompanying documents to the Additional Director HQ office in Delhi or the Additional Director’s office in other cities.

Documents Required for CGHS Card

For Pensioners:

  • Proof of residency

  • Proof of age for dependents

  • Residence proof for dependents

  • Disablement certificate from a recognised authority if the dependent is differently-abled

  • Bank Demand Draft

  • Attested copies of the last pay certificate

  • Surrender certificate if a CGHS Card was issued during employment

For Eligible Serving Employees:

  • Residence proof of dependents

  • Proof of residency

  • Disablement certificate from a recognised authority if the dependent is differently-abled

  • Proof of age

Validity of the CGHS Card

  • Yearly contribution pensioner cards require contribution prior to the completion of each year to maintain card validity.

  • The CGHS card retains validity across all CGHS cities for investigation, treatment, and hospitalisation.

  • For serving employees, the CGHS card remains valid until the date of retirement.

  • In the event of a serving employee's transfer to a non-CGHS covered area, the CGHS service card remains valid for family members for up to six months after the transfer, provided six months' CGHS contribution has been made in advance.

Importance of a Medical Insurance Policy

Even with the Central Government Health Scheme (CGHS) in place for government employees, having a health insurance plan remains crucial since medical emergencies never come announced.

Tata AIG offers cashless access to network and non-network hospitals across India, ensuring you and your loved ones have options for quality healthcare. We provide round-the-clock customer assistance, especially in medical insurance for senior citizens, ensuring prompt support and guidance during emergencies, regardless of the time of day.

You can now say goodbye to long queues and paperwork hassles with us. With Tata AIG’s mediclaim policy, you can conveniently select, compare, and purchase policies online from the comfort of your home, offices, or even while on a weekend getaway.

Conclusion

Central Government Health Scheme (CGHS) stands as a cornerstone of healthcare provision for central government employees, pensioners, and their dependents within India.

By providing accessible, affordable, and high-quality healthcare services, CGHS not only fulfils its mandate of catering to the healthcare needs of central government personnel but also contributes significantly to the broader goal of ensuring health equity and inclusivity across the nation.

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