Health Insurance

Central Government Health Scheme

Central Government Health Scheme

Do you ever wonder why people still prefer central government jobs over the lavish workplaces and luxurious lifestyles offered by the private sector? The answer lies in the numerous benefits that central government employees can enjoy, such as job security, fixed working hours, retirement benefits, etc. One such major perk available to them is the Central Government Health Scheme (CGHS).

The central government offers this health scheme to its employees and pensioners. Depending on your pay, a small amount is deducted from the employees’ salary every month, allowing them to access a range of healthcare facilities.

So, what is CGHS? What does it cover? Let's cover all these questions and more in this article.
 

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What Is The Central Government Health Scheme (CGHS)?

The Central Government Health Scheme (CGHS) is one of the oldest health insurance schemes launched by the Government of India that is currently in effect. This scheme was introduced in 1954 for Central Government employees and pensioners.

A unique feature of this scheme is the large number of beneficiaries it serves. It currently covers approximately 41 lakh beneficiaries in cities across India. Various benefits are included in this scheme to ensure comprehensive coverage for government employees/pensioners.
 

Types Of Medical Systems Included Under CGHS

A major advantage of the Central Government Health Scheme is that it covers mainstream and alternative medicine. The CGHS covers an array of medical systems, like Allopathy, Homoeopathy, Indian systems of medicine, Unani, Siddha, Ayurveda, and Yoga.

Coverage Provided By The CGHS

The CGHS covers the following -

  • Outpatient Department treatments, i.e., treatments that don’t need hospitalisation for diagnosis or treatment. This includes the issue of medicines.

  • Indoor treatments at government and network hospitals.

  • Consultations by specialists at government hospitals/polyclinics.

  • Diagnostic tests at either empanelled diagnostic centres or government hospitals.

  • Consultation and medicines for AYUSH treatments, i.e., Ayurveda, Homeopathy, Unani, and Siddha.

  • Cashless claim facilities for treatments done at network hospitals or diagnostic centres.

  • Reimbursement facilities for -

  1.  Expenses incurred for emergency treatments at government/private hospitals.
  2. Expenses incurred for the purchase of hearing aids, artificial limbs, appliances, etc - as specified.
  • Family welfare, maternity and child health services.

Please Note:

Certain follow-up and in-patient treatments will not be covered if -

If it’s a declared emergency treatment, it can be done at any hospital, but reimbursement can be claimed only at the Additional General’s Office where the beneficiary’s CGHS card is registered.

If the beneficiary needs to reimburse medical bills, the beneficiary can be treated at any hospital but the claim amount is subject to the rates specified under the CGHS. The claim needs to be made at the Additional General’s Office where the beneficiary’s CGHS card is registered.
 

Eligibility Criteria For Availing Of Central Government Health Scheme

The eligibility for CGHS is determined by the residence of the Central Government employee. The employee and their family members residing in any notified cities are covered under the scheme.

Some of the persons Eligible under the Central Government Health Scheme include:

  • All Central Government employees paid from the Central Civil Estimates (except Railways and Delhi Administration), including their families, including their dependent family members residing in CGHS-covered areas.

  • Pensioners of the Central Government (except pensioners belonging to Railways and the Armed Forces) and their families.

  • Central Government Pensioners retiring with Contributory Provident Fund benefits and their families.

  • Widows of Central Government pensioners, in receipt of family pension.

  • Delhi Police personnel and their families, in Delhi only.

  • Railway Board employees.

  • Child drawing pension on death of a Central Government employee including minor brothers and sisters of such child.

  • Ex-Governors and Lt. Governors and their families.

  • Ex-Vice Presidents and their families.

  • Parliamentary Secretaries of the Central Government and their families.

  • Members of Parliament and their families.

  • Ex-Members of Parliament.

  • Sitting Judges of the Supreme Court and High Court of Delhi and former Judges of Supreme Court and High Courts.

  • Serving and retired Railway Audit Staff.

  • CISF personnel (and their families) and CAPF (Central Armed Police Forces) personnel posted in CGHS cities.

Here’s a detailed list of eligible employees under the CGHS:

https://cghs.gov.in/CghsGovIn/faces/ViewPage.xhtml

Important Requirement: The CGHS Card

A CGHS card is a plastic card that consists of a photo ID and beneficiary ID number. It is provided to central government employees who are eligible under CGHS. With this card, employees can avail the benefits of the scheme by presenting it at an authorised wellness centre.

The validity of the CGHS card for serving employees extends to the day of their retirement. If the card expires, the employee has to surrender it to the concerned department. If they wish to renew it further, they can do so by making a contribution one year before and submitting a form along with the requisite documents.
 

Cost Of Central Government Health Scheme (CGHS) Facilities

Employees have to make a monetary contribution to access CGHS facilities. This contribution amount is determined by your employment status. CGHS facilities cost differently for serving and retired government employees.

1. For Serving Government Employees

The CGHS card must be obtained by all central government employees working in CGHS-covered areas. Each month, the concerned department deducts a certain amount from the employee's salary, based on his/her grade pay.

2. For Pensioners

Pensioners who wish to use CGHS will also have to pay according to their grade pay when they were in service. Contributions can be made annually or in one go -

  • Yearly contribution: A certain amount of money based on grade pay is to be contributed to the CGHS each year.

  • One-time contribution: Pensioners make a one-time contribution to CGHS for 10 years. This is a lifetime contribution.
     

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Wards Are Determined By Pay Grade

Private hospitals that are empanelled under the CGHS offer wards on the basis of the pay grade of the individual. Below is a table that provides more information about ward entitlements.

Ward Entitlement Monthly Basic Pay
General Ward Up to Rs.47,600
Semi-Private Ward Rs.47,601 to Rs.63,100
Private Ward Rs.63,101 and above

 

Registration Process For Central Govt Health Scheme

 

To register for the Central Government health scheme, you need to follow different processes depending on whether you're a pensioner or a serving employee. Here is an overview of the procedure you need to follow.

1. For Current Employees

Step 1: Open the CGHS's online portal. The application form can also be obtained from any of the authorised CGHS wellness centres operated by the Central Government of India.

Step 2: The application form must be downloaded and filled out. Attach all supporting documents, including photographs.

Some of the documents to be submitted include -

  •  The application form in the given format
  •  Photographs of beneficiary family members
  •  Necessary documents of the family members.

Step 3: The application form must be endorsed by the head of the department or the office.

Step 4: All the required documents must be submitted to the Additional Director's HQ office in Delhi or in any of the other CGHS-covered cities.

2. For Pensioners

Pensioners need to visit the office of the Joint Director or Additional Director of their city to register for the CGHS.

Some of the documents to be submitted include -

  •  The application form in the given format
  •  Age proof of the pensioner's dependants
  •  Photographs of the pensioner’s family members
  •  Address proof of the pensioner
  •  Address proof of the pensioner’s dependants
  •  Disability certificate, if applicable
  •  Surrender certificate, in case the pensioner has an active CGHS card
  •  Attested copies of the last pay certificate
  •  Provisional card if PPO is not given
  •  Draft for the required amount towards CGHS scheme
     

Central Government Health Scheme & Health Insurance Policy

Employees covered by the CGHS may also be covered under a health insurance policy. So, if they undergo emergency medical treatment at a private hospital, they can make a partial reimbursement claim under the CGHS and a partial claim under the health insurance policy.

To get reimbursement under the CGHS, the employee will need to -

  • Contact their department head.
  • Submit medical bills that they’ve already submitted to the insurance company.
  • Submit a certificate from the insurance company which says that the remaining amount will be claimed under the CGHS.
     

Wrapping Up!

The central government introduced the CGHS scheme to provide affordable and quality healthcare. It provides comprehensive healthcare coverage to central government employees and pensioners. The concerned department withholds a certain amount from the employee's salary each month, according to his/her grade to provide coverage. We hope this article helped you gain enough insights about CGHS.