The Central Government Health Scheme (CGHS) was introduced to extend complete medical care to Central Government employees and their dependents for the last six decades. Over the years, the Government expanded the scheme to cover pensioners, freedom fighters and other specific groups.
The scheme offers reimbursement and cashless treatment to any enrolled member who avails healthcare services. It covers healthcare under different systems of medicine, including Allopathic, Ayurveda, Unani, Homeopathic, Siddha and Yoga. Currently, the Central Govt Health Scheme covers around 38.5 lakh beneficiaries in 74 cities across the country.
The following sections will cover all the particulars of CGHS, including facilities, eligibility criteria, costs, and cities included.
The Central Government Health Scheme (CGHS) provides existing and former employees of the Central Government with the following benefits:
Also read: Universal Health Insurance Scheme
The cost of Central Government employees’ health schemes differs depending on one’s employment status. Given is a detailed breakdown of prices:
Pensioners will have to contribute as per their pay grade, which they received during service, to get the benefits of CGHS insurance. They can make either an annual contribution towards the CGHS facility or a one-time contribution.
The pensioner will have to pay a certain amount every year as a yearly contribution, depending on their past pay grade. For a one-time contribution, the pensioner will need to make a lump-sum contribution towards CGHS insurance every ten years.
Central Government employees currently servicing in a CGHS covered city can apply for a Central Govt health scheme card to be eligible. All beneficiaries under the scheme can get the CGHS photo ID card from the CGHS web portal or a nearby wellness centre.
Every month, the scheme makes a deduction from the beneficiary’s salary, depending on their pay grade.
Now, let’s take a look at the following central government medical scheme rate list for some common treatments.
|CGHS Treatment Procedure||Rates for NABH/NABL Accredited Hospitals||Rates for non-NABH/NABL Hospitals|
|OPD Consultations||Rs. 135||Rs. 135|
|Consultations- Inpatients||Rs. 270||Rs. 270|
|Suturing Wounds With Local Anaesthesia||Rs. 124||Rs. 108|
|Removing Stitches||Rs. 41||Rs. 36|
|Dressing Wounds||Rs. 52||Rs. 45|
|Aspiration Plural Effusion- Therapeutic||Rs. 200||Rs. 174|
|Abdominal Aspiration- Therapeutic||Rs. 476||Rs. 414|
|Aspiration Plural Effusion- Diagnostic||Rs. 138||Rs. 120|
|Abdominal Aspiration- Diagnostic||Rs. 380||Rs. 330|
|Joints Aspiration||Rs. 329||Rs. 285|
|Pericardial Aspiration||Rs. 393||Rs. 342|
|Biopsy Skin||Rs. 239||Rs. 207|
|Venesection||Rs. 143||Rs. 124|
|Sternal Puncture||Rs. 199||Rs. 173|
|7 Injections For Varicose Veins||Rs. 363||Rs. 315|
|Injection For Haemorrhoids||Rs. 428||Rs. 373|
|Intercostal Drainage||Rs. 144||Rs. 125|
|Incision And Drainage||Rs. 435||Rs. 378|
|Dilatation of Urethra||Rs. 518||Rs. 450|
|Peritoneal Dialysis||Rs. 1517||Rs. 1319|
Also read: Nirmaya Health Insurance Scheme
The following groups of individuals are eligible for the Central Government employees’ health scheme:
Follow-up and In-patient Treatments are not addressed in the following cases:
In case of an emergency, the treatment can be done at any hospital.
In case of reimbursement of medical bills, the beneficiary can be treated at any hospital and the claim amount will be limited to the rates as mentioned under CGHS.
In either case, the reimbursement claim can only be submitted to the Additional General where the CGHS card is registered.
The following medical systems are covered under the Central Government Health Scheme:
Indian system of medicine
All government employees are provided with a CGHS plastic card which contains the photo ID and beneficiary ID number. This card is mandatory to furnish at the wellness centre if the beneficiary seeks to avail of any of the facilities under CGHS. In case the employee loses this card, he/she needs to report to the police station and CGHS authorities in the case. In order to obtain a duplicate card, the employee needs to submit a copy of the FIR, application form, and a penalty of ₹50.
Here are the salient features of the CGHS card:
Here’s how you can apply for the CGHS card online:
Step 1: Fill out the entire application form with the correct details and attach photos in the designated areas.
Step 2: Submit the application form online and take a printout.
Step 3: Attach supporting documents. Endorsement of documents by the Head of the Department or Office for serving employees.
Step 4: Submit the documents to the Additional Director HQ office in Delhi or Additional Director’s office in other cities.
Eligible Serving Employees need to submit the following documents for procuring a CGHS Card:
The following is a full list of cities covered by the central government medical scheme:
|Amritsar||Delhi and NCR regions, including Faridabad, Ghaziabad, Greater Noida, Gurgaon etc.||Jammu||Puducherry|
|Cuttack||Jodhpur||Patna||Visakhapatnam & Vijayawada|
In case the treatment is needed urgently and in a non-empanelled hospital, the expenditure incurred for this needs to be submitted by the beneficiary within 6 months of discharge from the hospital.
In case of delay in submission of the said claim beyond 6 months, the reasons justifying the delay must be stated.
Follow the steps to apply for the Central Govt health scheme:
Step 1: Log in to the official CGHS portal.
Step 2: The CGHS application form is available on the official website, CGHS city pages and at health and wellness centres (HWCs). One can submit the application form at any of these places.
Step 3: Enter beneficiary ID and click on ‘Generate OTP’.
Step 4: Check the OTP from your registered mobile number. Enter it and select ‘Proceed’.
Step 5: Check if beneficiary details shown on the screen are correct and click on ‘Proceed’.
Step 6: Choose the correct option for Speciality, Dispensary and Doctor and click ‘Proceed’.
Step 7: Select the date of appointment from the displayed calendar.
Step 8: Choose your desired slot timings as per your convenience.
Step 9: Click the ‘Proceed to Book Appointment’ option.
Step 10: Check the details of your appointment and select ‘Confirm to Book Appointment’ to get a confirmation slip.
The Central Govt health scheme aids Government employees, pensioners, and other individuals to avail of cashless healthcare facilities in many cities in India. However, the scheme only covers a part of total costs and only for empanelled hospitals. Hence, employees may want to purchase a separate health insurance policy to cover the rest of the treatment expenses.
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Ans: Serving Central Government employees need to furnish proof for age, residency, dependency certificate or disablement certificate (if applicable). In addition, pensioners will have to submit copies of their PPO/Pay certificate and a demand draft.
Ans: The son is eligible to avail of CGHS facilities till he starts earning or gets married. In case he suffers from permanent disability, he is eligible to avail of the benefits even after crossing 25 years of age. The daughter can avail of the CGHS benefits until she starts earning, irrespective of her age.
Ans: Under Central Government Health Scheme (CGHS) rules, married women employees have the option to either opt their dependent parents or dependent in-laws for CGHS facilities.
Ans: A computerized printout of the CGHS card is issued on the same day. The original plastic card, however, is sent to the residence in about 3 weeks.
Ans: If the individual is not in a position to reach an empanelled private hospital for admission, he may be admitted in an “emergency” at any hospital of his choice or as is dictated by the circumstances of the emergency.
Ans: Medical facilities for CGHS are available through wellness centres (or CGHS dispensaries) or polyclinics for AYUSH. One can also get treatment at empanelled hospitals or nursing homes.
Ans: The term ‘dependent’ refers to any individual whose net income is less than Rs. 9000. Male children can qualify as dependent till the time they are 25 years old or start earning. Female children are eligible till they get married or employed.
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