Central Govt Health Scheme In India: 9 Facilities Covered Under CGHS

Health Insurance

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. 

What Facilities are Available under the Central Govt Health Scheme?

1. Indoor treatment facilities at Government and empanelled hospitals.
2. Cashless facility in empanelled hospitals and diagnostic centres. 
3. Medical consultation and medicines under the AYUSH system of medicine (Ayurveda, Homeopathy, Unani and Siddha).
4. Diagnostic tests at Government and empanelled diagnostic centres.
5. Specialist consultations at polyclinic and Government hospitals.
6. Maternity, child health and family welfare services.
7. Compensations for expenses incurred for treatment in Government and private hospitals during an emergency.
8. Compensation for expenses for the purchase of medical appliances, artificial limbs and hearing aids, etc.
9. OPD (Outpatient Department) Treatment, including the issue of medicines.

Components of the Central Government Health Scheme

The Central Government Health Scheme (CGHS) provides existing and former employees of the Central Government with the following benefits:

• X-ray, ECG and other laboratory services
• OPD care via a network of dispensaries
• Consultations from specialist doctors
• Immunisation
• Hospitalisation at recognised hospitals (public and private)
• Antenatal and postnatal services
• Treatment and medicines under AYUSH
• Maternity, family welfare and child care services
• Supply, storage, purchase and distribution of medicines
• Supply of various medical appliances like hearing aids, pacemakers and orthopaedic devices
• Health education to beneficiaries

Also read: Universal Health Insurance Scheme

How Much is the Cost of Various Facilities under CGHS?

The cost of Central Government employees’ health schemes differs depending on one’s employment status. Given is a detailed breakdown of prices:

For pensioners

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. 

For serving Government employees

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.

Also read: Nirmaya Health Insurance Scheme

Who is eligible for the Central Govt Health Scheme?

The following groups of individuals are eligible for the Central Government employees’ health scheme:

1. Freedom fighters 
2. Military officers on deputation to civil departments
3. Civilian employees of the Defence industry
4. Sitting and former judges of the Supreme Court and High Courts
5. Members of the parliament
6. Ex-vice presidents
7. Ex-Governors and Lt. Governors
8. Journalists accredited with Press Information Bureau
9. Railway board employees
10. Delhi police personnel
11. Post and telegraph employees
12. Pensioners of the Central Government
13. Central Government employees and dependent family members
14. Widows of Central Government pensioners
15. Some families of IAS officers, families of Government servants and employees of Kendriya Vidyalayas and Ordnance Factory Board, etc.
16. CISF personnel and CAPF personnel in CGHS cities
17. Serving and retired Railway Audit Staff
18. Employees of the Indian Audit and Accounts Department
19. PSU absorbees 
20. Absorbees of statutory/autonomous bodies of Central Government

Treatments Not Covered Under Central Government 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.

Different Types of Medical Systems Covered Under Central Govt Health Scheme

The following medical systems are covered under the Central Government Health Scheme:

Indian system of medicine

Unani

Siddha

Homoeopathic

Ayurveda

Allopathic

Yoga

What is a CGHS Card?

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.

Features of CGHS Card

Here are the salient features of the CGHS card:

• Dispensary services including domiciliary care.
• IPD (Indoor Patient) and OPD (Outdoor Patient) Services
• Family Welfare & Maternal and Child Healthcare Services
• Consultation facilities by Specialists
• Diagnostic tests
• Hospitalisation 
• Health Education 

How to apply for 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.

Documents required for CGHS Card

Eligible Serving Employees need to submit the following documents for procuring a CGHS Card:

• Proof of residency
• Age proof
• Residence proof of dependent 
• If the dependent is differently-abled, a disablement certificate from a valid authority 

For pensioners:

• Proof of residency
• Age proof of dependent
• Residence proof of dependent
• If the dependent is differently-abled, a disablement certificate from a valid authority 
• Bank Demand Draft 
• Attested copies of last pay certificate
• Surrender certificate, if CGHS Card was issued during employment

Cities Covered Under Central Government Health Scheme

The following is a full list of cities covered by the central government medical scheme:

What is the claim procedure under Central Govt Health Scheme

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. 

How to Book CGHS Appointment Online?

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.  

Final Word

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.

Download the Navi app to purchase one of the best health insurance policies in the market. You will not need any paperwork or help from agents to avail of cashless treatment using Navi. 

FAQs on Central Government Health Scheme

Before you go…

How about an affordable health insurance policy 👨‍⚕️ starting at a monthly premium of just ₹235? Install the Navi app now and get your policy in under 2 minutes.

Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.