Central Government Health Scheme (CGHS)

Know the coverage, benefits, eligibility, and application process for Central Government Health Scheme (CGHS)
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Central Government Health Scheme (CGHS)
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3 min
30-July-2023

Central Government Health Scheme (CGHS) is a healthcare scheme provided by the Indian government for its central government employees and pensioners. This scheme was launched to provide quality healthcare facilities at reasonable rates to its employees. The main objective of this scheme is to provide comprehensive medical care to all the beneficiaries and to improve the quality of medical care available to them.

Central Government Health Scheme (CGHS): Overview

Given below is an overview of the Central Government Health Scheme (CGHS):

Scheme name

Central Government Health Scheme

Commencement year

1954

Objective

Providing comprehensive healthcare facilities to central government employees

Beneficiaries under the scheme

Central government employees and their families (pensioners and present employees)

Coverage under CGHS

Healthcare treatment through Allopathy, Homoeopathy, Indian system of medicine,

No. of cities covered

80

 

What is the Central Government Health Scheme (CGHS)?

You should first know what is the full form of CGHS? The answer to this is that the full form of CGHS is the Central Government Health Scheme. This health insurance scheme enables medical treatment under various forms of medicine. The benefits provided under the Central Govt Health Scheme include OPD treatment and medication charges, indoor treatment, and tests at government or CGHS-affiliated hospitals, child health services, family welfare, medical advice, and distribution of AYUSH medicines.

You may obtain the CGHS application form from the Central Government's official website. Upon becoming a beneficiary, you will receive a CGHS card that will serve as proof of identification to avail of the benefits.

The eligibility for hospital wards in private hospitals affiliated with the Central Government Health Scheme (CGHS) insurance scheme depends on the pay scale of the concerned individual. For further details regarding ward eligibility, please refer to the table mentioned below.

Ward type

Monthly basic pay

General ward

Up to Rs. 47,600

Semi-private ward

Rs. 47,601 to Rs. 63,100

Private ward

Above Rs. 63,101


Also check: ABHA card

Who are the beneficiaries under CGHS? (Central Govt. Health Scheme)

Individuals falling under the categories mentioned below are eligible to become beneficiaries of the Central Govt Health Insurance Scheme:

  • Employees receiving salaries from the Central civil estimates
  • Family members of beneficiaries receiving salaries from Central civil estimates
  • Dependents of families residing in areas covered by the Central Govt Health Scheme
  • Retired Central Government pensioners
  • Members of Parliament
  • Former Vice Presidents
  • Former and Lieutenant Governors
  • Current or retired judges of the Supreme Court and the High Court
  • Employees of the post and telegraph department
  • Delhi police personnel
  • Freedom fighters
  • Journalists from the Press Information Bureau
  • Employees of the Railway Board

How to apply for Central Government Health Scheme (CGHS) card?

The enrollment process under Central Govt Health Scheme involves the steps discussed below:

  • Confirm eligibility for CGHS enrollment.
  • Apply online on the official website (cghs.gov.in) or visit a CGHS wellness center.
  • Since the online application process cannot be completed on the official website, you need to visit a wellness center for document verification. Print the online application and submit it with supporting documents at a wellness center.
  • You can visit the wellness center between Monday to Saturday, 7:30 AM to 2:00 PM (closed on Central Government holidays).
  • Submit a photo, proof of residence, dependents' proof, age proof, and for pensioners, the Pension Payment Order (PPO) or provisional PPO/last pay certificate.
  • Eligible dependents include parents, parents-in-law (for female employees), unmarried children up to 25 years, unmarried/divorced/separated daughters, and minor siblings with an income less than Rs. 9,000 + DA per month.
  • Receive a photo ID plastic card with policy details and a unique beneficiary number.
  • The card is valid until the primary insured's retirement; a new card is required for dependents after the primary insured's death.

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In which states and cities can you avail CGHS (Central Government Health Scheme) facilities?

As of 2019, CGHS is presently operational in 37 cities all over the country. A list of cities presently covered under CGHS is given below:

SI. No.

State/UT

City

Allopathic

Ayurvedic

Homeopathic

Unani

Sidha

Yoga

1

Assam

Guwahati

5

0

1

0

0

0

2

Andhra Pradesh

Visakhapatnam

1

0

0

0

0

0

3

Bihar

Patna

5

1

1

0

0

0

4

Chhattisgarh

Raipur

1

0

0

0

0

0

5

Delhi

Delhi

86

12

13

5

1

4

6

Goa

Panaji

1

0

0

0

0

0

7

Gujarat

Ahmedabad

8

1

1

0

0

0

Gandhinagar

1

0

0

0

0

0

8

Haryana

Faridabad*

1

0

0

0

0

0

Gurgaon*

2

1

0

0

0

0

9

Himachal Pradesh

Shimla

1

0

0

0

0

0

10

Jammu & Kashmir

Jammu

2

0

0

0

0

0

11

Jharkhand

Ranchi

3

0

0

0

0

0

12

Karnataka

Bengaluru

10

2

1

1

0

0

13

Kerala

Thiruvananthapuram

3

1

1

0

0

0

14

Madhya Pradesh

Bhopal

2

0

0

0

0

0

Jabalpur

5

0

0

0

0

0

Indore

1

0

0

0

0

0

15

Maharashtra

Mumbai

26

2

3

0

0

0

Nagpur

11

2

1

0

0

0

Pune

9

1

2

0

0

0

16

Manipur

Imphal

1

0

0

0

0

0

17

Meghalaya

Shillong

2

0

0

0

0

0

18

Mizoram

Aizawl

1

0

0

0

0

0

19

Nagaland

Kohima

1

0

0

0

0

0

20

Odisha

Bhuvaneshwar

3

1

0

0

0

0

21

Puducherry

Puducherry

1

0

0

0

0

0

22

Rajasthan

Jaipur

7

1

1

0

0

0

23

Sikkim

Gangtok

1

0

0

0

0

0

24

Tamil Nadu

Chennai

14

1

1

0

2

0

25

Telangana

Hyderabad

13

2

2

2

0

0

26

Tripura

Agartala

1

0

0

0

0

0

27

Uttrakhand

Dehradun

3

0

0

0

0

0

28

Uttar Pradesh

Allahabad

7

1

1

0

0

0

Ghaziabad*

1

0

0

0

0

0

Greater Noida*

1

0

0

0

0

0

Indirapuram*

1

0

0

0

0

0

Kanpur

9

1

2

0

0

0

Lucknow

9

1

1

1

0

0

Noida*

2

0

0

0

0

0

Meerut

6

1

1

0

0

0

Sahibabad*

1

0

0

0

0

0

29

West Bengal

Kolkata

18

1

2

1

0

0

30

Chandigarh (UT)

Chandigarh

1

0

0

0

0

0

Total

288

33

35

10

3

4


* Please note that this information may be subject to change, and it's advisable to check for the latest updates on CGHS facilities in specific cities.

Benefits of the Central Government Health Scheme (CGHS)

There are numerous benefits of being enrolled under the Central Government Health Scheme (CGHS). Below is the list of CGHS benefits:

  • Comprehensive medical care:
    CGHS provides comprehensive medical care facilities to its beneficiaries. It includes hospitalisation, diagnostic tests, and consultations, among others.
  • Affordable medical care:
    The medical facilities provided under CGHS are available at reasonable rates.
  • Cashless service:
    CGHS provides cashless service to its beneficiaries. The medical bills can be directly submitted to the concerned department for settlement.
  • Preventive health care benefits:
    CGHS provides various preventive health care benefits such as health check-ups, immunisation, and dental care facilities, among others.
  • Emergency medical care:
    CGHS provides emergency medical care to its beneficiaries. It includes ambulance services, 24x7 medical assistance, and critical care services, among others.

Eligibility criteria for CGHS (Central Government Health Scheme)

Central Government Health Scheme (CGHS) is a health insurance scheme for central government employees and pensioners in India. To avail of the benefits of the CGHS scheme, individuals need to fulfil certain criteria. Here are the eligibility criteria for the Central Government Health Scheme:

  • Central Government employees and their family members are eligible for the scheme.
  • Pensioners of the central government and their family members can also enrol in the CGHS scheme.
  • Individuals should be residing in the cities where CGHS facilities are available.
  • The individuals should have a valid CGHS card.

By fulfilling these eligibility criteria, individuals can avail of a range of healthcare facilities at CGHS centres and empanelled hospitals across the country.

List of CGHS empaneled hospitals

Given below is the list of a few of the empaneled hospitals under the Central Govt Health Scheme:

City

Hospital name

Faridabad

Accord Super Speciality Hospital

Lucknow

Chandan Diagnostic Centre

Fortis Hospital Ltd

Bengaluru

Star Hospitals

Hyderabad

Matis Multispeciality Hospital

Ahmedabad

Sevenhills Healthcare

Mumbai

Lifeline Hospital

Pune

Note: CGHS has partnered with multiple other hospitals across the country. You can get a detailed list of empaneled hospitals on the official website. Also, these hospitals are subject to multiple factors, it is suggested to check the official website for the latest list of empaneled hospitals.

What are the types of medical systems covered in Central Government Health Scheme?

The Central Government Health Scheme (CGHS) covers various types of medical systems, which are as follows:

  • Allopathic: It is the most common medical system that covers all the diseases and conditions.
  • Ayurvedic: It covers various treatments based on traditional Indian medicine.
  • Homeopathy: It covers various treatments based on homeopathy medicine.
  • Unani: It covers various treatments based on the Unani system of medicine.
  • Indian system of medicine: Ayurveda, Yoga and Naturopathy, Unani and Siddha streams of medicines are known as Indian Systems of Medicine.
  • Siddha and Yoga: Siddha and Yoga are ancient Indian practices that focus on achieving physical, mental and spiritual well-being.

Also, read: Ladli Bhena Yojana

Facilities under Central Government Health Scheme - CGHS

The facilities under Central Government Health Scheme are as follows:

Out-patient department (OPD):

It is a unit in the hospital where patients can consult medical specialists for their health problems.

In-patient department (IPD):

It is a unit where patients are admitted to the hospital for treatment.

Diagnostic services:

The diagnostic services under CGHS include X-rays, ultrasounds, lab tests, CT scans, MRI scans, among others.

Medical stores:

The medical stores under CGHS provide all the necessary medicines and medical equipment.

Consultation with specialists:

Under Central Government Health Scheme, beneficiaries can consult medical specialists for their health problems.

Treatments covered under Central Government Health Scheme (CGHS)

Central Government Health Scheme covers various treatments that are listed below:

  • General surgery: It includes surgeries related to the abdomen, chest, and soft tissues.
  • Obstetrics and gynaecology: It covers all the procedures related to pregnancy, childbirth, and female reproductive health.
  • Medicine: It covers all medical conditions such as respiratory diseases, gastrointestinal diseases, and infectious diseases, among others.
  • Paediatrics: It covers all the health problems of infants, children, and adolescents.
  • Ophthalmology: It covers all the treatments related to the eye.
  • ENT: It covers all the treatments related to the ear, nose, and throat.
  • Orthopaedics: It covers all the treatments related to bones and muscles.

Treatments not covered under Central Government Health Scheme (CGHS)

CGHS does not cover the following treatments:

  • Non-allopathic treatment
  • Cosmetic surgery
  • Fertility treatments
  • Genetic testing
  • Alternative medicines

How to book an appointment under Central Government Health Scheme?

Follow the steps below to apply for the scheme:

Step 1: Visit the official CGHS online portal.

Step 2: Enter your login credentials, i.e., the beneficiary ID, and generate an OTP. Enter the OTP and click on ‘Proceed’.

Step 3: Cross-check the details that appear on the screen. If all the details are correct, click on ‘Next’ and choose the speciality, the CGHS dispensary, and a doctor.

Step 4: Choose an appointment date as per your convenience. Select the ‘Book an appointment’ option.

Step 5: After selecting your preferred time slot for a CGHS appointment online, a summary of the appointment details and your personal information will be presented on the screen for your confirmation.

Step 6: Confirm your appointment and you will receive an SMS on your registered mobile number with booking confirmation.

How to claim benefits under CGHS: Procedure and guidelines?

Submit the claim at the CGHS wellness center where you are registered. Upon verification against the checklist, if the claim is complete with all required documents, an acknowledgment with a claim number will be generated in the wellness center's computer system.

What is a CGHS card?

The CGHS card serves as proof of identification for beneficiaries seeking medical treatment or mediclaim under this scheme. The card contains the individual's personal and health information. It also specifies the type of medical benefit that the individual is eligible for under the CGHS scheme. The card is not transferable, and it is authorised only for the person whose name is mentioned on it. The beneficiary must carry the CGHS card along with a valid government ID proof at the time of receiving medical services under this scheme.

In conclusion, the Central Government Health Scheme (CGHS) is an excellent initiative by the Indian government to provide quality healthcare facilities to its employees and pensioners. The plan provides comprehensive medical insurance, affordable medical care, cashless service, preventive health care benefits, and emergency medical care, among others.

Eligible beneficiaries can avail themselves of the benefits of this scheme by enrolling themselves. The scheme covers various medical systems, treatments, facilities, and services. It is a step towards achieving the goal of providing healthcare to the masses.

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Frequently asked questions

What is the process of applying for the Central Government Health Scheme online?

To apply for the CGHS scheme online, applicants need to visit the official CGHS website and select their respective cities. Once they select their city, they need to fill up the application form with their personal and healthcare details, along with uploading the necessary documents, such as ID proof and address proof. After successful verification of the application, the CGHS card will be issued to the applicant.

What is a CGHS card?

A CGHS card is an identification card issued to the beneficiaries of the Central Government Health Scheme. It contains the personal and health information of the beneficiary and serves as proof of identification for availing of medical treatments and services under the scheme.

Is Central Government Health Scheme (CGHS) cashless?

Yes, the Central Government Health Scheme (CGHS) is a cashless healthcare scheme. Under this scheme, the beneficiaries can avail of medical services at any of the empaneled hospitals or CGHS dispensaries without having to pay in cash. The bills for the medical services are settled directly by the CGHS.

Who is eligible for CGHS card?

The Central Government Health Scheme (CGHS) card is issued to the central government employees and pensioners and their family members. The eligible family members include spouse, dependent children up to the age of 25 years, dependent parents, and unmarried daughters. The cardholders are eligible for medical facilities at CGHS dispensaries and empaneled hospitals across the country. In case if emergency medical services are required outside of the CGHS jurisdiction, the beneficiaries can get cashless medical services at the empaneled hospitals outside the jurisdiction. The cardholders need to ensure that their CGHS cards are valid and updated to enjoy healthcare benefits under the scheme.

What is CGHS and how can I avail its facility?

CGHS stands for Central Government Health Scheme which is a healthcare system for Central Government employees and pensioners. To avail its facility, you need to apply for a CGHS card by visiting the authorised CGHS dispensary or by registering online on the CGHS portal.

What is the maximum limit for CGHS?

The maximum limit for CGHS depends on the entitlement of the employee, on the basis of their pay scale. The higher the pay scale, the higher the entitlement to medical facilities and benefits. It is advisable to check with the authorised CGHS dispensary to get a clear understanding of the entitlement.

What is the time limit for medical bills in CGHS?

The time limit for medical bills in CGHS is 3 months from the date of completion of treatment. The medical expenses need to be claimed within this time period, failing which, it may not be admissible.

What documents are required for a CGHS card?

The documents required for a CGHS card are:

  • Proof of identity - PAN card, Aadhar card, Voter ID, Passport, or any other government-issued ID.
  • Proof of residence - Latest utility bill, rent agreement, or any other proof of residence.
  • Passport size photograph.
  • A copy of your government employee or pensioner ID card.
  • A valid CGHS application form.
Is it necessary to get separate CGHS cards in case both, the husband and the wife, are government employees?

Yes. Both government employees can choose to contribute to CGHS and acquire two separate CGHS cards. The names of eligible dependent family members can be enlisted on their respective cards.

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