CGHS

The Central Government Health Scheme, or CGHS , has been offering comprehensive medical care to pensioners and employees of the Central Government, provided they have enrolled under the scheme. Individuals are required to meet certain eligibility criteria to enrol under CGHS. They are covered below.

Eligibility Criteria 

The following group of people are eligible to avail CGHS:

  • All employees of the Central Government who draw their salary from central civil estimates
  • The dependent family members of the Central Government employees who draw their salary from Central Civil Estimates and reside in areas covered under the CGHS
  • Pensioners and family pensioners of the Central Government, who receive pension from central civil estimates
  • The eligible dependent family members of pensioners and family pensioners of the Central Government who receive pension from central civil estimates
  • Members of parliament, both ex- and sitting
  • Ex-vice presidents
  • Retired judges of high courts
  • Freedom fighters
  • Retired as well as sitting judges of Supreme Court
  • Journalists accredited with Press Information Bureau
  • Employees of the Railway Board
  • Delhi Police Personnel
  • Pensioners and employees of certain statutory/autonomous bodies that have been extended CGHS facilities in Delhi

Enrollment Process

The enrollment process under CGHS can be listed as follows:

  • Eligible employees and pensioners must apply for this cover in order to get enrolled.
  • The application can be made in the official websites (www.cghs.nic.in and www.cghs.gov.in) or by visiting the wellness centers.
  • The provision of uploading supporting documents is currently not available on the website portals. After online enrollment, the applicant must get a printout of that application and submit it along with the supporting documents.
  • Official CGHS wellness centers are open from 7.30 AM to 2.00 PM from Monday to Saturday. These centers will remain closed on all Central Government holidays.
  • The filled up enrollment form must contain an individual photograph along with personal details such as proof of residence, proof of stay of dependents, age proof of dependents, etc.
  • In addition to these documents, pensioners must also provide attested copies of their Pension Payment Order (PPO). If PPO is not available, provision PPO or last pay certificate must be submitted during enrollment.
  • For availing medical benefits, the government has deemed parents, parents-in-law (in case of female employees), unmarried son till the age of 25 years, unmarried/divorced/separated daughters, and minor siblings are deemed as dependents if their overall income from all sources is less than Rs.9,000 + DA per month.
  • Following the enrollment, CGHS beneficiaries will be issued a photo ID plastic card that contains all the relevant policy details including a unique beneficiary number.
  • The card obtained after the enrollment process is valid till the date of retirement of the primary insured.
  • In case of the death of the primary insured, the card will become invalid. Dependent family members have to apply for a fresh card upon drawing a pension.
  • In case of the transfer of the employee to another department or another CGHS-covered area, the same card will continue. The department may inform the CGHS to make the necessary changes.

Benefits

Some of the benefits available for enrolled members under this scheme can be listed as follows:

  • Inpatient treatment for all enrolled members at government and empanelled facilities
  • Cashless treatment at empanelled hospitals and diagnostic centers
  • Medical investigations conducted at government or empanelled diagnostic centers
  • Specialist consultations at polyclinic or government hospitals
  • Outpatient treatment (OPD) including expenses for medications
  • Reimbursement for emergency medical treatments undertaken at government or private hospitals
  • Expenses related to maternity, child health services, and family welfare
  • Expenses incurred for external medical accessories such as hearing aids, appliances, artificial limbs, etc.
  • Alternative treatment procedures such as Ayurveda, Homeopathy, Siddha, and Unani
  • Maternity, family welfare and child health services

    Contribution Towards Central Government Health Scheme

    Wards in private hospitals empanelled under CGHS are made available based on the basic pay of the individual in the pay band. Here are the ward entitlements under CGHS:

    Ward Entitlement Corresponding Monthly Basic Pay Drawn by the Officer in 7th CPC
    General Ward Up to Rs.47,600
    Semi-Private Ward Rs.47,601 to Rs.63,100
    Private Ward Rs.63,101 and above

    Revised Monthly Subscription for CGHS Facility

    Corresponding Levels in Pay Matrix as per 7th CPS Contribution per Month
    Level 1-5 Rs.250
    Level 6 Rs.450
    Level 7-11 Rs.650
    Level 12 and above Rs.1000

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