The Central Government Health Scheme (CGHS) is a comprehensive health care scheme for central government employees and pensioners in India. It was introduced in 1954 to provide medical facilities to government employees and their dependents in selected cities across the country.
The Central Government Health Scheme is a healthcare initiative by the Indian government aimed at providing comprehensive medical care to eligible Central Government employees and pensioners. The scheme offers a wide range of medical facilities, including specialist consultation, OPD treatment, and diagnostic tests, among others. This article provides a complete guide on how to apply for the Central Government Health Scheme. You will also find information about the scheme’s benefits, objectives, eligibility criteria, required documents, and how to book appointments. So, read on to learn more about this healthcare scheme.
Overview
| Scheme Name | Central Government Health Scheme |
| Launched By | Government of India |
| Year | 2023 |
| Beneficiaries | Employees And Pensioners Of Central Government |
| Application Procedure | Online |
| Objective | To Provide Healthcare Facilities |
| Benefits | Healthcare Facilities |
| Category | Central Government Schemes |
| Official Website | https://cghs.gov.in |
The Central Government of India has introduced the Central Government Health Scheme to cater to the healthcare needs of Central Government employees and pensioners, along with their dependents. This scheme provides a wide range of medical services such as outpatient treatment, specialist consultations, diagnostic tests, and more. In order to avail these facilities, beneficiaries are required to contribute a specific amount. The government has successfully implemented this scheme for over sixty years, ensuring beneficiaries receive holistic healthcare support.
Central Government Health Scheme 2023
Currently, there are approximately 3.85 million beneficiaries enrolled in the Central Government Health Scheme, benefiting from its services in 74 cities across India. The government is actively working towards extending coverage to those who are not yet included in the scheme. Under this scheme, beneficiaries have the option to receive inpatient treatment at government and empanelled hospitals. Additionally, the scheme encompasses various medical systems including homeopathy, ayurveda, Unani, and allopathy, ensuring beneficiaries have access to a wide range of medicinal options.
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Objective
The primary aim of the Central Government Health Scheme is to ensure the provision of healthcare services to Central Government employees and pensioners. This scheme offers a wide range of medical facilities for the beneficiaries. In order to avail these benefits, beneficiaries are required to make a specified contribution. The scheme encompasses various services, including outpatient treatment, specialist consultations, diagnostic tests, and more. Furthermore, the scheme goes beyond allopathic medicine and extends its coverage to homeopathic, ayurvedic, and Unani medicines, ensuring a holistic approach to healthcare for the beneficiaries.
Benefits And Features
- The Central Government Health Scheme has been introduced by the Government of India to cater to the healthcare needs of Central Government employees and pensioners.
- The scheme also extends its benefits to the dependents of the beneficiaries.
- A wide range of medical facilities, including OPD treatment, specialist consultations, and diagnostic investigations, are being provided through this scheme.
- Beneficiaries are required to make a specific contribution in order to avail the benefits of this scheme.
- The government has successfully implemented this scheme for over sixty years, providing comprehensive healthcare services.
- Currently, there are 3.85 million beneficiaries enrolled in the Central Government Health Scheme, spread across 74 cities in India.
- The government has plans to extend coverage to the remaining beneficiaries in the near future.
- Beneficiaries of the scheme have the option to receive inpatient treatment at both government and empanelled hospitals.
- The scheme covers various medical systems, including homeopathy, ayurveda, unani, and allopathy, ensuring beneficiaries have access to a diverse range of medicines.
- In case of emergencies, private hospitals are required to provide a certificate detailing the patient’s condition at the time of admission, justifying the emergency.
- Empanelled hospitals are obligated to admit beneficiaries in emergency situations and provide cashless treatment to them, without the option to refuse admission.
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Services Provided by the Central Government Health Scheme
- Outpatient department (OPD) treatment, along with the provision of necessary medicines.
- Reimbursement of expenses related to the purchase of hearing aids, artificial limbs, and other medical appliances.
- Family welfare services, including maternity and child health services.
- Medical consultation and dispensing of medicines in alternative systems of medicine, such as Ayurveda, homeopathy, Unani, and Siddha.
- Access to specialist consultations at polyclinics or government hospitals
- Inpatient treatment at both government and empanelled hospitals.
- Diagnostic investigations conducted at government and empanelled diagnostic centers.
- Cashless facility provided for treatment at empanelled hospitals and diagnostic centers, ensuring convenience for pensioners and other eligible beneficiaries.
- Reimbursement of expenses incurred for emergency treatment received in government or private hospitals.
Plastic Cards Under Central Government Health Scheme
Beneficiaries and dependents of the Central Government Health Scheme will receive plastic cards for identification purposes. These cards will feature a photograph and a unique beneficiary ID number, which must be presented at service points to access the scheme’s facilities. It is essential for beneficiaries to securely hold on to their cards. In the unfortunate event of card loss, the beneficiary should immediately inform the police and the appropriate authorities. To obtain a duplicate card, the beneficiary needs to submit an application, along with a copy of the First Information Report (FIR), to the respective Additional Director. A fee of Rs 50 will be levied for the issuance of the duplicate card.
Pensioners Living in Non-Covered Areas
Pensioners residing outside the covered areas have the flexibility to choose between a regular Central Government Health Scheme Card or an indoor treatment card along with a fixed medical allowance from the nearest covered city. However, it’s important to note that those holding indoor treatment cards will not be eligible for any form of outpatient treatment or the issuance of medicines from the wellness centers.
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Eligible Dependents in the Central Government Health Scheme
- Parents or parents-in-law for female employees.
- Unmarried sons up to the age of 25.
- Dependent unmarried, widowed, divorced, or separated daughters and sisters.
- Minor brothers.
The process of relocating CGHS Cards
In the event of a serving beneficiary being transferred within the same city to a different department, their existing CGHS card will remain valid. The new department will inform the Central Government Health Scheme authorities to update the necessary details in the database. If the beneficiary is transferred to a different city, the same card will still be utilised. In such cases, the employee must submit an application along with the transfer orders to the Additional Director (AD) of the current CGHS city. This ensures the transfer of the card to the new city of posting. Upon joining the new city, the beneficiary will need to submit an application with supporting documents to the AD of that city for card validation.
Duration of Central Government Health Scheme Card Validity
- The CGHS card remains valid until the employee’s retirement, given their eligibility.
- For pensioners making yearly payments, the validity can be continued by submitting the contribution prior to the completion of each consecutive year.
- If a serving employee is transferred to a non-CGHS covered area, the service card remains valid for the family members for up to six months after the transfer, provided that the contribution for six months is made.
- The CGHS card is valid for treatment, investigations, and hospitalization in all covered cities.
- No transit permit is required for receiving treatment in another city, except for obtaining high-value medicines classified as life-saving or restricted supply.
- A temporary attachment is also required to be submitted at the wellness center.
Procedure Of Referral
- All beneficiaries in CGHS covered cities can avail OPD consultation from specialists in any government hospital without requiring a referral.
- Beneficiaries below the age of 75 years can seek OPD consultation from specialists in empanelled hospitals after receiving a referral from the medical officer or CMO in charge of the wellness center.
- The referral remains valid for one month and allows for up to three OPD consultations.
- After the consultation, beneficiaries must report back to the respective wellness center, where the medical officer or CMO in charge will endorse investigations and issue necessary medicines.
- Beneficiaries above the age of 75 years can directly avail OPD consultation without the need for a referral.
Authorisation for Medical Procedures
- No prior permission is necessary for receiving treatment in empanelled diagnostic centers or hospitals if it is prescribed by the medical officer, CMO in charge, or government hospital specialist.
- The listed investigations or treatment procedures must be endorsed by the referring medical officer or CMO in charge.
- After the referral, an online referral ID will be generated, which needs to be presented at the empanelled diagnostic center or hospital.
- Permission is required for any unlisted investigations or treatments.
- Required Documents for Investigation at Empanelled Diagnostic Centres or Hospitals
- Referral letter or referral ID issued by the CGHS medical officer or CMO in charge, or prescription from a specialist at a government hospital.
- Copy of the patient’s CGHS card and the main card holder’s card.
- Original prescription and original card for verification purposes.
Emergency Hospitalisation Procedures
Emergency Hospitalisation Guidelines:
- In emergency situations, beneficiaries have the option to be admitted to either government or private hospitals.
- Reimbursement for emergency hospitalization will be based on the Central Government Health Scheme rates.
- Full reimbursement may be permitted in certain specific cases upon the recommendation of the Technical Standing Committee.
- For emergency admissions at private hospitals, a certificate detailing the patient’s condition at the time of admission, justifying the emergency, must be issued.
- Empanelled hospitals are obligated to accept emergency admissions for beneficiaries and provide cashless treatment. Refusal of admission is not permitted.
Indoor Treatment In Empanelled Hospital
- Preoperative investigations are included in the treatment procedure.
- Two preoperative and two postoperative consultations are provided.
- Room charges are based on the entitled category.
- Medicines and other necessary facilities are covered during the admission period.
- The cost of stents, implants, etc., is reimbursed based on the ceiling rate for Central Government Health Scheme or actual cost, whichever is lower, in addition to the package rate.
- Pensioners are provided with credit facility by the hospital.
- Serving employees are charged according to the rates.
- No additional charges are levied on the beneficiary beyond the package rate, except if the beneficiary chooses a more expensive implant or device than the approved one. In such cases, the extra amount will be reimbursed to the beneficiary.
Claim Submission
- In the case of emergency treatment at a non-empanelled hospital or expenditure incurred for treatment at an empanelled hospital, the beneficiary must submit a medical reimbursement claim.
- The claim should be submitted within 3 months from the date of discharge from the hospital.
- Serving employees need to submit the claim to the relevant department.
- Pensioner beneficiaries should submit the claim to the CMO of the Central Government Health Scheme wellness center.
- The claim must be submitted in duplicate using the prescribed form.
- Once the claim is verified and found to be complete with all the required documents, an acknowledgment with a claim number will be generated.
- Beneficiaries can track the status of their claim using the provided claim number.
- SMS notifications will be sent to the beneficiary at each stage of the Medical Reimbursement Claim (MRC) process.
Eligibility Criteria
- Central Government employees receiving salaries from the central civil estimates, along with their dependent family members residing in CGHS-covered areas (excluding railways and Delhi administration).
- Civilian employees of the defense sector receiving salaries from defense service estimates.
- Employees of the Railway Board.
- Personnel of the Delhi Police and their families (limited to Delhi only).
- Widows of Central Government pensioners receiving family pension.
- Central Government pensioners who retire with contributory provident fund benefits, along with their families.
- Pensioners of the Central Government and their families (excluding pensioners from the railway and armed forces).
Required Documents
Pensioners
- age of son
- Demand draft
- Proof of residence
- Proof of stay of dependents
- Surrender certificate of CGHS Card
- Attested copies of PPO/Last pay certificate
- In case of differently abled dependent son above 25 years, disability certificate from the competent authority
Serving employees
- Proof of residence
- stay of dependents
- Proof of age of son
- In case of differently abled dependent son above 25 years, disability certificate from the competent authority
Apply For CGHS Plastic Card
- Begin by accessing the official website of the Central Government Health Scheme. You will be directed to the homepage of the website.
- Proceed to the homepage and locate the “Apply for Plastic Cards” option. Click on it to proceed, and a new page will be displayed on your screen.
- On the newly displayed page, you will be required to provide your mobile number and enter the captcha code. Once completed, click on the “Generate OTP” button to proceed further.
- Next, input the received OTP into the designated OTP box on the page. Once you have entered the OTP, click on the “Submit” button to proceed with the submission.
- The application form will be displayed on your screen. Please provide all the necessary information requested in the form accurately and completely. Fill in all the required details as per the instructions provided.
- Proceed to upload all the necessary documents as per the specified requirements. Once you have successfully uploaded the required documents, click on the “Submit” button to complete the submission process.
How to Book Central Government Health Scheme Appointment
- Visit the official website of the Central Government Health Scheme. The homepage will be displayed on your screen.
- Next, proceed by selecting the “Book Appointment” option available on the website. Then, enter your beneficiary identification and the verification code provided in the form of a captcha.
- Subsequently, click on the “Generate OTP” button. Following that, input the One-Time Password (OTP) received into the designated OTP field.
- Now, proceed by clicking on the “Submit” button. Once done, you will be required to select the preferred dispensary from the available options.
- Next, you will need to choose the desired date and time for your appointment. Once you have made the selection, click on the “Submit” button to confirm your appointment details.
Login Process
- Access the official website of the Central Government Health Scheme. The homepage will be presented to you upon arrival.
- Next, proceed by selecting the “CGHS Login” option. The login form will be displayed in front of you.
- In order to proceed, please input your user ID, password, and the provided captcha code into the respective fields on the login form. Once you have entered the required information, click on the “Login” button to access your account.