Central Government Health Scheme (CGHS): Everything You Should Know

Posted on: Aug 2, 2024 | 3 mins | Written by: HDFC ERGO Team

Central Government Health Scheme (CGHS): Everything You Should Know

The ever-increasing healthcare costs often prevent some people from opting for quality and timely treatment. This deteriorates their health further and reduces their productivity, thereby affecting economic development. Keeping the importance of good health in mind, the Government of India launched the Central Government Health Scheme for its employees and pensioners. The employees covered under the scheme can avail of quality healthcare without dipping into their savings. Let’s understand the features and benefits of the Central Government Health Scheme.

What is the Central Government Health Scheme (CGHS)?

Introduced in 1954, the Central Government Health Scheme (CGHS) is an important health insurance scheme of the Indian Government. It covers current government employees, pensioners, and their families and ensures comprehensive and affordable medical facilities for the beneficiaries. The increasing healthcare costs can be a cause of concern for individuals and families with limited financial resources. Keeping this in mind, CGHS helps the beneficiaries access quality healthcare at any empanelled hospital or dispensary without fretting about the bills. The scheme fosters a sense of well-being for the beneficiaries and contributes to a healthier, happier, and more productive workforce.

The scheme is available in more than 80 cities across the country. It offers coverage for different types of healthcare treatment, including allopathy, homoeopathy, and alternative remedies (AYUSH). However, the scheme is not free of cost. The beneficiaries must contribute a small amount of INR 250 to INR 1000 every month toward the scheme, depending on their monthly income.

Features of the Central Government Health Scheme

The features of the Central Government Health Scheme are —

1. Coverage:

The scheme provides comprehensive coverage to the beneficiaries and ensures financial security during medical emergencies and planned procedures. It covers in-patient treatment as well as out-patient department bills, diagnostic tests, doctor’s consultation fees, cost of medicines, etc.

2. Cashless treatment:

Beneficiaries can opt for cashless treatment at government and empanelled hospitals and dispensaries across the country.

3. Reimbursement of expenses:

For medical emergencies, beneficiaries can claim reimbursement of their medical bills incurred at any government or private hospital in the country. Also, if a healthcare specialist from a government or private healthcare organisation advises treatment at a particular healthcare centre, the bills will be reimbursed.

4. Treatments covered:

The scheme covers various types of treatments, such as Allopathy, Homeopathy, Ayurveda, Unani, Siddha and Yoga.

5. Medical procedures covered:

The scheme covers general surgeries, gynaecological procedures, respiratory and gastrointestinal conditions, infectious diseases, ophthalmological procedures, orthopaedical procedures, ENT treatments, and paediatric conditions.

Eligibility for the Central Government Health Scheme

The eligibility criteria for the Central Government Health Scheme are:

• All Central Government employees and their families; the government employees should receive payment from the Central Civil Estimates (except Railways and Delhi Administration).

• Pensioners of the Central Government and their families; pensioners belonging to Railways and the Armed Forces are not included.

• Retired Central Government pensioners receiving Contributory Provident Fund benefits and their families

• Widows of Central Government pensioners receiving family pension

• Delhi Police personnel and their families residing in Delhi

• Employees of the Railway Board

• Former Vice Presidents and their families

• Current and former Members of Parliament and their families

• Family members of the deceased Members of Parliament

• Former Governors and Lieutenant Governors and their immediate family members

• Parliamentary Secretaries of the Central Government and their families

• Current and retired judges of the High Court and Supreme Court and their families

• Employees of the post and telegraph department and their families

• Freedom fighters and their family members

• Journalists from the Press Information Bureau

• Military officers deputed to civil departments

• Current and retired Railway Audit Staff

• Pensioners of Ordnance factories

Benefits of the Central Government Health Scheme

The following are the benefits of the Central Government Health Scheme —

1. Wide coverage:

Like a comprehensive health insurance policy, the Central Government Health Scheme also offers wide coverage to the beneficiaries. This includes —

• Hospital bills incurred at government and empanelled hospitals

• Out-patient department expenses incurred at welfare centres, government and empanelled hospitals

• Doctor’s consultation bills at polyclinic or government hospitals and CGHS-empanelled hospitals

• Diagnostic tests expenses at government and empanelled hospitals, both cashless and reimbursement

• Cashless treatment at empanelled hospitals

• Reimbursement of expenses for emergency medical treatment availed at government or private hospitals

• Reimbursement of specific treatments advised by a government or private healthcare specialist

• Reimbursement of expenses incurred for different medical devices, such as hearing aids, artificial limbs, and medical appliances

• Maternity expenses, child healthcare, and family healthcare

• AYUSH treatment consultation and medicine bills

2. Affordable healthcare:

CGHS ensures affordable healthcare to beneficiaries. If there is a medical emergency or planned procedure, they can opt for timely treatment at any enlisted government or private healthcare centre and recover sooner.

3. Cashless treatment:

Beneficiaries can opt for cashless treatment in empanelled hospitals without worrying about paying the bills from their pocket.

4. Preventive healthcare:

CGHS also promotes preventive healthcare for early diagnosis of a condition and its timely treatment. Regular health check-ups and screening programs are organised for the beneficiaries.

5. Dental expenses:

The scheme also covers dental check-ups and treatment, such as fillings, extractions, and complex procedures.

6. Pharmacy services:

The Central Government Health Scheme also runs many pharmacies across the country. Beneficiaries can obtain medicines prescribed by CGHS doctors from these pharmacies.

How to avail of CGHS services?

To avail of CGHS services, you must enrol under CGHS by following the steps below:

• Visit the official CGHS website and navigate to the downloads option. Download the application form for a plastic card.

• Fill out the form correctly. Collect the supporting documents, such as ID proof, photographs, government or pensioner ID card, proof of residence, proof of age of the dependents, etc.

• Submit the form and the supporting documents to the office of the Additional Director in any CGHS-covered city.

• After enrolment, you will receive a photo ID plastic card containing the unique beneficiary number and CGHS scheme details.

The following are some points to keep in mind:

• The CGHS card will be valid till the date of retirement of the primary insured.

• If the primary insured is transferred to another department, they can continue to use the same CGHS card. The department will ask the CGHS to update their records.

• When the primary insured dies, their CGHS card becomes invalid. In this case, the dependent family members must apply for a new card.

When you want to consult a doctor, you can book an appointment under the CGHS scheme by following the steps below:

1. Visit the official website of the Central Government Health Scheme and enter your beneficiary ID. You will receive an OTP on your registered mobile number. Enter the same to log into your account.

2. You will see your CGHS beneficiary details on the screen. If the details are correct, click on the “Agreed” option.

3. On the next page, fill out the required details, such as CGHS dispensary, doctor’s name and speciality, and select an available date to consult the doctor.

4. Select a slot that suits you and book your appointment.

5. Preview your appointment details and click on the ‘Confirm’ option.

6. Once your appointment gets confirmed, the system will generate a confirmation receipt. Take a printout and carry it with you on the appointment day.

FAQs On Central Government Health Scheme

1. Who can be the beneficiaries under the Central Government Health Scheme?

The Central Government Health Scheme (CGHS) covers central government employees and their families. The scheme covers present employees as well as pensioners. The eligible family members include a spouse, dependent parents, dependent children up to 25 years of age, and unmarried daughters. However, children suffering permanent disability of any kind are entitled to CGHS benefits even after the age of 25.

2. Is the Central Government Health Scheme cashless?

Yes, the CGHS is a cashless healthcare scheme. The beneficiaries can avail of medical facilities at any empanelled hospital or CGHS dispensary in the country. However, CGHS also offers reimbursement of medical expenses for treatment availed in government and private hospitals during medical emergencies.

3. What is the maximum limit for CGHS?

The maximum limit for CGHS depends on the pay scale and entitlement of the government employee (beneficiary). However, the maximum benefit per family cannot exceed INR 5 lakhs annually.

4. What is the time limit for claiming a reimbursement of the medical bills?

If you have opted for medical treatment under the scheme, you must claim a reimbursement of your medical bills within 3 months. If you fail to do so, you will have to bear the expenses from your pocket.

5. If both husband and wife are government employees, can they get separate CGHS cards?

Yes, if both are government employees, they can get separate CGHS cards and include their parents and dependent children.

6. Are CGHS facilities free of cost?

No, CGHS facilities are not entirely free of cost. The covered beneficiaries must contribute a small amount of INR 250 to INR 1000 every month, depending on their payment in the pay matrix. Pensioners covered under the scheme can either make this payment annually or opt for a one-time payment (for 10 years) for lifelong validity.

7. Are critical illnesses covered under CGHS?

The beneficiaries can enjoy a maximum benefit of INR 5 lakhs per year and this may include any medical bills, including critical illness expenses. However, since the treatment for critical illnesses is on the expensive side, you can opt for a critical illness insurance policy for better financial protection.

Conclusion

To sum up, the Central Government Health Scheme is an important scheme that helps government employees and their families access quality healthcare without fretting about the bills. With the CGHS card handy, they can avail of cashless treatment at any empanelled hospital or dispensary in the country. The scheme offers wide coverage to beneficiaries, including in-patient and out-patient department treatment, preventive healthcare, and dental treatment. It covers medical expenses of up to INR 5 lakhs per year and shields government employees and their families from increasing healthcare costs.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

17 Types of Government Health Insurance Schemes in India

Bhamashah Swasthya Bima Yojana Scheme: Application, Eligibility and Benefits

Digital Health Incentive Scheme: Meaning, Benefits and more

Government Health Insurance Plans for Senior Citizens

Mukhyamanrtri Amrutum Yojana: Eligibility, Coverage & Benefits