CGHS Medical Health Care Scheme for Central Government Employees and Pensioners

CGHS Medical Health Care Scheme for CG Employees and Pensioners

The Central Government Health Scheme (CGHS) was launched in India in 1954 with the objective of providing quality and affordable healthcare to government employees, pensioners and their dependents. The scheme is managed by the Ministry of Health and Family Welfare. The scheme provides free medical treatment at CGHS-approved hospitals and dispensaries. It also covers the cost of medicines and diagnostic tests. Treatment in private hospitals is also covered under the scheme, but there are certain rules that need to be followed.

Contribution of Lifetime Fees for CGHS Card

The Central Government Health Scheme (CGHS) was introduced in India in 1954 with the primary objective of providing quality and affordable healthcare to government employees, pensioners, and their dependents. The scheme is currently available in 33 cities across India. The lifetime membership registration in CGHS is very simple. Pensioners have to pay the subscription (according to your pay level as per 7th CPC) amount for ten years (120 months) as a one-time payment for a lifetime membership. For example, a pensioner retired at the pay level of 6 and he wants to join the scheme of CGHS for a lifetime membership. To obtain the CGHS card, he has to pay the amount for 120 months of subscription. A total of Rs. 54,000 (120 x 450=54000).

LIFETIME CGHS CARD: CGHS Card for Central Government Pensioners – Contribution as above depending on the Last grade pay at the time of retirement. The choice is with the individual. One can apply for a Life time card by paying 10 years’ contribution together or one can apply for one year, two years, etc. by paying for that applicable period. [Read more]

List of CGHS Approved Hospitals Near Me

To find a list of CGHS-approved hospitals and dispensaries in India, one can either visit the official website of the Central Government Health Scheme or contact their local CGHS office. The Central Government Health Scheme (CGHS) has released its approved list of hospitals for the year 2022, which includes general hospitals, eye hospitals, Dental clinics, and diagnostic labs. This scheme provides significant medical services to Central Government employees, pensioners, family pensioners, and eligible dependents in the form of cashless treatment as per existing CGHS Rules and CS(MA) Rules. For treatment in any Government or Private empanelled hospitals, a CGHS Card or referral letter is necessary. [Click to a detailed list of hospitals and Dispensaries]

CGHS Dispensary Online Appointment

“In order to book an online appointment in a CGHS dispensary, the first step is to visit the official website of CGHS. On the homepage, you will find a link for ‘Online Appointment Booking’. Click on this link and you will be redirected to a new page. Here, you will be required to enter your personal details such as your name, contact number, email id, etc. After entering all the required details, click on the ‘Submit’ button. Individuals may book an online appointment with the Medical Officer of the Wellness Centre or a Specialist who visits the particular Wellness Centre by visiting the CGHS portal, cghs.nic.in, via the ‘Book Appointment’ link. The steps for booking an online appointment (Self Registration) are as follows:

1. Visit the website cghs.nic.in.
2. Click on the ‘Book Appointment’ option on the right-hand side of the screen.
3. Enter the beneficiary ID and click ‘Generate OTP’.
4. A One Time Password (OTP) will be sent to either the beneficiary’s registered mobile number or, if that is the only registered number, the mobile number of the main cardholder.
5. Enter the OTP and click ‘Proceed’.
6. The beneficiary details will be displayed on the screen.

• Click ‘Proceed’ if these details are correct, otherwise click ‘NOT YOU’ and login again to proceed as previously outlined.
• Select your preferred Specialty, Dispensary, and Doctor, then click the Proceed button. A beneficiary can choose a GDMO (General Duty Medical Officer) or a Specialist from any of the CGHS wellness centers.
• Once a date with an available appointment has been chosen, the slot timings and appointments available at the top of the screen will be displayed. Select your desired slot.
• Click Proceed to Book Appointment to open the beneficiary and appointment details page. Make any desired changes by utilizing the Change the Specialty button.
• After confirming the details, click Confirm to Book Appointment to be taken to the Confirmation status page. Print the confirmation slip or book another appointment.
• The system would also send an SMS to the registered mobile number.
• Appointments with the General Duty Medical Officer (GDMO) can be made up to 72 hours in advance, while appointments with Specialists must be requested at least one month prior. Online appointments are not available for the same day or date. Please note that these booking times may be subject to change. Senior Citizens over the age of 75 can book appointments by calling the CGHS Helpline at 18002088900 using the registered mobile number.

CGHS Subscription Rate List 2023

Monthly Contribution for availing CGHS facility as per 7th CPC

Read more about the CGHS Subscription after 7th CPC

Hospitalization in Emergency under CGHS Scheme

In an emergency, beneficiaries of the Central Government Health Scheme (CGHS) may be admitted to any government-run or private hospital, with reimbursement as per CGHS rates. Full reimbursement may be allowed in specific cases on the recommendation of the Technical Standing Committee (as per the Office Memorandum No. 4-18/2005-C&P-[Vol1 (Pt 1)] dated 20/2/2009). Should reimbursement be necessary, the private hospital must produce an emergency certificate detailing the patient’s condition at the time of admission which necessitated the emergency. CGHS-empanelled hospitals are not permitted to refuse admission in an emergency to CGHS beneficiaries and must provide treatment on credit to pensioner beneficiaries and other entitled categories, regardless of whether the beneficiary is from within or outside the CGHS city.

Reimbursement of Medical Claims

For reimbursement of medical expenditures in an emergency for treatment in a non-empanelled hospital, or in an empanelled hospital, a Medical Reimbursement Claim (MRC) must be submitted by the beneficiary. For serving employees, the claim must be submitted to the relevant department and for pensioner beneficiaries, to the CMO I/C of the CGHS Wellness Centre (where the CGHS card is registered) within 3 months of discharge from the hospital. In the event of a delay in submission of the claim beyond 3 months, justification for the delay must be provided by the beneficiary in a forwarding letter. The claim is to be submitted in duplicate, in the prescribed form.

Procedure for Referral in CGHS 2023

Beneficiaries in all cities covered by the Central Government Health Scheme (CGHS) can access specialists for outpatient consultation without the need for a referral. For those aged under 75, referrals from the Medical Officer or CMO In-charge of the Wellness Centre are mandatory. These referrals are valid for one month and three outpatient consultations. After treatment and investigations, the beneficiary must report back to the concerned Wellness Centre and the Medical Officer or CMO In-charge will provide necessary medication in accordance with guidelines. For those aged over 75, direct access to empanelled hospitals is permitted without any referral from the CGHS Medical Officer. In case of an emergency requiring investigation or procedure, additional permission or endorsement is not required.

CGHS Reimbursement rules for CG employees

The Central Government Health Scheme (CGHS) provides reimbursement of medical expenses incurred by central government employees and pensioners for treatment at CGHS-approved hospitals and dispensaries. The scheme covers both inpatient and outpatient treatment, as well as preventive health check-ups.

To be eligible for reimbursement, employees must submit their medical bills and supporting documents to the concerned authorities within six months of incurring the expenses. The authorities will then process the claim and reimburse the employee accordingly. There are certain limits on the amount that can be claimed under the scheme, as well as on the types of expenses that are eligible for reimbursement. For example, only expenses related to treatment for illness or injury are covered, and not cosmetic procedures or elective surgery. In addition, pre-existing conditions are not covered under the scheme. Employees should check with the concerned authorities to ensure that their particular case is eligible for reimbursement before incurring any medical expenses.

CGHS Empanelled Hospital Latest News 2023

• Omni Hospitals is included in the Continuous Empanelment Scheme 2022 for Health Care Organisations (HCOs) with CGHS Hyderabad, valid until September 30th, 2024.
  Omni Hospitals
  (A unit of INCOR Hospitals Vizag Pvt. Ltd.),
  Waltair Main Road, opp. Lions Club, Ram Nagar, Visakhapatnam, Andhra Pradesh-530002.
• Sankar Foundation Eye Hospital is included in the Continuous Empanelment Scheme 2022 for Health Care Organisations (HCOs) with CGHS Hyderabad, valid until September 30th, 2024.
  Sankar Foundation Eye Hospital
  H.No.9-36-1, Near Kalabharathi Auditorium, Pithapuram colony, Maddilapalem, Visakhapatnam–530013.
• TX Hospitals is included in the Continuous Empanelment Scheme 2022 for Health Care Organisations (HCOs) with CGHS Hyderabad, valid until September 30th, 2024.
  TX Hospitals
  8-2-680/A, Road No. 12, Banjara Hills, Hyderabad-500034
• Ramanarajus Vision Tree Superspeciality Eye Care Centre is included in the Continuous Empanelment Scheme 2022 for Health Care Organisations (HCOs) with CGHS Hyderabad, valid until September 30th, 2024.
  Ramanarajus Vision Tree Superspeciality Eye Care Centre
  10-171/1/1, Sri Padmavathi Venkata Ramana Nilayam, Opp. Sri Kodanda Ramalayam, Visalakhshi Nagar,
  Visakhapatnam-530043.
• Raju Neuto & Multispeciality Hospitals is included in the Continuous Empanelment Scheme 2022 for Health Care Organisations (HCOs) with CGHS Hyderabad, valid until September 30th, 2024.
  Raju Neuto & Multispeciality Hospitals Pvt.Ltd.,
  D.No. 76-4-7, Main Road, Gandhipuram-2, Rajahmundry–533101.
• Maxcare Hospital is included in the Continuous Empanelment Scheme 2022 for Health Care Organisations (HCOs) with CGHS Hyderabad, valid until September 30th, 2024.
  MAXCARE Hospitals
  (A unit of Dhruva Vijaya Health Care Services)
  H.No. 3-240/1, GMR Complex, Market Road, Gautham nagar R.C.Puram Hyderabad-502319.
• NUHA Hospital is included in the Continuous Empanelment Scheme 2022 for Health Care Organisations (HCOs) with CGHS Hyderabad, valid until September 12th, 2024.
  NUHA Hospitals
  D.No.12-19-61&62, Old Bank Road, Kothapet, Guntur, Andhra Pradesh-522001
• Star Hospital is included in the Continuous Empanelment Scheme 2022 for Health Care Organisations (HCOs) with CGHS Patna, valid until January 12th, 2025.
  Star Hospital
  (A Unit of Magadh Nursing Home),
  Between East of Alok Petrol Pump & West of Mahindra Show Room in Bypass fourlane, Fatuha Road, Bari Pahari, Patna–800007.