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Who is Eligible for Central Government Health Scheme in India

Amid the ongoing health crisis over the spread of COVID-19, medical and health insurance policies are back as the hot topics of discussion. Of the many health insurance policies available to the citizens of India, the Central Government Health Scheme (CGHS) caters to those who work for the government. The terms and conditions for this policy are somewhat different from your standard health policy.

This blog discusses everything you need to know about the CGHS - its scope, eligibility criteria, the application process, and procedure to receive benefits.

What Is CGHS?

As the name implies, the Central Government Health Scheme (CGHS) is a health insurance policy that provides healthcare facilities to working or retired central government employees and their family members.

CGHS is one of the largest health insurance schemes in the world because of two reasons. First, India has one of the most significant numbers of existing or retired employees directly working under the central government. Second, the scheme started in 1954 and is operational even after 66 years. This indicates the popularity of theCGHSas a comprehensive medical care provider that covers almost the entire nation.

The Scope of CGHS

CGHS provides medical benefits that go beyond traditional allopathic treatment. In addition to Allopathy, the beneficiaries of CGHS may seek medical support under Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH).

Facilities Under CGHS

Any central government employee or pensioner having a CGHS card can get the following benefits:

  • OPD treatment at empanelled hospitals
  • Doctor consultation at government clinics or hospitals
  • Cashless medical treatment at empanelled hospitals for pensioners and other notified beneficiaries
  • Reimbursement in case of treatment received during emergency medical conditions
  • Maternity, family welfare, and child health services

Who Is Eligible for CGHS?

CGHS is a comprehensive health insurance policy that is applicable for almost all categories of central government employees, which include in particular:

  • All government employees working under the central government and their dependent family members, living or working in CGHS-covered areas
  • Pensioners who receive pensions under the Central Civil Estimates
  • Members of Parliament, sitting and former
  • All former Governors and Lieutenant Governors of Indian states
  • Freedom Fighters
  • Former Vice Presidents
  • Judges of Supreme Court and High Courts, sitting and former
  • PIB-accredited journalists (for Delhi)
  • Police Personnel working in Delhi
  • Employees of Railway Board

In Which Cities Is CGHS Available?

CGHS provides health insurance benefits to central government employees in the following cities:

  • Agartala
  • Agra
  • Ahmedabad
  • Aizawl
  • Ajmer
  • Aligarh
  • Allahabad
  • Ambala
  • Amritsar
  • Baghpat
  • Bengaluru
  • Bhopal
  • Bhubaneshwar
  • Chandigarh
  • Chennai
  • Dehradun
  • Delhi & NCR
  • Gandhinagar
  • Guwahati
  • Hyderabad
  • Jabalpur
  • Jaipur
  • Jammu
  • Kanpur
  • Kolkata
  • Lucknow
  • Meerut
  • Mumbai
  • Nagpur
  • Patna
  • Pune
  • Ranchi
  • Shillong
  • Shimla
  • Thiruvananthapuram

How Do I Register With CGHS?

Registration with CGHS is a walk in the park. Click here to download the application form. After filling out the details in the form, take photocopies of the following documents:

  • Residential proof
  • Dependents' proof of stay
  • Son/daughter's age proof
  • Disability Certificate for son(s) above the age of 25, if applicable
  • Passport photos of eligible family members
  • Attested copies of the Last Pay Certificate and PPO (for retired staff)
  • Demand Draft towards CGHS contribution, in favour of PAO, CGHS, New Delhi (for Delhi) or Additional Director, CGHS, of the respective city

For Existing Employees:

After filling out the application form and taking photocopies of the above documents, submit it to the Ministry, Department, or Office where you are employed. The Ministry, Department, or Office will forward the application to the Additional Director of the respective city.

For Retired Employees:

After filling out the application form and taking photocopies of the documents mentioned above, submit it to the Additional Director of the city or Additional Director, Headquarters (for Delhi). Remember to attach the CGHS surrender certificate, if it was issued while in service.

Once the card is ready, it will be sent to the Wellness Centre of the respective city.Click hereto find the wellness centre in your city.

When Will I Receive the Plastic Card?

Although the printout of the index card is available on the same day, it takes about three to four weeks to prepare the plastic card. Once it is ready, CGHS dispatches it to the concerned Wellness Centre. In case you do not receive the CGHS card within the stipulated time, contact the Joint Director, CGHS (HQ) in Delhi, or the concerned city's Additional Director.

After receiving the plastic card, the first thing to do is check whether all details are valid or not. If there is an anomaly or any error in the record, approach the Joint Director CGHS (HQ) in Delhi or the concerned city's Additional Director immediately.

Colour Code of CGHS Cards

CGHS health insurance policy cards come in one of four colour strips that you may find on the top of the card. The categorisation of the cards is as follows:

  • Blue is for existing central government employees.
  • Green is for former government employees, MPs, and freedom fighters.
  • Red is for existing MPs
  • Yellow is for PIB-accredited journalists and beneficiaries of autonomous bodies

What Are the Charges for the CGHS Card?

For existing central government employees residing in CGHS-covered areas, applying for a CGHS card is mandatory. The contribution is automatically deducted from the salary every month, as per the Grade Pay of the employee:

Grade PayContribution Amount
Up to Rs. 1650Rs. 50
Rs. 1800 - Rs. 2800Rs. 125
Rs. 4200Rs. 225
Rs. 4600 - Rs. 6600Rs. 325
Rs. 7600 and aboveRs. 500

Pensioners may choose to contribute the above amounts every year, or they may give the total amount of ten years at once for lifelong validity. They need to draw a demand draft in favour of 'PAO, CGHS, Delhi' (for Delhi) or concerned city's 'Additional Director, CGHS.'

Further details about the contribution amount can be found in the particular bank where your pension amount is credited.

How to Get More Information About CGHS?

If you want more information regarding Wellness Centres and their timings, CMOs, facilities, eligibility, entitlement, plastic card related issues, issuance of drugs, permission procedure, reimbursement claims, and grievance redressal, you may call the 24x7 helpline number 18002088900.

Conclusion

The Central Government Health Scheme (CGHS) is a fully functional healthcare scheme that ensures high-quality medical treatment to its beneficiaries. The benefits that fall under the scheme are almost equivalent to those received by Indian citizens under any premiumhealth insurance policyoffered by a reputed health insurance provider.

To understand the procedures and benefits of CGHS in greater detail,click here.

Recommended Link:India's Top Government Health Insurance Schemes

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