CGHS - Central Government Health Scheme

• The current working employees of Central Government and their dependent family members living in CGHS covered areas.
• Existing and Former members of the Indian Parliament.
• Former governors & Lieutenant governors of India.
• Freedom Fighters of India.
• Former Vice Presidents of India.
• Existing and Former Judges of Supreme Court & High Courts of India.
• Workers and Pensioners of selected autonomous organizations in the Delhi state.
• Journalists qualified with PIB (In Delhi Only).
• Police Personnel (In Delhi Only).
• Workers of Railway Board.

• All employees of the central government who receive wages from the Central Civil Estimates.
• All dependent family members of Central Government employees who receive wages from Central Civil Estimates and are residents of areas covered under CGHS.
• Pensioners and family pensioners of the Central Government.
• Eligible dependent family members of pensioners and family pensioners of the Central Government.
• Members of parliament
• Ex-vice presidents
• Ex-Governors & Lt. Governors
• Retired/sitting judges of high courts and Supreme Court.
• Freedom fighters
• Journalists accredited with Press Information Bureau
• Employees of the Railway Board
• Delhi Police Personnel in Delhi only
• Pensioners and employees of certain statutory/autonomous bodies that have been extended CGHS facilities in Delhi.
• Post and Telegraph Department Employees.

CGHS provides health care through following systems of Medicine:

• Allopathic
• Homoeopathic
• Indian system of medicine
• Ayurveda
• Unani
• Siddha and
• Yoga

• OPD Treatment including issue of medicines.
• Specialist Consultation at Polyclinic/Govt. Hospitals.
• Indoor Treatment at Government and Empanelled Hospitals.
• Investigations at Government and Empanelled Diagnostic centers.
• Cashless facility available for treatment in empanelled hospitals and diagnostic centers for Pensioners and other identified beneficiaries.
• Reimbursement of expenses for treatment availed in Govt. /Private Hospitals under emergency.
• Reimbursement of expenses incurred for purchase of hearing aids, artificial limbs, appliances etc. as specified.
• Family Welfare, Maternity and Child Health Services.
• Medical consultation and dispensing of medicines in Ayurveda, Homeopathy, Unani and Siddha system of medicines (AYUSH).

The cost of CGHS facilities differs for the serving employees and the pensioners of the central government of India.

In case a pensioner wants to avail the facilities of CGHS they will also have to make a contribution according to the grade pay they were entitled at the time of their service.

The contribution can be done as yearly contribution and one time contribution:

• Yearly Contribution: Every year a certain amount of money (as per grade pay) is to be contributed towards CGHS.
• One Time Contribution: A pensioner pays onetime contribution amount towards CGHS for 10 years. It will be considered as a life time contribution.

A central government employee, who is currently serving in CGHS covered area, is bound to take the CGHS card. A deduction is made from the salary by their department every month, which depends upon the grade pay of the serving employee.

A printed index card of CGHS is issued on the day of application for CGHS. Later, the plastic cards are issued and sent to the concerned card holders within 3 weeks. The cards are sent to the residence of the government employees.

CGHS beneficiaries can undergo treatment at any empanelled private hospital without having to provide a referral letter. An order issued by the Health Ministry has stated that private empanelled hospitals shall perform the treatment on cashless basis for ex-MPs, pensioners, Freedom Fighters, Regular employees (both CGHS and CS (MA) beneficiaries) of Ministry of Health & Family Welfare and other categories of CGHS beneficiaries, who are presently eligible for credit facility. The order reads that they “shall enclose the prescription issued by Government Specialist or a CGHS Medical Officer, in original (or a self-attested photocopy) along with the hospital bill submitted to the competent authorities.”

Steps to book online appointment:

• Step 1: Go to CGHS portal.
• Step 2: Enter beneficiary ID and select "Generate OTP".
• Step 3: An OTP will be sent on registered mobile number of the beneficiary or to the main card holder's mobile, if that is the only registered number. Enter OTP and click on "Proceed".
• Step 3: Beneficiary details shall be displayed on the screen. Press the "Proceed" button if the details shown on the screen are accurate, otherwise click on "Not You". In this case, the user will need to login again and proceed.
• Step 3: Choose Specialty, Dispensary and Doctor and click on "Proceed" button'. A beneficiary can select a GDMO or a Specialist of any of the CGHS Wellness Centre for appointment.
• Step 3: A calendar is displayed and the user needs to select a date that has the availability of appointment for the selected doctor. Choose the appointment date.
• Step 3: On choosing the date, the top of the screen will show the slot timings and the appointments available. A beneficiary can choose the desired slot.
• Step 3: Click on "Proceed to Book Appointment". One can go back and make changes using the 'Change the Specialty' button.
• Step 3: On selecting "Proceed to Book Appointment", details of beneficiary and the appointment are displayed for confirmation.
• Step 3: Click on "Confirm to Book Appointment", and a confirmation status page will appear. The confirmation slip can be printed, or another appointment can be booked. The system would also send an SMS to the registered mobile number.

Source: CGHS Bengaluru

Follow-up and In-patient Treatments are not addressed in case of the following:

• In case of a declared emergency, the treatment can be done at any hospital, but the reimbursement claim can only be submitted to the Additional General where the CGHS card is registered.
• In case of reimbursement of medical bills, the beneficiary can be treated at any hospital and the claim amount will be limited to the rates as per mentioned under CGHS. The reimbursement claim can only be submitted to the Additional General where the CGHS card is registered.

An individual may have a Mediclaim insurance policy also along with the CGHS. If due to the medical emergencies, the individual is treated in a private hospital, and some of the bills are paid by the insurance company, the individual will still be able to get the rest of the cover from CGHS.

All the medical bills submitted to the insurance company and the duplicate bills with certificate from Insurance Company will be claimed from CGHS by the pensioner. The serving employees will have to contact their concerned departments for getting the balance from CGHS.

CGHS in Private Hospitals

CGHS is only provided in the Government hospitals and the empaneled private hospitals under CGHS. But if an individual faces an emergency and is treated from a non empaneled private hospital, the expenses are reimbursed as per normal CGHS rates.

Surgeries at Private Empaneled Hospitals under CGHS

Before proceeding for doing a surgery, an individual will have to obtain advice from a government specialist/ CMO i/c of Wellness Center.

However, to obtain advice, pensioners will have to apply to CMO i/c of Wellness Center for getting the permission before doing the surgery. However, CGHS will provide reimbursement at CGHS rates to contact their respective department/office.

Central Government Health Scheme is an important and unique scheme that is introduced in India to help the Government employees in providing health care.