Central Government Health Scheme (CGHS) : Rules & Application Form
For the last six decades Central Government Health Scheme is providing comprehensive medical care to the Central Government employees and pensioners enrolled under the scheme. In fact CGHS caters to the healthcare needs of eligible beneficiaries covering all four pillars of democratic set up in India namely Legislature, Judiciary, Executive and Press.
About Central Government Health Scheme (CGHS)
CGHS is the model Health care facility provider for Central Government employees & Pensioners and is unique of its kind due to the large volume of beneficiary base, and open ended generous approach of providing health care.
CGHS provides health care through following systems of Medicine
- Indian system of medicine
- Siddha and
Eligibility Conditions For Joining Central Government Health Scheme
- All Central Govt. employees drawing their salary from Central Civil Estimates and their dependent family members residing in CGHS covered areas.
- Central Govt. Pensioners/family pensioners receiving pension from central civil estimates and their eligible dependent family members.
- Sitting and Ex-members of Parliament.
- Ex-Governors & Lt. Governors.
- Freedom Fighters.
- Ex-Vice Presidents.
- Sitting and Retired Judges of Supreme Court.
- Retired Judge of High Courts.
- Journalists accredited with PIB (in Delhi).
- Employees and pensioners of certain autonomous/statutory bodies which have been extended CGHS facilities in Delhi.
- Delhi Police Personnel in Delhi only.
- Railway Board employees
- Post and Telegraph Department employees
Facilities Provided Under Central Government Health Scheme
- 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)
Cities Covered Under CGHS
CGHS, presently provides Comprehensive Health Care to more than 30 Lakh Beneficiaries in following cities:
- Delhi & NCR
Contribution Towards Central Government Health Scheme:
Wards in private hospitals empanelled under CGHS are made available based on the basic pay of the individual in the pay band. Here are the ward entitlements under CGHS:
|Ward Entitlement||Corresponding Monthly Basic Pay Drawn by the Officer in 7th CPC|
|General Ward||Up to Rs.47,600|
|Semi-Private Ward||Rs.47,601 to Rs.63,100|
|Private Ward||Rs.63,101 and above|
Revised Monthly Subscription for CGHS Facility:
|Corresponding Levels in Pay Matrix as per 7th CPS||Contribution per Month|
|Level 12 and above||Rs.1000|
Wellness Centre Timings Under CGHS
- The timings of health centers under the Central Government Health Scheme is given below:
- Working hours of the Wellness Centre or Polyclinic:
- Wellness Centers are open from 7:30 AM to 2 PM on all working days except emergency services wherever applicable, with effect from 1/4/2015. The Wellness Centers remain closed to all Central Govt. holidays. However, in case of 3 consecutive holidays occurring together, Wellness Centers will not be closed for more than 2 consecutive days.
- The registration is stopped 15 minutes before the scheduled closing time of dispensary. However, no serious patient is returned back unattended in the dispensary.
Treatment of CGHS Beneficiaries In Areas That Do Not Cover CGHS
- At various times of emergencies, treatment of beneficiaries is allowed in any hospital, but the medical claim has to be submitted to the additional director of the city in which the individual’s CGHS card is registered.
- When there are non-emergency conditions, the beneficiary of CGHS will be allowed to avail treatment from local/state/central government hospitals. However, prior approval has to be obtained from the CMO I/C of CGHS WC (in the city where the individual’s’ CGHS card is registered). The hospitals from which treatment can be availed must be approved and should fall in the list of CSMA/Empanelled hospitals under ECHS.
- At the time of follow-up treatment in case of knee/hip replacement, cardiac/neuro surgery, renal transplant or cancer, the beneficiary of a CGHS is allowed to receive follow up treatment in the approved hospitals provided he/she has received prior permission from CMO.
- In case of reimbursement for medical expenses, the amounts that can be claimed will be limited to the rates according to CGHS, and the beneficiary can be treated in any hospital. The medical claim, however, has to be submitted to the additional director of the city in which the CGHS card is registered.