Central Government Health Scheme
What is CGHS? Benefits, Coverage & Eligibility
The Central Government Health Scheme (CGHS) is a healthcare initiative for central government employees, pensioners, and their dependents. It provides affordable medical services through a network of CGHS hospitals, dispensaries, and wellness centres.
With coverage across 80 cities, CGHS ensures access to Allopathy, Homeopathy, and Indian medicine treatments. If you are eligible, you can register online via a CGHS login and book an appointment for an online consultation. Keep reading to know more!
What is the Central Government Health Scheme (CGHS)?
The Central Government Health Scheme (CGHS) is a central government health insurance scheme that provides medical benefits to central government employees, pensioners, and their dependents. Launched in 1954, it offers healthcare services through a network of CGHS hospitals, dispensaries, and empanelled private medical centres.
How Does the Central Government Medical Insurance Scheme Work?
The central government medical insurance scheme operates on a subscription-based model, where employees contribute a fixed monthly amount based on their pay scale.
The subscription fees are determined according to the employee's pay level in the
7th Central Pay Commission (CPC) pay matrix. The current rates, effective from January 1, 2017, are as follows:
| Pay Level (7th CPC) | Monthly Subscription (₹) |
|---|---|
| Levels 1 to 5 | 250 |
| Level 6 | 450 |
| Levels 7 to 11 | 650 |
| Level 12 and above | 1000 |
For pensioners, there is an option to make a one-time contribution for a lifetime CGHS membership. This lifetime subscription is calculated as 120 times the applicable monthly subscription rate at the time of retirement. For example, a pensioner retiring at Level 6 would pay a lump sum of ₹54,000 (i.e., ₹450 x 120) for lifetime coverage.
What is Covered Under CGHS?
The CGHS covers various medical services for central government employees, pensioners, and dependents. These include:
1
Healthcare Services
Under CGHS insurance, you can avail of:
- Outpatient Department (OPD) services
- In-patient treatment
- Diagnostic tests
- Hospitalisation expenses
- Consultation fees
- Preventive healthcare
- Ambulance services
- Home healthcare support
2
Types of Medical Systems
The central government health insurance scheme provides treatments under various medical systems, including:
- Allopathy
- Ayurveda
- Homoeopathy
- Naturopathy
- Unani
- Siddha
You can book a CGHS online appointment for consultations in any of these systems.
3
Types of Medical Treatments
The Central Govt Health Insurance Scheme covers various medical specialities, including:
- Paediatrics
- ENT (Ear, Nose, Throat)
- General surgeries
- Medicine
- Orthopaedics
- Obstetrics & Gynaecology
- Ophthalmology
What is Not Covered Under CGHS?
While the Central Government Health Scheme (CGHS) offers extensive medical coverage, certain treatments and procedures are excluded, such as:
- Cosmetic treatments and surgeries
- Genetic testing-related services
- Alternative medicines
- Fertility treatments
- Non-allopathic treatments
- Dental treatments
- Medical bills from treatments outside India
- Vision-related treatments
Benefits of Central Government Health Scheme (CGHS)
The CGHS provides extensive healthcare benefits to central government employees, pensioners, and their families. It helps you manage medical expenses efficiently while ensuring access to quality healthcare services. Some of these benefits include:
1
Comprehensive Medical Coverage
With CGHS insurance, you can access a broad range of medical services, including:
- Inpatient and outpatient care
- Medication and diagnostic tests
- Hospitalisation expenses
- AYUSH treatments
2
Cashless Hospitalisation
You can receive treatment at CGHS hospital list facilities without paying upfront. The scheme directly settles bills with Central Government Health Scheme hospitals, reducing your financial burden. You can also book a CGHS online appointment for consultations at the CGHS dispensary & health scheme centres.
3
Affordable Healthcare
The central government health insurance scheme operates on a fixed subscription fee deducted from your salary or pension. This structure makes it a cost-effective solution, allowing you to manage medical expenses without financial strain. You can download the CGHS card form and submit it online if you need to apply.
4
Emergency Support
In medical emergencies, CGHS insurance provides:
- Ambulance services to transport beneficiaries to the nearest CGHS facility.
- Immediate treatment for critical conditions.
- Reimbursement for emergency care at non-empanelled hospitals through a CGHS claim.
5
Preventive Care
The central government medical insurance scheme also focuses on preventive healthcare, offering:
- Regular check-ups at Central Government Health Scheme dispensary & health scheme centres.
- Vaccinations for diseases like hepatitis and influenza.
- Health screenings to detect conditions early and reduce long-term medical costs.
Eligibility Criteria for the Central Govt Health Scheme?
To qualify for the CGHS, you must meet the following criteria:
- Hold a CGHS card.
- Be a central government employee or a dependent family member.
- Be a central government pensioner or a family member of a pensioner.
- Reside in a city where CGHS facilities are available.
- Be an employee of the Railway Board.
- Be an employee of the Postal Department.
- Be a Delhi Police personnel.
- Be an Ex-Governor or Lieutenant Governor.
- Be an Ex-Vice President of India.
- Be a freedom fighter eligible for government healthcare benefits.
If you do not meet these criteria, explore other CarePal Secure insurance schemes to find the best one for you and your family.
How can you book an appointment under the Central Government Health Scheme?
You can schedule a medical appointment through the CGHS online appointment system by following these steps:
- Visit the CGHS website and navigate to the “Beneficiary Corner.”
- Click on “Book an Appointment.”
- Enter your CGHS login details and generate an OTP.
- Verify your details and select your city, dispensary, specialty, and doctor.
- Choose a date and time for the appointment.
- Review your selection and confirm the booking. You will receive an
appointment confirmation on your registered mobile number.
Booking an online appointment through CGHS ensures smooth access to medical services at Central Government Health Scheme hospitals.
How do you apply for the Central Government Health Scheme (CGHS) Card?
The CGHS card is essential for accessing healthcare under the central health scheme. You can apply online by following these steps:
Step By Step CGHS Card Download Process
- Go to the CGHS login portal.
- Enter your mobile number and captcha, then click "Generate OTP."
- Verify the OTP and select "Apply Here" for a new card.
- Fill out the CGHS application form with your personal details, address, and required information.
- Collect all necessary documents (listed below).
- Print the completed application and submit it to:
- Your department head (for active employees).
- The Additional Director’s office (for pensioners and other eligible applicants).
Documents Required to Apply for the CGHS Card
The documents required to apply for the CGHS Card are:
- Completed CGHS application form.
- Proof of residence (Aadhaar card, rental agreement, etc.).
- Recent photographs of all eligible family members.
- Disability certificate (if applying for a dependent son over 25).
- Draft letter for the required CGHS contribution amount.
- Attested copies of the Pension Payment Order (PPO) and last pay certificate (for pensioners).
How to Claim Benefits Under the CGHS Health Scheme?
You can claim CGHS medical benefits through a cashless process at empanelled hospitals or reimbursement if treated at a non-empanelled facility. Follow these steps to claim your benefits:
- Get treatment at a CGHS-empanelled hospital for a cashless claim or any other hospital for reimbursement.
- Collect all required documents, including medical reports, bills, and prescriptions.
- Submit the claim form and supporting documents at the nearest CGHS Wellness Centre where you are registered.
- Receive a claim number for tracking purposes.
- Wait for verification. CGHS authorities will review and process your claim.
- Receive payment in your bank account (for reimbursements) or have the hospital bills settled directly (for cashless claims).
How to File a CGHS Claim for Your Medical Expenses?
If you have received treatment at a non-empanelled hospital, you need to file a reimbursement claim. Here's how:
- Download the CGHS claim form from the official website.
- Fill in the required details, including personal and treatment-related information.
- Attach the following documents:
- Original hospital bills and receipts.
- Medical reports and prescriptions.
- Discharge summary (if applicable).
- Doctor’s prescription for treatment.
- A copy of the CGHS card.
- Submit the claim at your registered CGHS Wellness Centre.
- Track your claim status using the provided claim reference number.
- Receive reimbursement in your registered bank account after approval.
In which states and cities can you avail of CGHS (Central Government Health Scheme) facilities?
Below is a list of states and their respective cities where you can access CGHS benefits:
| State/UT | Cities |
|---|---|
| Andhra Pradesh | Guntur, Nellore, Rajahmundry, Vijayawada, Tirupati, Visakhapatnam |
| Assam | Chhapra, Darbhanga, Gaya, Muzaffarpur, Patna |
| Chandigarh | Chandigarh |
| Chhattisgarh | Raipur |
| Delhi & NCR | Delhi, Faridabad, Ghaziabad, Greater Noida, Gurgaon, Indirapuram, Sahibabad |
| Goa | Panaji |
| Gujarat | Ahmedabad, Gandhinagar |
| Haryana | Sonepat |
| Himachal Pradesh | Shimla |
| Jammu & Kashmir | Jammu, Srinagar |
| Jharkhand | Ranchi, Dhanbad |
| Karnataka | Bengaluru |
| Kerala | Thiruvananthapuram |
| Madhya Pradesh | Bhopal, Gwalior, Indore, Jabalpur |
| Maharashtra | Mumbai, Nagpur, Pune |
| Manipur | Imphal |
| Meghalaya | Shillong |
| Mizoram | Aizawl |
| Nagaland | Kohima |
| Odisha | Bhubaneswar, Cuttack, Berhampur |
| Punjab | Ambala, Amritsar, Jalandhar |
| Puducherry | Puducherry |
| Rajasthan | Ajmer, Jaipur, Jodhpur, Kota |
| Sikkim | Gangtok |
| Tamil Nadu | Chennai, Tiruchirapalli, Tirunelveli |
| Telangana | Hyderabad |
| Tripura | Agartala |
| Uttar Pradesh | Agra, Aligarh, Prayagraj, Bareilly, Gorakhpur, Kanpur, Moradabad, Lucknow, Meerut, Saharanpur, Varanasi, Bagphat |
| Uttarakhand | Dehradun |
| West Bengal | Kolkata, Jalpaiguri |
CGHS Hospital List
CGHS has partnered with multiple hospitals across India to provide cashless medical services. Below is a list of some CGHS-empaneled hospitals:
| City | Hospital Name |
|---|---|
| Faridabad | Accord Super Speciality Hospital |
| Lucknow | Chandan Diagnostic Centre, Fortis Hospital Ltd |
| Bengaluru | Kolkata, Jalpaiguri |
| West Bengal | Star Hospitals |
| Hyderabad | Matis Multispeciality Hospital |
| Ahmedabad | SevenHills Healthcare |
| Mumbai | Lifeline Hospital |
| Pune | Multiple empanelled hospitals |
To access the complete list of CGHS-empaneled hospitals, visit the official CGHS website.
CGHS Grievance System to File Complaints
If you face any issues with CGHS services, you can file a grievance using the CGHS online complaint system. The steps for this are:
1
Ensure you are a CGHS beneficiary with a registered mobile number.
2
Visit the CGHS grievance portal.
3
Log in using your CGHS card details.
4
Select the category of complaint (hospital issues, reimbursement delays, appointment concerns, etc.).
5
Provide details about your grievance and upload supporting documents.
6
Submit the complaint and note the reference number for tracking.
Conclusion
The Central Govt Health Insurance Scheme simplifies medical care for government employees and pensioners, offering extensive coverage and affordable treatments. Whether you need CGHS insurance, a CGHS claim, or access to the CGHS hospital list, the scheme ensures streamlined healthcare support. Register through CGHS login, book a CGHS online appointment, and secure quality medical care with ease.
