Central Government Health Scheme

Last updated : December 17th, 2019 05:06 pm

Central Government Health Scheme (CGHS)

The Central Government of India has been providing comprehensive medical care to the Central Government employees and pensioners for as long as the last six decades under the Central Government Health Scheme. The Scheme is designed to cater to the healthcare and needs of beneficiaries who are eligible. These beneficiaries are individuals who comprise to form the four pillars of the country’s democratic set up specifically Legislature, Judiciary, Executive and the Press. The Central Government Health Scheme is a primary health care facility provider which stand unique than any other scheme due to its generous open-ended system of providing health care and its large beneficiary base. This article talks about the Central Government Health Scheme (CGHS) and all its essential information.

Objective and Components of CGHS

The main aim of the CGHS is to provide health care for its employees and pensioners including the family members who depend on these beneficiaries. The components of the Central Government Health Scheme are listed below.

1. Dispensary services including domiciliary care.
2. M.C.H and F.W Services
3. Consultation facilities from Specialists at Dispensary, Polyclinic and Hospital.
4. Services such as X-Ray, ECG and Laboratory Examinations.
5. Hospitalisation
6. Organising for the purchase, storage, distribution and supply of medications and other necessities.
7. Health Education for all beneficiaries.

Eligibility

An individual who belongs to any of the following groups mentioned below is eligible to avail the benefits under the Central Government Health Scheme.

1. Any employee of the Central Government who draws their salary from Central Civil Estimates.
2. The family members who are entirely dependant on a Central Government Employee who draws their salary from the Central Civil Estimates. It should be noted that they should reside in the areas covered under the Scheme.
3. Individuals who are pensioners and family pensioners of the Central Government who obtains a pension from the Central Civil Estimates.
4. Both, Ex-Members and Sitting Members of the Parliament.
5. Ex-Vice Presidents
6. Freedom fighters
7. Retired Judges of any of the High Courts.
8. Journalists who are accredited with the Press Information Bureau
9. Employees of the Indian Railway Board
10. Police Personnel of the state of Delhi.
11. Employees of certain autonomous bodies or pensioners that have been granted the benefits of the Central Government Health Scheme in Delhi.

Procedure of Registration

The process of registration for Pensioners

A pensioner may register under the Central Government Health Scheme and obtain a CGHS card from the office of the Additional Director/ Joint Director of their city.

Documents required for Pensioners

Below listed are the documents needed to register for the CGHS for pensioners.

1. An application in the prescribed format.
2. The proof of residence of the pensioner.
3. The proof of residence of the dependant of the pensioner.
4. Certificate of Disability if any.
5. The proof of age of the son of the pensioner.
6. Photos of the beneficiary family members.
7. Certificate of Surrender, if the pensioner has an active CGHS card.
8. Attested copies of the Last Pay Certificate.
9. A draft for the required amount towards CGHS contribution.
10. Provisional Card, if PPO is not provided.

The procedure of registration for Current Employees

If an existing employee of the Central Government wants to register themselves for CGHS, the individual will have to submit an application form of the prescribed format along with the necessary photos and documents of the family members to the concerned authority (Ministry/ Department/ Office) where they are working at the moment.

Types of Medical Systems covered

The Central Government Health Scheme provides health care through the systems of medicine listed below.

• Allopathic
• Homoeopathic
• Ayurveda
• Siddha
• Unani
• Yoga

Facilities Offered

The facilities offered for a beneficiary under the Central Government Health Scheme are listed below.

1. Indoor treatment at all empanelled and government hospitals.
2. Out Patient Department treatment that includes the issue of medicines as well.
3. Reimbursement of the costs for treatment in a private or government hospital in the case of an emergency.
4. Consultation with Specialists at government or polyclinic hospitals.
5. Medical investigations at all empanelled and government hospitals.
6. Services such as Maternity, Family and Child Health services are provided.
7. Reimbursement of the costs incurred by purchasing medical appliances, artificial limbs, hearing aids and similar products.
8. Cashless facility for treatments at diagnostic centres and empanelled hospitals for sanctioned and identified pensioners and beneficiaries.
9. Dispensing of medications under the Homeopathy, Ayurveda, Unani and Siddha systems of medicines along with appropriate medical consultation.

Treatments Not Covered

Follow-up treatment or inpatient treatment that is not covered under the Central Government Health Scheme are listed below.

1. At times of an emergency, the treatment of a beneficiary is allowed at any hospital. However, the medical claim must be submitted to the additional director of the respective city where the individual’s CGHS card is registered.
2. Where there is no emergency, the beneficiary of the CGHS will be permitted to avail treatment from a Local, State or a Central Government hospital. However, it should be noted that prior approval has the attained from the Chief Medical Office in charge of the CGHS WC that is in the city where the individual’s CGHS card is registered. There is a list of approved CSMA/ Empanelled hospitals under the ECHS from where the treatments may only be availed.
3. When there is a need for a follow-up treatment regarding the case of a hip/ knee replacement, neuro/ cardio surgery, cancer or renal transplant, the beneficiary of the CGHS is permitted to receive follow up treatments in any of the hospitals on the approved list under the condition that the individual has received prior permission from the Chief Medical Officer in charge.
4. For reimbursement for medical expenses, the amount that may be claimed is limited to the rates according to the CGHS, and be treated in any hospital. However, the medical claim has to be submitted to the additional director of the city in which the individuals CGHS card is registered.

Cost of the CGHS Facilities

The cost of the CGHS facilities differs from each other depending on if the individual is a serving employee or a pensioner of the Central Government of India.

For Serving Government Employees

Central Government employees who are currently serving in the area covered by the CGHS has the advantage of obtaining the CGHS card. A deduction for this purpose is made from the salary that they receive from their department every month. The deduction is made depending on the pay grade of the employee.

For Pensioners

When a pensioner wants to avail the facilities provided by the CGHS, the individual will have to make a defined contribution to the same according to their pay grade they were entitled to at the time of their service with the Central Government. The contribution may be made as a one-time contribution or a yearly contribution.

• One Time Contribution: A pensioner may pay a one-time contribution amount to avail the benefits of CGHS for a period of 10 years. This payment would be considered as a lifetime contribution.
• Yearly Contribution: Every year the pensioner would have to pay a certain amount of money as per their pay grade to avail the benefits of CGHS.

Contribution to the CGHS

Wards in Private hospitals that are empanelled under the CGHS are made available to the beneficiaries based on the basic pay of the individual in the pay band. In the table below, listed are the ward entitlements under the CGHS.

CGHS Facility Monthly Subscription

Below is a table indicating the revised monthly subscription for a Central Health Government Scheme Facility.

Time to Issue

An index card of the CGHS in a printed form would be issued on the day of application for the CGHS. In three weeks, the plastic versions of the card would be issued and sent to the concerned card holder. These cards would be sent in the registered address of residence of the government employees.

Applicable Cities

The following cities are covered under the Central Government Health Scheme:

Ahmedabad, Allahabad, Bengaluru, Bhopal, Bhubaneshwar, Chandigarh, Chennai, Dehradun, Delhi and NCR, Guwahati,  Hyderabad, Indore, Jabalpur, Jaipur, Jammu, Kanpur, Kolkata, Lucknow, Meerut, Mumbai, Nagpur, Patna, Pune, Ranchi, Shimla, Shillong and Thiruvananthapuram.