Central Government Health Scheme 

In a country like India, which has the highest population living below the poverty line, healthcare is a major concern. The inadequacy of funds limits access to quality medical facilities. The Central Government Healthcare Scheme (CGHS) has been introduced to combat the health issues of all the employees of the central government.

 The CGHS scheme is a broader concept of health insurance. Hence, an individual must understand the basics of the plan before opting for it. Given below are the details of the CGHS health Scheme. Take a look:

What is CGHS

In 1954, the CGHS health scheme was launched for the current as well as former employees of the Central Government of India. The Government of India has specially crafted the scheme for the betterment of the beneficiaries. Therefore, medical services are facilitated through CGHS dispensaries or clinics under allopathy, Ayurveda, homeopathy, and so on.

Under the health care plan, the following Indian cities are covered:

CITIES

Mumbai

Dehradun

Ahmedabad

Guwahati

Delhi and NCR

Pune

Bangalore

Patna

Indore

Ranchi

Meerut

Hyderabad

Kolkata

Jaipur

Lucknow

Jabalpur

Shillong

Jammu

Thiruvananthapuram

 

Every health insurance policy consists of specific components based on the needs and preferences of an employee. Here’s a closer look at the components of the CGHS health scheme:  

CGHS

Components of CGHS

  • Dispensary services and domiciliary care

  • Consultation facilities

  • Hospitalization

  • Supply of medication and other medical requirements

  • Health education to beneficiaries

  • Laboratory examinations like X-rays, ECG, and so on

  • Maternal child health and family welfare services

Ideally, the CGHS beneficiaries are the central government employees and their families. Besides, there are a few other beneficiaries covered by the plan. Here’s a closer look at them:

Beneficiaries of CGHS

  • Current and former employees of the Indian Parliament

  • Former & Lieutenant governors of India

  • Freedom fighters of India

  • Formers Vice Presidents of India

  • Current & Former judges of the Supreme Court as well as the High court of India

  • Qualified PIB journalists (Delhi)

  • Police personnel (Delhi)

  • Railway board workers

  • Pensioners and workers of selective autonomous organizations (Delhi)

To avail the CHGS Scheme, every individual must meet specific eligibility criteria. An employee who belongs to the following categories mentioned below can enroll for the CGHS Scheme:

CGHS Eligibility Criterion

  • Employees who acquire wages from the Central civil estimates

  • Beneficiaries of the family members who receive wages from Central civil estimates

  • Dependents of those families who reside in the areas covered under the CGHS health scheme

  • Pensioners of the central government

  • Parliament members

  • Former Vice presidents

  • Formers and lieutenant governors

  • Current or retired judges of the supreme court and the high court

  • Post and telegraph department employees

  • Delhi police personnel

  • Freedom fighters

  • Press Information Bureau journalists

  • Railway board employees

There are multiple facilities offered under the Central Government Health Scheme for the betterment of the employees. Take a look at the following facilities provided by the central health scheme mentioned below:

Cost Details Of CGHS Facilities

The cost of CGHS is different depending on your employment status. Here’s how it is classified.

  • For Pensioners: If a pensioner wants to avail the CGHS facilities, they will have to make a contribution as per the pay grade that they received when in service. This contribution can be annually or as a one-time contribution.

    • Annual Contribution: Here, a specific amount (depending on your pay grade) is contributed towards the CGHS facility.

    • One Time Contribution: Here, the contribution is made only once towards the CGHS for 10 years. The amount contributed will be considered as a lifetime contribution.

  • For Serving Government Employees: If you are a central government employee and serving in CGHS covered location, then you can take a CGHS card. Your department will make monthly deductions from your salary (depending on your pay grade) and contribute it to the CGHS facilities.

CGHS Rate List

CGHS Treatment Procedure/

Investigation List

Rates For

Non-NABH

Rates For

NABH

Consultation OPD

135

135

Consultation- for Inpatients

270

270

Dressings of wounds

45

52

Suturing of wounds with local anesthesia

108

124

Aspiration Plural Effusion – Diagnostic

120

138

Aspiration Plural Effusion – Therapeutic

174

200

Abdominal Aspiration – Diagnostic

330

380

Abdominal Aspiration - Therapeutic

414

476

Pericardial Aspiration

342

393

Joints Aspiration

285

329

Biopsy Skin

207

239

Removal of Stitches

36

41

Venesection

124

143

Phimosis Under LA

1180

1357

Sternal puncture

173

199

Injection for Hemorrhoids

373

428

7 Injection for Varicose Veins

315

363

Dilatation of Urethra

450

518

Incision & Drainage

378

435

Intercostal Drainage

125

144

Peritoneal Dialysis

1319

1517

Facilities Offered Under CGHS

  • OPD treatment and medication costs

  • Consultation at the government or polyclinic hospitals

  • Indoor treatment at government or empanelled hospitals

  • Investigations at government or empanelled hospitals

  • Cashless facilities

  • Reimbursement for treatments, purchase of products like hearing aids, artificial limbs, and so on

Applicable Cities Under CGHS

Ahmedabad

Allahabad

Bengaluru

Bhopal

Bhubaneshwar

Chandigarh

Chennai

Dehradun

Delhi NCR

Guwahati

Hyderabad

Indore

Jabalpur

Jaipur

Jammu

Kanpur

Kolkata

Lucknow

Meerut

Mumbai

Nagpur

Patna

Pune

Ranchi

Shimla

Shillong

Thiruvananthapuram

Contribution Towards CGHS

Private hospital wards that are empanelled under CGHS are available based on your (each individual’s) pay grade. The ward entitlement under CGHS is as follows -

Ward Entitlement

Corresponding Monthly Basic Pay Drawn by the Officer in 7th CPC

General Ward

Up to INR 47,600

Semi-Private Ward

INR 47,601 to INR 63,100

Private Ward

INR 63,101 and above

Revised Monthly Subscription For CGHS Facility

Corresponding Levels in Pay Matrix as per 7th CPS

Contribution per Month

Level 1-5

INR 250

Level 6

INR 450

Level 7-11

INR 650

Level 12 and above

INR 1000

Treatments Not Covered Under CGHS

You cannot address the follow-up and in-patient treatments in case of -

  1. A declared emergency. You can avail the treatment at any hospital, but the reimbursement can only be done at the Additional General where the CGHS card is registered.

  2. Reimbursement of medical bills. You can avail treatment at any hospital, but the claim amount is limited to the rates mentioned under the CGHS. Again, the claim needs to be done at the Additional General, where the CGHS card is registered.

What is The Application Process of The CGHS Scheme?

Follow the steps given below to apply for a CGHS Scheme:

  • Log in to the online portal

  • Submit an application form

The CGHS application form is available on the official website of the Central Government. One can avail it from any of the authorized wellness centers run by the Central Government of India.

The government has also recently launched the Ayushman Bharat Yojana under to make health and wellness centres (HWCs) accessible to the underprivileged segments of the society. For Ayushman Bharat Yojana registration and eligibility check, you can head to the official PMJAY website.

CGHS Appointment Process Online

To book an online appointment, follow the steps below -

  1. Visit the CGHS portal

  2. Enter your ID (beneficiary ID) and Generate OTP (One-Time Password)

  3. Enter the OTP you receive on the registered mobile number and select ‘Proceed’

  4. Here, your (the beneficiary’s) details will be displayed. Proceed in case the details shown are correct or select ‘Not You’. If you select the ‘Not You’ option, you will have to login again to proceed.

  5. If the details shown are accurate, the next page allows you to choose Specialty, Dispensary, and Doctor. Click on ‘Proceed’ after doing the needful.

  6. Here, a calendar will be displayed for you to choose the date of your appointment according to the availability of the selected doctor.

  7. After choosing your appointment date, the screen will display slot timings and available appointments. Choose your desired slot timing.

  8. Select ‘Proceed to Book Appointment’. Know that you can always go back and make the necessary changes by choosing the ‘Change the Specialty’.

  9. Upon proceeding to book an appointment, your details, along with the summary of your appointment, will be displayed upon the screen for confirmation.

  10. Choose ‘Confirm to Book Appointment’ and a confirmation status will appear in no time. This confirmation receipt can be printed, or another appointment can be booked (if necessary). The system will also send a confirmation SMS to your registered contact number.

What is A CGHS Card?

A CGHS card is a plastic card provided to each employee by the Indian Government. It consists of a photo ID and a beneficiary ID number. When an employee presents the CGHS card, he receives the benefits of the scheme.

Is There An Age Cap?

Under the central government health scheme, the sons and the daughters are eligible to obtain the CGHS benefits. However, the age limit for them is different.

The son is eligible to avail CGHS facilities till he starts earning or gets married. In case he suffers from permanent disability, he is eligible to avail the benefits even after crossing 25 years of age.

The daughter can avail the CGHS benefits until she starts earning, irrespective of the age.

To sum up, CGHS offers its applicants with a comprehensive coverage beneficial for them in the long run. CGHS is beneficial for every citizen, whether you are a Central government employee or a pensioner due to the financial assistance and quality services. Moreover, the security of your dependents offers you peace of mind.

Also, read about the PMJAY scheme, which is a game-changer in the public health care sector. This is an initiative by the Government of India to make medical facilities accessible to all citizens of the country.

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