Central Government Health Scheme (CGHS)

The Central Government of India has been providing comprehensive medical care to the Central Government employees and pensioners for over six decades under the Central Government Health Scheme. The Scheme is designed to cater to the healthcare needs of eligible beneficiaries who form the four pillars of India's democratic setup: Legislature, Judiciary, Executive, and the Press. The Central Government Health Scheme is a primary healthcare facility provider, uniquely known for its generous open-ended system and large beneficiary base. This article provides essential information about the Central Government Health Scheme (CGHS).

Objective and Components of CGHS

The main goal of the CGHS is to offer healthcare services to employees and pensioners of the Central Government, along with their dependent family members. The key components of the Scheme include:

1. Dispensary services, including domiciliary care.
2. Maternity, Child Health, and Family Welfare (M.C.H and F.W) Services.
3. Consultation facilities with Specialists at Dispensary, Polyclinic, and Hospital.
4. X-Ray, ECG, and Laboratory Examinations.
5. Hospitalisation services.
6. Procurement, storage, and distribution of medications and essentials.
7. Health Education for all beneficiaries.

Eligibility

Individuals eligible for the benefits under the Central Government Health Scheme include:

1. Central Government employees drawing their salary from Central Civil Estimates.
2. Dependent family members of a Central Government Employee residing in the Scheme-covered areas.
3. Central Government pensioners and family pensioners obtaining a pension from Central Civil Estimates.
4. Former and current Members of Parliament.
5. Ex-Vice Presidents, Freedom fighters, and Retired High Court Judges.
6. Journalists accredited with the Press Information Bureau.
7. Employees of the Indian Railway Board and Delhi Police Personnel.
8. Employees and pensioners of certain autonomous bodies granted CGHS benefits in Delhi.

Procedure of Registration

The process of registration for Pensioners

Pensioners can register under the Central Government Health Scheme and obtain a CGHS card from the Additional Director/Joint Director office in their city. Learn more about the process of ESI registration for startups in a similar manner.

Documents required for Pensioners

To register for CGHS, pensioners need the following documents:

1. An application in the prescribed format.
2. Proof of residence of the pensioner and dependents.
3. Disability Certificate, if any.
4. Proof of age of the pensioner's son.
5. Photos of beneficiary family members.
6. Certificate of Surrender if an active CGHS card exists.
7. Attested copies of Last Pay Certificate.
8. Draft for CGHS contribution.
9. Provisional Card if PPO is not provided.

The procedure of registration for Current Employees

Current Central Government employees wishing to register for CGHS should submit the prescribed application form alongside necessary photos and documents of family members to the respective authority where they work. To understand more about employee registrations, explore the Professional Tax Registration process in Guntur.

Types of Medical Systems covered

The Central Government Health Scheme supports various medical systems, including:

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

Facilities Offered

The CGHS offers various facilities to its beneficiaries, including:

1. Indoor treatment at empanelled and government hospitals.
2. Outpatient Department treatment, inclusive of medication issuance.
3. Cost reimbursement for emergency treatments in private or government hospitals.
4. Consultations with Specialists at government or polyclinic hospitals.
5. Medical investigations at all empanelled and government hospitals.
6. Maternity, Family, and Child Health services.
7. Reimbursement for medical appliances, artificial limbs, hearing aids, etc.
8. Cashless treatment facilities at diagnostic centers and empanelled hospitals for eligible pensioners and beneficiaries.
9. Medications dispensing under Homeopathy, Ayurveda, Unani, and Siddha medical systems with suitable medical consultation.

Treatments Not Covered

Treatments and services not covered under CGHS include:

1. Emergency treatments in any hospital are allowable, but claims must be submitted to the city's additional director where the CGHS card is registered.
2. Non-emergency treatments require prior approval from the Chief Medical Office in charge of the CGHS WC in the city where the CGHS card is registered.
3. Follow-up treatments for specific cases like hip/knee replacement, neuro/cardio surgery, cancer, or renal transplant require prior Chief Medical Officer approval.
4. Medical expense reimbursements are subject to CGHS rates, and claims must be submitted to the respective city's additional director.

Cost of the CGHS Facilities

For Serving Government Employees

Central Government employees serving in CGHS-covered areas can acquire a CGHS card, with monthly salary deductions based on pay grade for this purpose. Discover more about deductions and registrations, like ITR Form 5 in Gujarat.

For Pensioners

Pensioners availing CGHS facilities must contribute based on their pay grade at service time. Contributions can be one-time or yearly:

• One-Time Contribution: A one-time payment provides CGHS benefits for 10 years, considered a lifetime contribution.
• Yearly Contribution: Annual payments are made based on the pensioner's pay grade to avail CGHS benefits.

Contribution to the CGHS

Private hospitals empanelled under the CGHS provide ward availability based on the individual’s pay band basic pay. Consider exploring related practices via employment laws relating to wages.

CGHS Facility Monthly Subscription

Revised monthly subscription fees for CGHS are as follows. Learn how tax structures may vary similarly, such as declaring crypto, share, and mutual fund income.

Time to Issue

Upon application, an index card of the CGHS is issued. Post three weeks, plastic cards are sent to the registered address of the government employees. For more regulatory management, explore GST Registration on ICEGATE.

Applicable Cities

The Central Government Health Scheme covers the following cities: 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. If you are in Kanpur and need related registrations, check 12A & 80G Registration in Kanpur.