Introduction
Are you employed or retired from the Central Government? Are you aware that you have the facility of low-cost healthcare? Under the Central Government Health Scheme, CGHS beneficiaries get all their healthcare needs met, such as visits to doctors, medicines, tests, and even cashless admission into hospitals.
What is CGHS?
First, let’s understand what CGHS is. CGHS stands for Central Government Health Scheme. It is a comprehensive healthcare initiative run by the Ministry of Health and Family Welfare. CGHS provides subsidised, cashless medical services through a nationwide network of health centres and empanelled hospitals.
The importance of the Central Government Health Scheme (CGHS)
The Central Government Health Scheme was established in 1954. CGHS is a notable health insurance scheme provided by the Indian government. It provides health coverage to current government employees, pensioners, and their dependents.
With the high cost of medical facilities, it is definitely something of concern for people who cannot afford to pay for their costs. CGHS provides its beneficiaries with quality treatment. They do not have to worry about the high costs of medical bills. The plan covers expenses for health care. This program brings wellness among the beneficiaries, hence a healthy and productive labour force.
It operates in more than 80 cities throughout India. It provides coverage to various healthcare treatments, which include allopathy, homoeopathy, and other alternative treatments (AYUSH).
There is a cost involved with the scheme. The recipients will have to make a contribution towards the scheme out of their monthly salary, which can be between INR 250 to INR 1000. The total expenditure incurred will depend solely upon the salary of the employee.
Pay Scales 1 to 5: ₹250 per month. Lower-grade Central Government employees such as clerks, assistants, support staff, MTS, etc.
Pay Scale 6: ₹450 per month. Employees like inspectors, junior officers, section officers, and equivalent posts.
Pay Scales 7 to 11: ₹650 per month. Gazetted officers, senior officers, and mid-level administrative officials.
Pay Scales 12 onwards: ₹1,000 per month. Senior government officers, high-ranking officials, directors, and equivalent posts.
Who can apply?
All employees of the Central Government who render services along with their dependent relatives. Retired officers/officials of the Central Government and their dependents.
The criteria for the Central Government Health Insurance Scheme are:
• All Central Government servants and their dependents; the servants must draw their salary through the Central Civil Estimates except for the services of Railways and Delhi Administration.
• Retired servants of the Central Government who are getting a pension under the scheme of the Contributory Provident Fund and their dependents.
• Widow of a Central Government servant, who is entitled to family pension.
• Delhi Police force, including their dependents living in Delhi.
• Servants of the Railway Board
• Ex-Vice President and his/her dependents
• Present/Ex-Members of Parliament and their dependents
• Dependents of deceased Members of Parliament
• Ex-Governors/Lieutenant Governors and their immediate relatives
• Parliamentary Secretaries of the Central Government and their dependents
• Judges of the High Court and Supreme Court and their dependents
• Servants of the Post & Telegraph department and their dependents
• Freedom fighters and their dependents
• Journalists of the Press Information Bureau
• Officers of the Military, deputed to Civil Departments
• Present/Ex-Railway Audit Staff
• Pensioners of Ordnance Factories
• Pensioners of the Central Government and their dependents, except pensioners of Railways and armed forces
What are the required documents for CGHS cards?
The list of required documents for a CGHS card depends on the employee’s age:
1. For salaried employees
Identity proof: Aadhaar card.
Proof of income: Current month’s salary slip (reflecting CGHS deductions).
Proof of address: Aadhaar card, electricity bill, or allotment letter.
Photograph: Passport-size photographs of the employee and all dependents.
2. For Pensioners
PPO Copy: Photocopy of the Pension Payment Order (PPO).
Payment Receipt: Fee receipt provided through the Bharatkosh portal.
Identity Proof: Aadhaar Card and PAN Card.
Photograph: Passport-size photographs of the pensioner and all dependents.
3. Separate documents required for family members
For children: Birth certificate or 10th-grade certificate (to verify age).
For parents: Proof of monthly income less than ₹9,000 (such as a bank statement or affidavit).
For children with disabilities: Medical certificate from a government hospital.
Online application process
To apply for a CGHS card online, visit the official CGHS Portal, then verify your mobile number with an OTP, and fill out the application form. After submitting, download the completed form and print it. Attach the required supporting documents to submit to the Additional Director in your city or your department.
How to download the card?
Step-by-Step Online Download Guide
- Visit the Portal: Open the official CGHS Beneficiary Login Page.
- Generate Password (If Needed): If you do not have a password, click Generate/Reset Password, enter your details, and create one.
- Log In: Enter your Beneficiary ID (Ben ID), password, and the captcha code, then click Sign In.
- OTP Verification: Enter the One-Time Password (OTP) sent to your registered mobile number and click Proceed.
- Access the Download Option: Click on the Download or Beneficiary tab on the top menu bar, then click Print Plastic Card or Print Card.
- Save the PDF: Click the download icon next to the name of the specific family member whose card you want to save. Save it as a PDF or take a colour printout.
What are the Benefits of CGHS Cards?
The Central Government Health Scheme (CGHS) card covers all aspects of healthcare services, which include cashless treatments, free medications, and consultation of specialists for the employees of the central government and their families.
Key Healthcare Benefits Outpatient Department (OPD) Treatment: Provision of free consultations as well as medication from the Wellness Centre of the CGHS.
- Cashless Hospitalisation: Total exemption from paying cash for IPD services in any Government or private empanelled hospital in India.
- Expert Opinion at Specialist Clinics: Expert opinion available at any of the government polyclinics or private empanelled hospitals through a referral from a Wellness Centre.
- Covered Diagnostics: Laboratory tests, X-Ray, MRI, and CT scan examinations carried out by approved diagnostics centres.
- AYUSH Treatment: Full coverage for the treatment of illnesses using alternative healthcare systems like Ayurveda, Yoga, Unani, Sidha, and Homoeopathy.
Reimbursements & Medical Appliances Claims on Emergency Basis:
Payment of all medical costs incurred when admitted into a non-empanelled private hospital in life-threatening emergencies.
Medical Appliance Reimbursements: Provision of assistance towards the purchase of essential appliances, including hearing aids, prosthetic devices, and pacemakers, post-receiving the necessary authorisation from official sources.
The following are some points to keep in mind:
The CGHS card remains valid until the date of retirement of the insured person.
- If the insured person gets transferred to another department, the CGHS card continues to remain valid for him. The concerned department will notify the CGHS to update the record of the insured.
- On the death of the insured person, his/her CGHS card will not be valid any more, and hence, the dependent members need to get a new one issued to them.
Common problems
Whereas the CGHS offers essential health insurance benefits, users have been known to face many challenges with the system.
Operational & Technological Problems
- Medicine Supply Interruptions: During migrations within the different portal systems, there may be issues in data uploads that create interruptions in medicine supply locally.
- Long Dispensary Waiting Times: High pedestrian traffic and doctor shortages in various health centres lead to long queues.
- Technical Issues With The Website Portal: Application changes can cause technical difficulties when making online appointments and downloading plastic cards
- Cashless Facility Limitations: Any delays by the government in settling payments can lead to hesitation by empanelled private hospitals offering upfront cashless services.
- Restriction in Retaining Hospitals: Some of the premium groups may have chosen to leave due to the non-changing government package reimbursement.
- Referral Requirements for Specialists :
The beneficiaries are required to systematically acquire a referral letter from the Wellness Centre doctor before proceeding to a specialist in empanelled private hospitals.
Ensure the Wellness Centre doctor inputs the referral into the CGHS system, rather than just writing it by hand. Private hospitals verify this digitally via your Beneficiary ID.
Once issued, you must complete your initial specialist consultation within 30 days. If you miss this window, the digital referral expires, and you must return to the Wellness Centre for a fresh slip.
Delays In Claim & Reimbursement Processes Involve Strict Documentation:
The reimbursement process for treatment in cases of emergencies from hospitals that do not belong to the empanelled sed list entails thorough scrutiny, thereby increasing claim processing delays in case there are any errors made in documentation.
Claims face a high chance of being rejected on receipt due to lack of medical history or delay in informing authorities.
Conclusion
The Central Government Health Scheme (CGHS) is ensuring that health services remain affordable and easily available to central government employees and their families. Whether it is seeking medical advice, getting medication, undergoing cashless hospitalization or availing of diagnostic tests.
CGHS remains one of the most beneficial health schemes in the country. Having knowledge about the requirements for being eligible for the scheme. The documentation necessary and the process involved makes using the scheme easier.
FAQs
1. Who is eligible for a CGHS card?
CGHS card is available to Central Government employees, retirees, and their dependent family members.
2. Is the CGHS card free?
No, there is a monthly fee that depends on the salary/pension slab of the beneficiary.
3. Can pensioners apply for a CGHS card online?
Yes, pensioners can submit the application online using the CGHS website after paying the subscription online.
4. How can I download my CGHS card?
Download your CGHS card using the CGHS Beneficiary portal after logging in via your Beneficiary ID and OTP verification.
5. What should I do if my CGHS card application is rejected?
Make sure that you have uploaded all the required documents and that the details entered match your official ones before applying again.
6. Does CGHS cover treatment in private hospitals?
Yes, CGHS does provide cashless treatment in both private and government hospitals in India.
Disclaimer: The above information is only for illustration purposes. For further information, kindly refer to the policy wordings and prospectus before closing sales transactions.
