CGHS Complete Handbook for Beneficiaries : Who can be the beneficiaries of the Central Government Health Scheme?

The Central Government Health Scheme (CGHS) was initiated by the Indian Central Government in 1954. It offers healthcare benefits to registered employees and pensioners of the Central Government of India through the CGHS card. This program serves as exclusive medical insurance provided by the central government for its employees through reimbursement and cashless facilities.

India’s healthcare industry is continuously evolving, but it still faces certain challenges and room for improvement. Access to quality healthcare for all citizens is a pressing concern in the country. To address this issue, the government has introduced several health programs and schemes time-to-time. The Central Government Health Scheme is one such government-backed program that aims to bridge the gap and provide equal healthcare opportunities to the population. 

The CGHS aims to deliver comprehensive healthcare to beneficiaries from the Legislative, Judicial, Executive, and Press sectors. It stands out due to its extensive beneficiary base and aims to provide healthcare services inclusively and generously. Currently, the CGHS covers approximately 3.5 million beneficiaries across 71 cities in India, with plans to expand its services to more cities, enhancing accessibility for all.

The Central Government Health Scheme encompasses a wide range of medical systems, including both conventional and alternative practices. CGHS provides coverage for various medical systems, ensuring a comprehensive approach to healthcare. Here is a detailed overview of the diverse range of medical systems covered by the CGHS:

• Ayurveda
• Yoga
• Unani
• Siddha
• Allopathy
• Homoeopathy

The Government of India issues a photo ID plastic card known as the CGHS card to all beneficiaries and their dependents under the Central Government Health Scheme. This card features a unique beneficiary identity number that must be presented at CGHS facilities for any services. The CGHS card is predominantly white, with a coloured stripe on the top indicating the cardholder’s status. The colour of the stripe can vary as follows:

• yellow for journalists of autonomous companies
• blue for serving government employees
• red for members of Parliament
• green for pensioners, ex-MPs, retired personnel, or freedom fighters

CGHS cards remain valid until the retirement date of the beneficiary. To extend its validity post-retirement, the contribution must be made one year prior to the retirement date. It is important to surrender the expired card to the concerned department, and in case of renewal, a form and necessary details need to be submitted. Transferring the card to another employee is strictly prohibited, and failure to produce the card may result in penalties or disciplinary actions.

• Central government employees who receive payment from the central civil estimates
• Family members of individuals whose salaries are paid by the Central Civil Estimates
• Central government employees residing in areas covered by the CGHS, along with their families
• Individuals receiving pensions from the central government
• Former Vice Presidents of India and their immediate family members
• Current and former Governors and Lieutenant Governors, as well as their immediate family members
• Employees of the Railway Board
• Current and former Members of Parliament
• Employees of the Post and Telegraph Department
• Civilian defence employees
• Freedom fighters and their family members receiving pensions under the Sainik Samman Scheme
• Current and former judges of the Supreme Court and High Court
• Widows receiving family pensions from central government pensioners
• Personnel of CISF and CAPF posted in areas covered by the CGHS, along with their families
• Employees of the Supreme Court Legal Services Committee
• Current and former Divisional Accountants and Divisional Accounts Officers
• Employees of Kendriya Vidyalaya Sangathan stationed in Delhi and NCR, Chennai, Mumbai, Kolkata, Hyderabad, and Bengaluru

• Demand draft
• Copies of Provisional PPO/PPO/Last Pay Certificate

• Proof of residence
• Proof of age for dependents
• Proof of dependent’s residence
• If a dependent is differently-abled, a certificate of disability issued by a recognised authority is also required.

• Access to medical consultations and treatments at CGHS dispensaries
• The scheme offers consultation services with specialised doctors at empanelled hospitals
• Laboratory examinations, X-Ray, and ECG: the CGHS covers the cost of various diagnostic tests and imaging procedures
• Hospitalisation
• The CGHS covers the purchase, storage, and supply of prescribed medicines and other medical requirements
• The scheme also offers health education programs and information to beneficiaries
• Maternity, childcare, and family welfare services: the CGHS includes services related to maternity care, childcare, and family welfare

• Reimbursement of medical treatment expenses: Both private and government hospitals are covered, and beneficiaries can reimburse the incurred expenses.
• Reimbursement for hearing aids, appliances, and artificial limbs: A beneficiary can request reimbursement for the purchase of any or all of these items.
• Maternity, childcare services, and family welfare coverage: Expenses related to maternity care, childcare services, and family welfare are covered under the scheme.
• Cashless treatment at diagnostics centres and empanelled hospitals: Pensioners and beneficiaries can avail of cashless treatment if they receive medical care at diagnostics centres and hospitals that are empanelled with the CGHS.
• Coverage for expenses related to AYUSH: The scheme covers expenses for consultations, medications, and treatments related to the Indian system of medicines (Ayurveda, Unani, Siddha, and Homeopathy).
• Coverage for OPD treatment and medications: Expenses related to outpatient department (OPD) treatment, including medications, are covered by the scheme.
• Coverage for consultations with health experts: Expenses for consultations with health experts at polyclinics or government hospitals are covered.
• Coverage for treatment at empanelled and government hospitals: Expenses for medical treatments at hospitals that are empanelled with the CGHS, as well as government hospitals, are covered.

• In the event of a declared emergency, medical treatment can be sought at any hospital. However, reimbursement benefits under the CGHS card will only be provided if the treatment is obtained at a hospital registered with the CGHS.
• For pensioners and eligible beneficiaries of the CGHS, the reimbursement amount for medical treatment is predetermined.

• For Serving Employees: Central Government employees residing in regions covered by the CGHS must possess a CGHS card. The employee’s department deducts a monthly amount from their salary, which is determined by their pay grade. This deducted amount is contributed towards CGHS facilities.
• For Pensioners: pensioners who wish to avail themselves of CGHS facilities are required to contribute based on the pay grade they were entitled to during their service. The contribution can be made annually or as a one-time/lifetime contribution.

• Get the application form from the CGHS website (www.cghs.nic.in or www.cghs.gov.in) or any CGHS wellness centre.
• Complete the application form by providing accurate information and affixing the required photographs.
• Attach all the necessary supporting documents to the application.
• If you are a serving employee, make sure the form is endorsed by the Head of the Department or Office.
• Submit the application along with the supporting documents to the Additional Director HQ office in Delhi or the respective Additional Director’s office in CGHS-covered cities.

• Submit an application along with a bank draft and supporting documents to the CGHS from the employee’s office.
• The pensioner card will be issued on the retirement day and activated the following day if the application was submitted at least six weeks before the retirement date.

• Visit the official CGHS online portal.
• Log in to your CGHS account by entering your beneficiary ID and generating a One-Time Password (OTP).
• Enter the OTP received on your registered mobile number and click on ‘Proceed’.
• Verify that your displayed details are correct. If they are not, select ‘Not You’ and log in again.
• If the details are accurate, proceed to choose the speciality, CGHS dispensary, and doctor. Click on ‘Proceed’ after making your selection.
• A calendar will be displayed, allowing you to select a date for your appointment based on the doctor’s availability.
• Once you choose a date, available slot timings and appointments will be shown. Select your desired slot.
• Click on ‘Proceed to Book Appointment’. You can go back and make changes by selecting ‘Change the Speciality’.
• After proceeding, a summary of your appointment details will be displayed for confirmation.
• Choose ‘Confirm to Book Appointment’, and a confirmation status will be provided. You can print the confirmation receipt or book another online appointment if needed. A confirmation SMS will also be sent to your registered contact number.