To provide the present and former central government employees and their dependents with a comprehensive medical coverage, the Central Government Health Scheme (CGHS) was rolled out in 1954, by the Ministry of Health and Family Welfare. What makes the scheme unique is its broad beneficiary base and its elevated accessibility to healthcare services.
The treatments under the scheme can be availed in CGHS covered cities which at present is available in 37 cities including Dehradun, Ahmedabad, Agartala, Goa, Chennai, Gangtok, Lucknow, Kolkata, Imphal, and Hyderabad. The scheme is self-funded where employees contribute a certain amount towards the scheme every month and the amount depends on the salary of the individual. Pensioners who wish to avail services under the CGHS scheme can either make a yearly contribution or a one-time contribution for 10 years to avail benefits for a lifetime.
There are various CGHS forms available on the official site of CGHS - www.cghs.gov.in for availing different services under the scheme. The forms are available in the ‘Downloads’ section of the site. Below are the details of the various forms available:
- Application form for new CGHS plastic cards - This form is used to apply for a plastic card that is mandatory while availing medical services at the empanelled hospitals. Along with the form, serving employees need to attach residence proof of self and dependents, age proof of children, and disability certificate of dependent aged above 25 years, if any. Pensioners need to submit the filled application form with attested copies of provisional PPO/PPO/ last pay certificate, surrender certificate of CGHS card if issued during the service period, and a demand draft payable at ‘PAO CGHS New Delhi’, attached.
- Application form for renewal of plastic card (serving employees) - Serving employees who wish to renew their CGHS cards can do so by submitting this filled application form.
- Application form for renewal of plastic card (pensioners) - Pensioners can use this application form for renewing their CGHS cards.
- Medical reimbursement claim form - There are 2 types of medical reimbursement claim forms that are available for download on the CGHS site. One is to be used by serving employees and the other by pensioners who wish to avail the benefits.
Coverage Offered Under the CGHS:
- Under the CHGS, financial cover is provided for cost of medicine and Out Patient Department (OPD) treatments.
- Indoor treatment can be availed at empanelled and government hospitals.
- The CGHS covers all systems of medicine - allopathic, AYUSH (Ayurveda, Unani, Siddha, and Yoga), and homeopathic.
- Consultation with specialists at government hospitals or polyclinics is also covered under the scheme.
- Beneficiaries can avail diagnostic tests at government or network hospitals.
- The CGHS also provides cover for maternity, child health, and family welfare services.
- For all enrolled beneficiaries, cashless facility can be enjoyed at all empanelled hospitals and government hospitals.
- In case of emergency hospitalisation in other hospitals other than network or government hospitals, the expenses will be reimbursed. The reimbursement amount, however, will be based on the CGHS rates.
- Cost of hearing aids, artificial limbs, etc. will also be reimbursed to the beneficiary.
- For the benefit of beneficiaries affected with critical illnesses like cancer, life-saving medicines will be issued provided if it falls under the CGHS list of medicines.