The Central Government Health Scheme (CHGS) provides healthcare to the employees and pensioners of the Central Government that are enrolled under this scheme. It covers health care under different systems of medicine, ranging from allopathy and homeopathy to Ayurveda, Unani, Siddha, and Yoga. The beneficiary base spreads across 71 cities and covers more than 35 lakh beneficiaries.
Eligibility Criteria for Availing Central Government Health Scheme:
The criterion for availing the CGHS is not the headquarters, but the residence of the employee who is availing the medical facilities provided under the scheme. Thus, eligible employees of the Central government and their family members who reside in any of the notified cities are covered.
The eligibility criteria for availing CGHS is as follows:
- All Central Government employees who are paid from the Central Civil Estimates (except for Railways and Delhi Administration), including their dependent family members who reside in the CGHS covered areas.
- Pensioners of Central Government (except pensioners belonging to the Railways and the Armed Forces) and their families.
- Central Government Pensioners who retire with Contributory Provident Fund benefits and their families
- Widows of Central Government pensioners who are eligible for family pension.
- Delhi Police personnel and their families who reside in Delhi
- Railway Board employees
- Civilian employees of Defence who are paid from Defence Service Estimates
- Children who draw pension on the death of a Central Government employee including minor siblings of such a child.
- Ex-Governors and Lt. Governors and their families
- Ex-Vice Presidents and their families
- Central Government servants who are deputed to semi-government and autonomous bodies that are financed by the Central Government or receive grants from it
- Central Government employees on deputation who are statutory or autonomous during the time of the deputation
- Military Officers who are on deputation to civil departments and who obtain emoluments from the Central Civil Estimates.
- Families of Governments servants who are transferred to a non-CGHS area for a maximum period of six months on deposit of the CGHS contribution (for the period of 6 months) in advance.
- Families of IAS Officers in the North-Eastern Cadre who continue to stay back in Delhi after the repatriation of the IAS Officer to the North-Eastern Cadre, as long as they continue to occupy Government accommodation in Delhi or New Delhi, on deposit of CGHS contribution in advance (one to three years). This is also applicable to the families of IAS Officers of the J&K Cadre
- Sitting Judges of Supreme Court and High Court of Delhi and former Judges of Supreme Court and High Courts.
- Members of Parliament and their families
- Ex-Members of Parliament
- Family members of Deceased Ex-Members of Parliament.
- Parliamentary Secretaries of the Central Government and their families.
- Work Charged and Industrial Staff working in establishments run by various Ministries or Departments of Central Government immediately from the date of their joining the service.
- Employees of Kendriya Vidyalaya Sangathan stationed at Delhi and NCR, Kolkata, Chennai, Hyderabad, Mumbai and Bengaluru.
- Employees of Ordnance Factory Board Headquarters, Kolkata, and Ordnance Equipment Factories Headquarters, Kanpur.
- Pensioners of Ordnance factories
- All India Service pensioners who retire while serving under the State at their option
- Freedom Fighters and members of their family who receive Central Pension under the Swatantrata Sainik Samman Pension Scheme
- Members of Staff Side of the National Council of the Joint Consultative Machinery
- Employees of semi-government and autonomous bodies who are allowed to join the CGH Scheme
- Accredited journalists with certificates from the Press Council of India stating membership of the Press Association, New Delhi (for OPD and at RML Hospital)
- Retired Divisional Accountants of the Indian Audit and Accounts Department and those whose pay and pension are borne by the State governments
- Absorbees of the PSU who had commuted 100 percent of their pension and have been restored one third portion of their pension after 15 years
- Absorbees of Statutory Bodies or Autonomous Bodies of the Central Government (including those who proceeded on deputation initially or were on deemed deputation and then absorbed), who are in receipt of Central Civil Pension
- Serving and retired Railway Audit Staff
- Serving and retired Divisional Accounts Officers and Divisional Accountants posted in the Office of Accountant Generals in States
- CISF personnel (and their families) and CAPF (Central Armed Police Forces) personnel posted in CGHS cities
- Employees of Supreme Court Legal Services Committee
- Employees of India Pharmacopoeia Commission and their families.
- Family and dependent members of a CGHS beneficiary who stays back in CGHS covered area after posting of the employee to N.E. region (including Sikkim), Andaman and Nicobar Lakshadweep or Ladakh region as well as CAPF personnel posted in Left Wing Extremist areas, on payment of annual CGHS contribution in advance.
- Defence Industrial Employees of Naval Dockyard Central Ordnance Depot and AFMSD in Mumbai.
Facilities Offered by Central Government Health Scheme:
These are the facilities that can be availed under CGHS:
- Out Patient Department treatments including the issue of medicines
- Indoor treatments at government and empaneled hospitals
- Diagnostic tests at government and empaneled diagnostic centers.
- Specialist Consultation at government hospitals or polyclinics
- Medical consultation and dispensing of medicines in Ayurveda, Homeopathy, Unani and Siddha system of medicines (AYUSH)
- Cashless facility is available for treatments in empaneled hospitals and diagnostic centers
- Reimbursement of expenses for emergency treatments availed in government or private hospitals
- Reimbursement of expenses for the purchase of hearing aids, artificial limbs, etc., as specified
- Family Welfare, Maternity and Child Health Services.
Cities Covered under Central Government Health Scheme:
The cities that are covered under CGHS are as follows:
- Delhi & NCR
- Delhi, Faridabad, Ghaziabad, Greater Noida, Gurgaon, Indirapuram, Sahibabad
Cities where CGHS is planned to be offered in future are:
Contribution Towards Central Government Health Scheme:
Wards in private hospitals that are empaneled under the CGHS are offered on the basis of the basic pay drawn per month according to the 7th CPC. The ward entitlements are as given below:
|Ward Entitlement||Monthly Basic Pay|
|General Ward||Up to Rs.47,600|
|Semi-Private Ward||Rs.47,601 to Rs.63,100|
|Private Ward||Rs.63,101 and above|
FAQs Central Government Health Insurance Scheme
- What is the meaning of the term dependent under the CGHS?
- Is there an age limit for dependent children under the CHGS?
- Can family members who are not residing with the central government employee eligible for the CGHS?
- Are step-children allowed to avail the CGHS benefits?
- Are in-laws who are dependent on the central government employee eligible for CHGS benefits?
The term dependent under the CHGS refers to an individual whose income from all sources, including the pension and pension equivalent of the DCRG benefit, is less than Rs.9,000 per month, including the DA. This is not applicable for spouses, however.
For male children, eligibility to be a dependent under the CGHS is until he is 25 years old, gets married, or starts earning, whichever is earlier. However, if any disability (physical or mental) has occurred to the child before the age of 25 years, he is eligible for benefits even after the age of 25.
For female children, eligibility to be dependent under the CGHS is until she gets employed or gets married, whichever is earlier, irrespective of age.
Family members who are wholly dependent on the central government employee are expected to be residing with them. However, if they are visiting a city which is covered under the CHGS list, they are eligible for the CGHS facilities offered there.
If step-children are dependent on the CHGS card-holder and fulfil the other criteria for dependent children, then they are eligible to avail the CGHS benefits.
The option to include in-laws is available to lady central government employees who can include either her in-laws or her parents to avail the CGHS benefits provided the other conditions of residence and dependency are satisfied.