Central Government Health Scheme | Everything You Need to Know

The Central Government Health Scheme (CGHS), launched in 1954, is a landmark healthcare initiative by the Government of India aimed at providing comprehensive medical care to eligible beneficiaries. Serving over 42 lakh beneficiaries across 80 cities, the scheme plays a crucial role in ensuring accessible, affordable, and quality healthcare services.

CGHS offers extensive coverage, including OPD consultations, hospitalisation, emergency care, diagnostic tests, and specialised treatments through a network of empanelled hospitals and wellness centres. Over the years, the scheme has expanded both in reach and benefits, evolving into a robust healthcare support system.

This guide helps you understand CGHS, its features, coverage, eligibility criteria, and how it differs from conventional health insurance plans.

What is the Central Government Health Scheme?

The central govt health insurance scheme is a pioneering initiative taken by the Government of India aimed at providing affordable medical care to its employees and their families. Unlike typical insurance policies, the CGHS offers a mix of cashless services and reimbursement options, ensuring financial security during medical emergencies.

Overview of the Central Government Health Scheme

1. It operates through a network of government and enrolled private hospitals in 80 cities.

2. Ensures that beneficiaries are getting enough medical wihout being worried about finances. 

3. Covers a wide range of treatments, including Allopathy, Ayurveda, Homeopathy and other AYUSH treatments.

4. It only requires a nominal contribution ranging from ₹250 to ₹1000.

5. Serves as a crucial health insurance scheme for central government employees.

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What are the Features of the CGHS?

The CGHS stands out among government insurance schemes due to its extensive features, designed to cater to the diverse healthcare needs of its beneficiaries:

1. Enrolled Private Network Hospitals: CGHS is covered in a list of private network hospitals, diagnostic centres and clinics. Additionally, you can get the benefit from the government hospitals as well.

2. Comprehensive Healthcare Coverage: The scheme covers both inpatient and outpatient treatments. Beneficiaries can claim expenses for surgeries, diagnostic tests, doctor consultations, medicines, and preventive healthcare measures.

3. Sponsored Rates: CGHS beneficiaries are required to pay a nominal contribution every month to avail these services.  The rate is highly subsidised, thus making it more affordable for people.

4. Family Member Coverage: Like any other health insurances central government health insurance scheme can be extended to provide coverage for family members. You can include your spouses, children and your dependent parents. 

5. Pension Scheme: If you are a retired central government employee, then you will also get a pension from this scheme. 

6. Online Facilities: The CGHS has introduced an online service. With this, you can track down the appointment booking, tracking claims and prescriptions.

7. Access to a Large Number of Wellness Centres: CGHS operates in a large array of wellness centres in India. These centres assist you with a basic medical checkup and provide medicines. 

8. Cashless Treatment: Many empanelled hospitals provide cashless treatment facilities to the beneficiaries. 

9. Reimbursement Facility:  If, in any case, you take treatment at a non-empanelled hospital, you can claim reimbursement for eligible medical expenses.

10. Preventive Healthcare: Regular health check-ups and screenings are organised under the scheme to promote early diagnosis and timely intervention, improving overall health outcomes.

11. AYUSH Treatments: CGHS’s inclusion of alternative medicine treatments under AYUSH allows beneficiaries to explore holistic and traditional remedies, making it a versatile govt health insurance scheme.

While the central government scheme provides reliable coverage, rising healthcare costs require additional coverage. Explore comprehensive health insurance plans from Bajaj General Insurance and strengthen your financial safety net today!

Is it Mandatory to Link CGHS to ABHA ID?

According to the Ayushman Bharat Digital Mission, linking of the ABHA ID with CGHS  is made mandatory by the Ministry of Health and Family Welfare from April 1 2024. The aim is to provide better integration of the health programme.

Key Details Regarding Linking CGHS to ABHA ID

1. You can get coverage of ₹ 5 lakhs if you are a central government employee to cover medical expenses.

2. 4.4 million people are benefited from CGHS across 75 cities.

3. Linking CGHS with the ABHA ID ensures hassle-free treatment facilities.

4. The linkage helps to digitise the health records and helps providers to get access to your medical history easily.

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How to Link CGHS with ABHA ID?

1. Navigate to the official website of the Central Government Health Scheme.

2. Click on the beneficiary login from the top right panel.

3. Enter your beneficiary ID and password and click on login.

4. On this page, you will have to click on the link ABHA ID.

5. If you have the ABHA ID, then click on linking with ABHA Number.

6. Enter the Aadhaar card number to receive OTP for authentication.

7. Upon successful completion of the linking process, print the ABHA Card.

*These steps are only for those who hold an ABHA ID.

What are the Eligibility Criteria for CGHS?

The central government insurance scheme is available to a broad range of beneficiaries. These include:

1. Central government employees and their families (excluding employees from Railways and Delhi Administration).

2. Pensioners of the central government and their families.

3. Retired judges of the Supreme Court and High Courts.

4. Former Vice Presidents and Members of Parliament.

5. Employees of the Railway Board and their families.

6. Journalists accredited by the Press Information Bureau.

7. Freedom fighters and their families.

8. Widows receiving family pensions and their dependent children.

9. Delhi Police personnel residing in Delhi.

10. Retired employees from Ordnance Factories.

This extensive eligibility criterion underscores the scheme’s aim to provide inclusive healthcare services.

Not eligible for the central government health insurance? You can still secure quality medical coverage for yourself and your family. Discover affordable health insurance plans from Bajaj General Insurance that are designed to meet your healthcare needs. 

How to Apply for a CGHS Card?

Enrolling in the central govt health insurance scheme is a straightforward process:

1. Application Form: Visit the official CGHS website, download the plastic card application form, and fill in the details accurately.

2. Document Submission: Submit the completed form along with supporting documents, such as ID proof, photographs, and residence proof, to the CGHS office in your city.

3. Receive CGHS Card: Upon successful verification, beneficiaries receive a photo ID card containing a unique beneficiary number.

4. Online Appointment Booking: Once enrolled, beneficiaries can book online appointments with CGHS-empanelled doctors and hospitals. This ensures streamlined access to medical services without unnecessary delays.

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What Documents are Required to Apply for a CGHS Card?

For serving government employees

1. Your address proof.

2. Age proof.

3. Residential proof.

4. If you are physically disabled, then you need to submit a disability certificate.

For pensioners

1. Draft of bank demand.

2. Pension payment order along with the last pay certificates.

List of Hospitals Enrolled Under CGHS

Comparison with Other Health Insurance Options

While private health insurance policies offer extensive coverage, government insurance schemes like CGHS have unique advantages. For instance, the CGHS provides comprehensive healthcare at nominal costs, making it accessible to a wider audience. Additionally, its inclusion of family members under a single plan aligns with the features of a family floater health insurance policy.

However, private health insurers like Bajaj General Insurance Limited offer customisable plans that complement CGHS coverage. Such plans often provide higher sum insured amounts, specialised treatments, and access to international healthcare facilities. Combining the benefits of CGHS with a private health insurance plan ensures holistic financial protection against escalating medical costs.

Also Read: Difference Between Sum Insured vs. Sum Assured

Final Thoughts

The central government health scheme is a cost-effective measure taken by the government to provide health care services to government employees and pensioners. In addition to the existing network of hospitals and cashless facilities, the inclusion of Ayush is another support the government health insurance provides to employees and pensioners.

However, with rising healthcare costs and evolving medical needs, it is wise to consider additional coverage options from Bajaj General Insurance to complement CGHS benefits. This helps ensure stronger financial protection, wider treatment access, and greater peace of mind during medical emergencies.

Frequently Asked Questions

When can I pay my medical bills under the CGHS cover?

Under the central govt health insurance scheme, most of the treatments, specifically eligible treatments, are cashless. Therefore, you do not have to pay any upfront payment. In case of treatment done in non-empanlled hospital, you can claim reimbursement.

Will I get cashless treatment under the CGHS cover?

Yes, you will get cashless treatment under the CGHS cover. Cashless treatment is given to the empanelled hospitals where the central government health scheme is available. Go through the list of hospitals to know better.

What are the different types of CGHS cover?

OPD, hospitalisation, surgeries, diagnostic tests, medicines, preventive health care, dental services, and AYUSH treatments for eligible employees, pensioners, and their dependents are covered under the health insurance scheme of the Central Government.

What is the maximum limit I can spend on CGHS cover?

The Central Government Health Scheme does not have any maximum limit for inpatient treatment in empanelled hospitals. The basic benchmark can be ₹5 lakh. However, the treatment is essentially free under this scheme.

Can corporate employees get CGHS cover?

No, the corporate employees cannot get the benefits of CGHS cover unless they work under some autonomous organisations that are authorised by the central government. However, they can get the benefits of group health insurance if not CGHS.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.

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