CGHS - Central Government Health Scheme

The Central Government Health Scheme (CGHS) is a healthcare facility scheme for the employees of the Government of India· Its beneficiaries mainly include:

• All Central Government employees: Including their dependent family members residing in CGHS-covered cities.

• Pensioners of the Central Government: Including their dependents, can opt for CGHS benefits.

• Members of Parliament: They and their dependents are eligible for CGHS facilities.

• Judges of the Supreme Court and High Courts: Including their families, are covered under CGHS.

• Freedom Fighters: They are also entitled to the CGHS facilities along with their dependents.

• Former Vice-Presidents and Presidents of India: Along with their dependents, they can avail the benefits of the scheme.

• Employees and pensioners of certain autonomous/statutory bodies: Depending on their eligibility and the decisions made by the - government from time to time, employees of certain autonomous/statutory bodies may be covered under CGHS.

• Journalists (Accredited with PIB): Under certain conditions, they might get CGHS coverage.

• Railway Board employees: Including their family members, are covered under the CGHS.

• Delhi Police Personnel: Depending on specific government decisions, they may also be covered.

• Post and Telegraph Department employees: They and their dependents are eligible for CGHS facilities.

The Central Government Health Scheme (CGHS) scheme brings with it several amazing benefits that significantly ease healthcare accessibility.

• Extensive Coverage: CGHS covers both serving and retired central government employees and their dependents, including parents, spouses, and children.

• Wide-ranging Healthcare Services: It provides a broad spectrum of healthcare services ranging from consultation and hospitalisation to emergency services.

• Accessibility: CGHS dispensaries are established in various parts of the country, ensuring medical help is never too far.

• Health education: Regular health education programs are conducted to improve lifestyle and awareness about common health issues.

• Convenience: The cashless facility in empanelled hospitals lessens the financial burden during hospitalisation.

• Referral Facility: For advanced treatment not available at CGHS wellness centers, patients can be referred to private hospitals empanelled with CGHS.

• Comprehensive Medicinal Provision: It caters to a wide variety of allopathic, homeopathic, and Ayurvedic treatments and therapies. The dispensary even facilitates the purchase of important healthcare equipment.

The Central Government Health Scheme Eligibility mainly depends on the category of government employment rather than a salary-based criterion· Below is a broad overview:

• All Central Government employees including their dependant family members residing in areas covered by CGHS

• Pensioners of Central Government (excluding pensioners belonging to Railways and the Armed Forces) and their families

• Sitting and ex-Members of Parliament

• Ex-Governors and Lieutenant Governors

• Freedom Fighters

• Sitting and Retired Judges of the Supreme Court of India

• Retired Judges of High Courts

• Employees and Pensioners of certain statutory/Autonomous Bodies which have been extended CGHS facilities

• Journalists accredited with the Press Information Bureau (in Delhi)

• Delhi Police Personnel in Delhi only

• Railway Board employees

Dependent Criteria

The dependents eligible for CGHS cover include:

• Spouse

• Legitimate children, including stepchildren and adopted children.

• Parents (mostly in the case of serving employees).

• Dependent Sisters and Brothers (in exceptional cases).

Note on Salary Requirements

While CGHS eligibility is not determined by specific salary requirements, the contributions towards the scheme are determined by the pay band/pay scale or pension amount. These contributions are subject to revisions and updates. For instance, the monthly contribution rates are categorically defined based on the pay grade of the employees or pension amount for pensioners. These rates can vary and are periodically revised according to the directives of the Government of India.

Visit the official CGHS website or contact the nearest CGHS Wellness Centre to know more about this· This ensures access to the most current guidelines and contribution structures.

The Central Government Health Scheme (CGHS) in India provides comprehensive medical care to its beneficiaries that encompasses different types of medical systems.

• Allopathic: The most common type of healthcare, the Allopathic system under CGHS covers all types of standard Western medicinal practices, including surgeries, radiology, and medication.

• Homeopathic: CGHS offers Homeopathic system services which employ natural substances and minimal doses to stimulate the body's self-healing abilities.

• Ayurvedic: An ancient Indian system of medicine, Ayurveda is also covered under CGHS. It uses holistic treatment methods combining diet, exercise, and lifestyle practices.

• Unani: Originating from Greece, Unani medicine focuses on balancing the four humors of the body. CGHS includes Unani treatments, emphasising the prevention of diseases.

• Siddha: This is an ancient system of medicine, prevalent in South India. It utilises substances from nature for healing, and it's part of the CGHS scheme.

• Yoga: Under CGHS, beneficiaries can also avail of Yoga therapy, a traditional physical and mental discipline that originated in India.

• Naturopathy: CGHS covers Naturopathy which emphasises the body's inherent ability to heal itself, using natural treatments such as diet and lifestyle changes, herbs, and massage.

Central Government Health Scheme (CGHS) is an extensive healthcare system, established by the Indian government, that provides a plethora of medical services to central government employees and pensioners.

• Comprehensive Health Coverage: CGHS covers a wide range of health services, from consultations, and surgeries, to treatments for diseases and conditions such as cancer and diabetes.

• Dental Services: Under this scheme, beneficiaries can access regular check-ups, oral health education, extractions, fillings, and even complex dental procedures.

• AYUSH: The scheme embraces traditional forms of Indian healthcare systems like Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH), in addition to conventional allopathic treatments.

• Family Welfare Services: Beneficiaries can avail of family planning advice, antenatal care, postnatal care and immunisation services.

• Medical Reimbursement: CGHS also provides reimbursement for expenses incurred for medical treatment in emergencies in non-empanelled hospitals.

• Pharmacy Services: CGHS runs numerous pharmacies where beneficiaries can obtain medicines prescribed by CGHS doctors.

• Pensioner Portal: A unique feature of CGHS is its online portal designed for pensioners. It provides vital information about the pension status, card status and various available facilities.

• Health education and Counseling: CGHS promotes preventive healthcare by organising regular health check-ups, screening programs and health education talks.

Under the auspices of India's Central Government Health Scheme (CGHS), beneficiaries can avail of an extensive range of healthcare services.

• Outpatient Services: The CGHS covers consultations with specialists and medical officers· Investigations, physiotherapy, and wellness check-ups are also included.

• Hospitalisation: Beneficiaries can be admitted to empanelled hospitals for treatment or surgeries without worrying about hospital bills.

• Emergency Care: CGHS encompasses emergency care, ensuring beneficiaries receive immediate and necessary treatment in dire situations.

• Medicines: Prescription drugs are included under the scheme, and beneficiaries can get them from any empanelled dispensary.

• Pregnancy and Childbirth Services: Expectant mothers can receive pre and postnatal care, as well as childbirth services under CGHS. This includes routine check-ups and tests during pregnancy.

• Dental Treatment: Basic dental procedures are covered under the scheme· Beneficiaries can access dental check-ups and treatments.

• Alternative Treatments: To embrace comprehensive healthcare, CGHS includes Ayurveda, Homeopathy, Yoga, and other forms of traditional Indian medical practices.

Listed below are the treatments that are not covered under the Central Government Health Scheme (CGHS).

• First and foremost, experimental treatments are generally not covered by CGHS. These include any kind of trials, or novel or unproven methods of treatment.

• Cosmetic surgeries, for purposes like reshaping, enhancement or other beauty-related objectives, also fall under the non-covered category, barring certain exceptional medical conditions.

• Procedures deemed as unessential or avoidable like certain fertility treatments, alternative therapies, or treatments for self-inflicted conditions such as smoking-related diseases, alcohol dependency etc., are excluded as well.

• A broad category of therapies which don't align with conventional, recognized forms of medical care like chiropractic treatments, aromatherapy etc· aren't covered under the scheme.

• Lastly, dental procedures and treatment related to teeth whitening, cosmetic dentistry and other such non-emergency oral care services are also not a part of the scheme coverage.

Central Government Health Scheme (CGHS) offers a wide range of services aimed at supporting and facilitating the healthcare needs of senior citizens. These provisions ensure not just regular medical attention but also emergency assistance.

• OPD treatment: Under CGHS, senior citizens can avail of general or specialist Out-Patient Department services across its wellness centers.

• Indoor treatment: If the patient's condition necessitates it, the scheme also provides provisions for hospitalisation and associated medical assistance.

• Emergency Services: CGHS extends to critical care as well with their round-the-clock emergency services.

• Preventive Health Check-ups: For members aged 60 years and above, CGHS organises preventive health check-ups.

• Provision of medicines: Under this scheme, senior citizens can procure drugs and medications prescribed by the doctors either from CGHS dispensaries or from private pharmacies at government expense.

• Reimbursement of medical expenses: If senior citizens receive treatment in a private hospital under emergency conditions, they can apply for a reimbursement of their medical expenses.

• Exclusive services for cancer and kidney disease patients: CGHS provides high-end treatments including Radiotherapy, Dialysis, and Chemotherapy.

In a nutshell, CGHS serves as a comprehensive health safety net for senior citizens under its ambit, ensuring their health and well-being

The Central Government Health Scheme (CGHS) provides comprehensive health services to Central Government employees and pensioners in major cities across India.

Here's how to get the CGHS appointment online.

Step 1: First, you need to register on the Central Government Health Scheme (CGHS) official website.

Step 2: Create an account with a unique username and password· Verify the account with the email you provided.

Step 3: Once logged in, click on 'Beneficiary Login'.

Step 4: After signing in, look for the option to 'Book Appointment'.

Step 5: Here, you will have to select the CGHS Wellness Center, the speciality department you need to consult, and the medical officer.

Step 6: You will see available appointment slots· Choose a suitable date and time according to your convenience.

Step 7: Click on 'Confirm Appointment'. You will receive a booking ID.

Step 8: This booking ID will be used for all further references and at the time of consultation.

Step 9: The appointment details can also be printed or emailed directly from the website.

Step 10: If needed, the appointment can be canceled or rescheduled online as well· Always ensure to note down your appointment details to avoid confusion or delays.

To claim reimbursement for medical expenses follow the below procedure.

Step 1: Eligibility Check and Registration

• Check if you’re eligible for CGHS· It covers government employees, pensioners, and dependents.

• For new users, registration is required· You can register by submitting the required documents at the nearest CGHS Wellness Centre· Documents typically include government ID proof, passport-size photographs, and proof of dependence (for family members).

Step 2: Obtain a CGHS Card

• After registration, you will receive a CGHS card, which is crucial for availing services under the scheme· ensure that the details on the card are correct.

Step 3: Visit a CGHS empanelled Hospital/Clinic

• For medical treatment, you can visit any CGHS-empanelled hospital or wellness center.

• In non-emergency cases, you should visit the CGHS Wellness Centre for consultation and obtain a referral to a CGHS empanelled hospital if specialist consultation is required.

Step 4: Medical Treatment and Documentation

• For cashless treatment in empanelled hospitals, show your CGHS card at the time of admission· The hospital will then follow up with the CGHS authority for cost approvals.

• In case of emergency or treatment in a non-empanelled hospital, pay for the treatment and collect all original bills, payment receipts, and medical reports for reimbursement.

Step 5: Submit a Reimbursement Claim (if applicable)

• To claim reimbursement for treatments availed in non-empanelled hospitals or for expenses incurred in empanelled hospitals where cashless treatment was not provided, submit the following documents to the CGHS office:

• Duly filled CGHS reimbursement form

• Original bills, receipts, and discharge summary

• Copy of your CGHS card

• Any other relevant medical documents

• ensure that your application is complete in all respects to avoid any delays in processing.

Step 6: Track Your Claim

• Keep a copy of the acknowledgement of your claim submission.

• You can track the status of your claim by contacting the CGHS office where you submitted your claim.

Step 7: Claim Settlement

• If your claim meets all criteria, it will be processed and settled· The reimbursement amount will be credited to the bank account provided in your application.

Quick Tips:

• Ensure to adhere to the CGHS guidelines and provide accurate information to avoid claim rejection.

• Regularly check the CGHS website or contact CGHS customer service for any updates or changes in the process.

Central Government Health Scheme (CGHS) and Ayushman Bharat are two health initiatives implemented by the Indian government to improve public healthcare.