Central Government Health Scheme

What is the Central Government Health Scheme?

Central Government Health Scheme is a health insurance scheme for present and previous employees of the Central Government of India. The CGHS scheme is applicable in various places of India like Ahmedabad, Allahabad, Bhopal, Bangalore, Bhubaneshwar, Chandigarh, Chennai, Delhi & NCR, Dehradun, Guwahati, Hyderabad, Indore, Jabalpur, Jaipur, Kolkata, Kanpur, Lucknow, Meerut, Mumbai, Nagpur, Patna, Pune, Ranchi, Shillong, Thiruvananthapuram and Jammu.

CGHS provides healthcare facilities via Wellness Centers which covers different types of treatments like Allopathic, Yoga, Sidha, Unani, Ayurveda and Homeopathic medicines.

Components of the Central Government Health Scheme

Below are the components of the CGHS:

  • Domiciliary care
  • F.W. and M.C.H. Services
  • Dispensary, polyclinic and hospital’s specialist’s consultation facilities
  • X-Ray, ECG and Laboratory Examinations
  • Hospitalization
  • Health-related Education to beneficiaries
  • Purchase, Storage, distribution and supply of medicines and any other requirements.

Eligibility Criteria for Central Government Health Scheme

There are a certain group of people who are eligible for Central Government Health Schemes. They are:

  • Employees who receive wages from Central Civil
  • All the dependents family members who receive earnings from Central Civil and who are residing in CGHS covered area.
  • Pensioners and family pensioners and their dependent members
  • Parliament Members
  • Ex-Vice presidents
  • Ex-Governors and L.t. Governors
  • Retired or sitting judges of high courts and Supreme Courts
  • Freedom Fighters
  • Journalists who are accredited with the Press Information Bureau
  • Railway Board Employees
  • Delhi Police personnel (Delhi)
  • Pensioners and Employees of certain statutory or autonomous bodies (which is extended CGHS facility in Delhi)
  • Employees of Post and Telegraph Department

Medical Systems covered

Below is the list of medical systems covered under CGHS:

  • Allopathic
  • Homoeopathic
  • Ayurveda
  • Unani
  • Siddha
  • Yoga

Treatments and Facilities Covered and Not covered under Central Government Health Scheme

CGHS beneficiaries can receive benefits under private hospitals with cashless facilities without the need to provide a referral letter. The health minister has issued an order with this regard.

Below facilities are offered by the Central Government of India under CGHS:

  • OPD Treatment also including the issue of medicines.
  • Specialist Consultation at Polyclinic or Government Hospitals.
  • Indoor Treatment provided at Government and Empaneled Hospital.
  • Government and Empanelled Diagnostic centres Investigation cost.
  • Cashless facility for treatment in empanelled hospitals and diagnostic centres for Pensioners and other beneficiaries.
  • Expenses Reimbursement for treatment availed in Government or Private Hospitals under emergency.
  • Expenses Reimbursement which was incurred while purchasing hearing aids, artificial limbs, appliances, etc.
  • Family Welfare, Maternity, Child Health Services.
  • Medical consultation, dispensing of medicines in Ayurveda, Homeopathy, Unani and Siddha medicinal systems (AYUSH).

However, there are certain exclusions under CGHS which are:

  • If there is an emergency case, then treatment can be given in any hospital but the reimbursement claim must be given to the Additional General where the registration of the card took place.
  • For reimbursement of medical bills, the claims can be made at any hospitals; the claim amount will be as per CGHS norms.

Cost of Central Government Health Scheme

The cost of the Central Government Health Scheme varies for pensioners and serving employees:

Government Employees who are serving: A certain amount of deduction is made from the salary of the employee after which they are issued the CGHS card.

Pensioners: Pensioners can provide a certain amount of yearly or onetime contributions towards CGHS for 10 years which will be considered as a lifetime contribution.

Central Government Health Scheme Appointment Online

Below steps must be followed to book an appointment online:

  1. Visit CGHS website
  2. Fill up beneficiary ID
  3. Click – Generate OTP
  4. OTP generated on the registered mobile number must be entered
  5. Click- Proceed
  6. Details of beneficiaries will be shown. Click-Proceed.
  7. Select Specialty, Doctor and Dispensary. Proceed. A beneficiary could select a GDMO or a specialist of CGHS Well Care center
  8. Select an appropriate appointment date and the slot
  9. Click-Proceed to Book Appointment
  10. Click-Confirm to book Appointment

Central Government Health Scheme and Mediclaim Policy

An individual can have a Mediclaim Insurance policy and can claim for the same if they are treated under private hospitals. However, if the amount gets exhausted, they can utilize CGHS for the remaining payment.

FAQs

1. How to apply for central government health scheme?

One can apply for CGHS by submitting a duly-filled application form which is available in website cghs.nic.in (or cghs.gov.in). The physical form is also available in listed wellness centers.

2. Who is covered under the central government health scheme?

All the government employees who are working for the Central Government of India are covered under this scheme.

3. What is a CGHS card?

A CHGS card is provided to all government employees which contains photo id, beneficiary ID number. This card is essential to display at the wellness centre if the benefits opt to claim or seek any benefits under CGHS.

4. What makes the central government health scheme the best plan?

There are various benefits provided by CGHS such as inpatient treatment, cashless treatment at network hospitals, medical investigations cost, OPD expenses, Reimbursement of medical treatments, maternity, child health care, medical accessories cost, other Indian treatments like Ayurveda, Homeopathy, Sidha and Unani.

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