Central Government Health Scheme

CGHS, or Central Government Health Scheme, was launched by the Central Government of India in the year 1954. Under this scheme, the central government employees get health care facilities through the central govt health scheme card. It is a special central government medical insurance only for government employees. The medical facilities for the employees are provided through the CGHS Dispensaries, Ayurveda, Yoga, Unani, Allopathy and Homeopathy.

CGHS or Central Government Employees Health Insurance Scheme is mainly for the betterment of the individuals by providing them with medical facilities without any hassle. The CGHS scheme is a much broader concept of health insurance. So before taking the CGHS scheme, it is recommended that you understand the various components of the scheme. Broadly the following medical services can be availed under the health insurance central government scheme: 

• Dispensary services
• Consultation facilities by the special doctors at empanelled hospitals
• Laboratory examinations, X-Ray and ECG 
• Hospitalization
• Purchase, storage, and supply of medicines and the other medical requirements
• Health education to the beneficiaries
• Maternity, childcare and family welfare services.

To understand more about the CGHS central government health scheme, read on. 

Features and Benefits under Central Government Health Insurance Scheme

Following facilities/ coverage are given to the beneficiaries of the Central Government Health Scheme:

• The benefit of reimbursement of medical treatment expenses if there is an emergency case. This is applicable to both private and government hospitals
• You can request reimbursement if you purchase hearing aids, appliances, and artificial limbs
• Expenses on maternity, childcare services, and family welfare are covered
• Cashless treatment can be availed by pensioners and beneficiaries if they get the treatment in diagnostics centers and empanelled hospitals.
• Expenses related to the Indian system of medicines – AYUSH (Ayurveda, Unani, Siddha, and Homeopathy), medical consultation, and medicines are covered.
• Expenses related to the OPD treatment along with medications are covered
• Expenses related to the health experts’ consultations at polyclinic or government hospitals are covered 
• Expenses on the treatment at empanelled and government hospitals are covered. 

Eligibility Criteria for Central Government Health Scheme

The foremost eligibility criterion of the central government health scheme is that it is for central government employees. However, there are certain other categories that are also covered in the scheme. Given below is an indicative list; for an exhaustive list, you can visit the official CGHS website: 

• Those employees who work for the central government and take payment from the central civil estimates
• Members of the family whose salaries are paid by the Central Civil Estimates are entitled to benefits
• Employees of the Central Government who reside in the CGHS-covered areas and their families
• Individuals who get pensions from the central government
• Former Vice Presidents of India and their immediate family 
• Current and former Governors and Lieutenant Governors and their immediate family 
• Railway Board employees
• Current and former Parliament members
• Employees of the post and the telegraph department
• Civilian defense employees 
• Freedom fighters and their family members who are receiving pensions under the Sainik Samman Scheme
• Current and former judges of the Supreme Court and High Court
• Widows receiving family pensions from central government pensioners
• CISF and CAPF personnel who are posted in the CGHS-covered areas and their families as well
• Employees of the Supreme Court Legal Services Committee
• Current and former Divisional Accountants and Divisional Accounts Officers
• Employees of the Kendriya Vidyalayas Sangathan who are stationed at
  1. Delhi and NCR
  2. Chennai 
  3. Mumbai
  4. Kolkata
  5. Hyderabad
  6. Bengaluru.

Cities covered under CGHS

There are approximately 71 cities where CGHS is operational, including:

1. Agartala
2. Ahmedabad
3. Bangalore
4. Bhopal
5. Bhubaneshwar
6. Chandigarh 
7. Chennai
8. Delhi
9. Gandhinagar
10. Gaya
11. Gangtok
12. Kanpur
13. Mumbai
14. Ranchi
15. Shimla
16. Varanasi
17. Hyderabad
18. Jammu
19. Patna
20. Visakhapatnam, etc

These are just a few cities; if you want to check whether your city is listed under this scheme, then click on this link https://cghsbng.gov.in/pdf/faq_cghs.pdf. 

CGHS online appointment process 

If you want to book an appointment online under the CGHS scheme, then you have to follow the following procedure:

• Step 1: Go to the official website of the CGHS scheme.
• Step 2: On the top menu bar of the home page, click on the beneficiary corner.
• Step 3 : A pop-up menu will appear. Then, select beneficiary login.
• Step 4: Enter the beneficiary ID and password to sign in to the account. If you are a new user/have forgotten the password, then generate/reset a new password.
• Step 5: Check the beneficiary details and go to the next page to select one option from Speciality, CGHS dispensary, and doctor. Click on ‘Proceed’ to visit the next page.
• Step 6: Book your appointment on the calendar that is displayed on the screen at your convenience
• Step 7: Then select proceed to book an appointment. Remember that appointment changes can be made by choosing the option changes in the speciality.
• Step 8: Afterwards, the confirmation message regarding the date of the appointment and your details will appear
• Step 9: Confirm the appointment by clicking on it. You will get a confirmation message on your registered mobile number. 

What is Not Covered under the Central Government Health Insurance Scheme?

Those who have the central government health scheme card will not be considered for getting the benefits of the scheme in the following cases:

• In case of a declared emergency, the medical treatment can be taken at any hospital, but the reimbursement benefit of the CGHS or central govt health scheme card is given to those who take the treatment where the CGHS card is registered.
• The reimbursement claim amount of medical treatment is pre-determined for the pensioners and eligible beneficiaries of the central government health insurance scheme.

CGHS Card

The Government of India extends the CGHS scheme’s benefits with the CGHS card’s help. This is a white-coloured plastic card with a photo of the beneficiary. On the top of the card, the beneficiary number is given to avail of the scheme’s benefits. The strip of the card can be of the following colors:

• Yellow: Journalist 
• Blue: Central government employee
• Green: Pensioner, freedom fighter, ex-MP, etc.
• Red: Member of the Parliament of India.

CGHS card is valid till the retirement period of the employee. The card can be renewed by submitting a form. But the scheme can’t be transferred. 

Terms and conditions of the CGHS card

Read the following terms and conditions of the CGHS card:

• The misuse of the CGHS card in any way will attract penalties and disciplinary actions
• If the card expires, then it should be surrendered to the concerned department
• For the renewal process of the CGHS card, fill out the form and other necessary details
• Only the eligible cardholder can enjoy its benefits. Its benefits can’t be transferred in any case. 

How to Apply for the CGHS Card?

People who are eligible for getting the benefits under the central government employees health scheme should apply to the scheme by following the given steps:

Online

• Step 1: You must visit the website https://cghs.gov.in/CghsGovIn/faces/ViewPage.xhtml to fill out an online application form.
• Step 2: Fill out the application form correctly and attach your photos in the designated areas.
• Step 3: Attach the required documents with the application form
• Step 4: Submit the application form and documents online
• Step 5: Download the form and take out its printout.

Offline

• If you want to submit the application form offline, then you should make sure that the application is endorsed by the Head of the Department of serving employees. You should submit the application form to Delhi’s Additional Director HQ office. Furthermore, you can send that application form and documents to the Additional Director’s office in other cities.
• If you are a serving employee, you can apply for the central government healthscheme for pensioners. You should submit an application with a bank draft and enclosures to the CHGS from the employee’s office. 

Documents Required for Central Government Employees Health Insurance Scheme

The following documents are required to attach with the application form of the central government health insurance scheme:

Central Govt. Health Scheme for Pensioners

• Bank demand draft
• Provisional PPO/PPO/Last Pay Certificate copies

Central Govt. Health Scheme for serving government employees

• Address Proof 
• Dependent’s Age Proof
• Dependent Residential Proof
• If the dependent is physically disabled, a certificate of disablement from a valid authority is attached. 

Validity of CGHS card 

If you are a cardholder of the CGHS card, then you should know the following points related to the validity of the CGHS card:

• CGHS card is valid till the last working day of the employee
• CGHS card is valid in only those 71 cities that are included in the CGHS scheme
• After retirement, the central government employee can avail of its benefits if they make a contribution a year before completion.
• This card is valid in all the government/private hospitals which come in the CGHS regions for hospitalization, diagnosis, and medications.

Transfer of CGHS card

Read the following points to learn about the transfer of a CGHS card:

• If the central government employee is transferred to the non-CGHS covered regions, then the CGHS card will be used by the beneficiary’s family for 6 months if a contribution has been made beforehand.
• If any employee’s department is transferred to the same city, then the current CGHS card can be used as the requisite changes will be done by the concerned department in the employee database.
• A transfer permit is required to get the treatment done in another CGHS city for the life-saving medications. 

Conclusion

CGHS (Central Government Health Scheme) offers many benefits to the beneficiaries and their dependent families by giving them monetary help to handle the medical expenses that can surround them at any time. If you still have not registered under this scheme, then enroll today and lead a well-protected and stress-free life. Such schemes are widely acclaimed by the beneficiaries for greatly relieving them.

DISCLAIMER

This article is issued in the general public interest and is for educational purposes only. The blogs should not be used as a substitute for competent expert advice from a licensed professional to best suit your needs. Insurance is a subject matter of solicitation. For more details on policy terms, conditions, exclusions, limitations, please refer/read policy brochure before concluding sale.