Eligibility Criteria for Central Government Health Scheme: Check CGHS Scope, Benefits and Eligibility

What is CGHS meaning?

CGHS, or the Central Government Health Scheme, is a comprehensive health policy available with specific terms and conditions for the employees (both working and retired) of the Central Government as well as their dependent family members.

The CGHS scheme is termed one of the largest central government health insurance schemes for two reasons:

1. India being one of the most populated countries, has the largest number of central government employees in both active and retired categories
2. The scheme is almost 70 years old and is still operational. This signifies the popularity of this policy as a comprehensive plan covering almost the entire nation.

Scope of Central Government Health Scheme

The scope of CGHS goes much beyond the traditional treatment of allopathy. Thus, along with allopathy, the policyholders of CGHS can avail of treatment under Ayurveda, Siddha, Homeopathy, Unani and Yoga & Naturopathy.

Benefits Available Under Central Government Health Scheme

Various CGHS card benefits can be availed by central government employees who are working currently or those who are retired. Here are some benefits:

• The plan allows the policyholder to avail OPD treatment at any of the impanelled hospitals
• It offers doctor consultations at central government hospitals and clinics
• Cashless treatment can be availed at the impanelled hospitals and diagnostic centers for retired employees as well as other beneficiaries notified under the plan
• The policyholder is also entitled to reimbursements for treatments availed at private/government hospitals in case of emergency medical conditions
• Maternity and child health care services are also available under the plan
• The policyholder can avail reimbursement of expenses incurred for hearing aids, artificial limbs, etc.

Who is Eligible for the Central Government Health Scheme?

CGHS insurance policy can be availed by all central government employees. Below are people who come under CGHS eligibility:

• Employees living in areas covered by the scheme and who are working under the central government
• Those who are dependents of policyholders
• Retired employees who are on a pension under the central government
• Current and former members of Parliament
• Former Governors and Lieutenant Governors who served in any of the Indian states
• Freedom Fighters who fought for the country
• All past Vice Presidents of India
• Supreme and High Court judges, both current and former
• PIB-accredited journalists (for Delhi)
• Police personnel working in Delhi
• Employees of the Railway Board, etc.

Which cities offer the Central Government Health Scheme?

CGHS provides health insurance benefits to central government employees in the following cities:

How to Register With CGHS? 

The registration process is very simple. You just need to download the CGHS application form and fill it with complete and correct details. You would need copies of the below documents:

• Address proof
• Proof of dependents’
• Age-proof of children
• Disability Certificate if any child is disabled and above the age of 25 years
• Passport-size photos of dependent family members
• Retired individuals need attested copies of the PPO and last pay certificate

You need to send a demand draft of CGHS contribution to PAO, CGHS, New Delhi (for Delhi) or Additional Director, CGHS, of the respective city.

Process for Existing Employees

The employees working currently under the central government can duly fill out the application form. They can collect all the copies of the required documents and submit the same to the concerned department where they are working. The department, in turn, will forward the same to the Additional Director of the respective city.

Process for Retired Employees

The retired employees should duly fill out the application. Next, they can take copies of the required documents as mentioned above. Similar to the above process of existing employees, the retired individuals must also submit the documents along with the application to the Additional Director, Headquarters (for Delhi) or Additional Director of your city. You must also attach the CGHS surrender certificate (in case it was issued during the service period)

Once the concerned department receives the application, they will process the CGHS Card. When the card is ready, it is sent to the Wellness Centre of the respective city before it reaches you.

What is a CGHS card? How Long Does It Take to Receive the CGHS Card?

CGHS card is the Central Government Health Scheme card. It takes about three to four weeks to prepare the plastic card, while the printout of the index card can be obtained on the same day. Once you receive the actual card, you need to check all the details to see if they are valid. If there is an issue or any error in the record, one needs to approach the Joint Director CGHS (HQ) in Delhi.

Colour Code of CGHS Cards

CGHS health cards come in one of four colors:

• Blue – existing CGHS employees
• Green – former government employees, MPs, and freedom fighters
• Red – existing MPs
• Yellow – PIB accredited journalists

What are the charges for a CGHS Card?

The contribution is automatically deducted from the salary every month depending on the grade of the employee: