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Central Government Health Scheme (CGHS)
Having the right comprehensive healthcare protection is important. It can help avert a financial crisis while battling unforeseen situations. Many people tend to avail of health insurance at various stages of their life. However, there are many who find it difficult to decide on an insurance scheme that meets their needs. This can include government employees and pensioners.
To ensure that their employees enjoy insurance benefits, the government introduced the Central Government Health Scheme or CGHS. It is a health insurance scheme that safeguards quality medical care for employees and their families. This results in promoting a healthy and happy government workforce.
Components of the Central Government Health Scheme – CGHS
The Central Government Health Scheme was introduced in 1954. It was formulated to be a comprehensive answer to the health insurance needs of all covered employees. Thus, today, the CGHS scheme encompasses multiple healthcare requirements. Its crucial elements guarantee a multi-faceted welfare for CGHS beneficiaries. These components are as follows.
- Outpatient Care: This element covers consultations, diagnostic tests, and medicines at CGHS dispensaries and empanelled private clinics.
- Inpatient Care: This element covers hospitalisation expenses, including room charges. It also covers surgeries and intensive care. These can be both at government and empanelled private hospitals.
- Additional services: This element covers maternity and child health care, family welfare services etc.
- Alternative medicine: CGHS gives access to Ayurveda, Yoga, Unani, Siddha, and Homeopathy (AYUSH) medical system treatments as well.
- Emergency Care: This essential coverage is for emergency medical services and related last-minute hospitalisation.
Benefits of Central Government Health Scheme – CGHS
The Central Government Health Scheme offers multiple benefits. These significantly improve the health welfare of government employees, pensioners, and even their families.
Firstly, the CGHS scheme provides all-round coverage for medical expenses. This list includes consultations, medications, diagnostic tests, and hospitalisation costs. Having health insurance with an all-encompassing benefit removes the associated financial burden on beneficiaries and guarantees timely availability to top-tier healthcare.
Secondly, CGHS beneficiaries have a huge network of healthcare providers. This network covers government hospitals, dispensaries, and empanelled private hospitals and clinics. This ensures access, convenience, and availability of medical services in pan-India.
CGHS also aims to bolster preventive care through regular health check-ups, vaccinations, and family welfare programmes. This benefit allows all the beneficiaries to make their health a top priority. The scheme also covers alternative medicine systems such as AYUSH, which allows patients to choose the treatment method they prefer.
Finally, the CGHS offers a cashless insurance facility at empanelled hospitals. This means the payment process is simplified, and any out-of-pocket spending is generally avoided.
Eligibility for Central Government Health Scheme – CGHS
CGHS benefits can be availed if the beneficiary meets specific eligibility criteria.
The CGHS scheme primarily caters to the Central Government’s employees and pensioners. Hence, the CGHS eligibility criteria include individuals working in various ministries, departments, and offices under Centre. Plus, all those who have retired from such services can also seek coverage.
Eligible family members can also be covered under the CGHS scheme. These will include spouses, dependent children, and parents. The criteria for dependent eligibility may be different. Hence, refer to the official CGHS guidelines for detailed information on this matter.
Another key point in determining eligibility is location. The CGHS facilities are currently available in select cities across the country. So, only those individuals who reside in a CGHS-covered area can avail of CGHS benefits.
Specific categories of individuals may also get CGHS benefits. This list includes Members of Parliament (MP), former Vice Presidents, retired or sitting judges of High Courts and Supreme Court, and freedom fighters. The criteria for these special categories can be found in the official CGHS documents.
Health Insurance Policies in October 2023
Health insurance in India is constantly evolving. You can witness several noteworthy developments over the years. One thing is certain; as the demand for comprehensive health coverage grows, insurance providers are customising their offerings. Here are some key health insurance policy focus areas:
- Preventive care: Many health insurance policies today cover preventive health check-ups, vaccinations, and wellness programmes.
- Critical illnesses: Lifestyle diseases are on the rise. Therefore, health insurance policies are increasingly offering comprehensive coverage for critical illnesses. This covers ailments such as cancer, heart disease, stroke, etc.
- Customisable plans: Many insurers are offering customisable plans to meet individual requirements and wallets. These plans come in the form of add-on covers for specific needs, such as maternity benefits, OPD expenses, dental care, etc.
As always, selecting the right health insurance policy is a process that requires careful consideration of individual requirements, budget, coverage and exclusions.
Types of Medical Systems Covered
The Central Government Health Scheme covers conventional allopathic medicine. Apart from this, beneficiaries can access treatments under AYUSH. Furthermore, CGHS also provides coverage to dental care. This offers essential oral health services to beneficiaries.
Facilities Offered Under Central Government Health Scheme
The Central Government Health Scheme provides a full range of medical facilities to beneficiaries.
Outpatient care is the foundational element of the CGHS. This ensures consultations, diagnostic tests, and medications at CGHS wellness centres and empanelled private clinics are duly covered. Beneficiaries can easily get primary healthcare services for a host of ailments.
CGHS understands that beneficiaries can have complex medical needs. For this, the scheme includes inpatient care at government and empanelled private hospitals. This provides for hospitalisation expenses for various treatments, surgeries, and intensive care. Thus, beneficiaries receive the necessary care without an iota of financial strain.
Family health is the keystone of Indians. Understanding this, the CGHS extends coverage to maternity and child healthcare services. Hence, prenatal check-ups, delivery assistance, postnatal care, and immunisations are all taken care of, safeguarding the health of both the mother and her child.
As mentioned, patients do look for treatments beyond conventional medical care. The CGHS covers alternative medicine systems, offering treatments under AYUSH. This inclusive approach aims to cater to the diverse preferences of beneficiaries.
Emergency medical services are also covered under the scheme. This is a great benefit, given the coverage extended to high-risk segments such as pensioners. This type of coverage ensures prompt and effective care during critical situations that may befall CGHS beneficiaries.
Cost of Central Government Health Scheme (CGHS) Facilities
For Pensioners
Pensioners get subsidised rates for availing CGHS facilities. The contributions are based on their last pay drawn. These are taken directly from their pension. In a manner of speaking, pensioners provide a nominal contribution. This removes the financial burden of healthcare needs during retirement.
For Serving Government Employees
Serving government employees are required to be given a fixed monthly premium. This money is based on their pay grade. Like pensioners pay from their pension, the premium of serving government staff is directly deducted from their salary. This offers a hassle-free gateway to the scheme's benefits.
The contribution rates are designed to be affordable for staff. Thus, this approach ensures that employees can avail quality healthcare without burning a hole in their pocket.
Required time to get CGHS Card
The time it takes to obtain a CGHS card can vary depending on several factors, including the completeness of the application, the volume of applications processed in that period, and potential verification steps.
Under normal circumstances, a CGHS card is issued typically in a few weeks. For new government employees, however, the CGHS card comes within a month of joining the service. This time period holds water, provided the application is submitted quickly and with all the documents. Pensioners can apply for the card after retirement. The processing time for this is similar. So, it can take from a few weeks to about a month.
However, in all the above cases, there is a possibility of delay due to unanticipated events. One can track the status of the application online. You can also pay a visit to the concerned CGHS office to get the latest information about the issuance progress.
CGHS Rate List
The CGHS Rate List is an important document. It enumerates the costs associated with various treatments, procedures, and investigations under this scheme. It can be a reference guide for both beneficiaries and healthcare providers, safeguarding transparency and cost standardisation.
The rate list is periodically revised to keep it in sync with prevailing medical costs and technological advancements in the healthcare field. It covers all the services, from consultations and diagnostic tests to surgeries and hospital stays.
The rates for different procedures differ and are based on factors such as the complexity of the procedure, the type of hospital (government or empanelled private), and the city or region.
Importantly, CGHS beneficiaries can access the latest CGHS rate list from the official CGHS website or through their respective CGHS centre.
CGHS - Treatment in Private Hospitals
CGHS is synonymous with government establishments, but that doesn’t mean private hospital treatment is not provided. In fact, CGHS's edge is in its coverage of private hospitals.
Beneficiaries can get medical services at numerous empanelled private hospitals across India. The flexibility to choose between government and private hospitals means beneficiaries have access to specialised care if the treatment or situation demands it.
Beneficiaries generally need a referral from their CGHS Wellness Centre in case they want the services of a private hospital. This ensures that the treatment is deemed medically necessary and covered under the CGHS coverage. Once the referral is procured, CGHS beneficiaries can select from the list of empanelled hospitals and then promptly proceed with receiving the required treatment.
The CGHS covers a wide range of treatments in private hospitals. Surgeries, diagnostic tests, consultations with specialists, and hospitalisations are all covered under the scheme. This type of coverage means that CGHS beneficiaries receive quality care in a timely manner, notwithstanding the fact that they prefer treatment in a private healthcare facility.
CGHS Appointment Online
The Central Government Health Scheme provides a convenient online appointment booking system. This e-system provides easy access to healthcare services.
CGHS beneficiaries can seamlessly schedule appointments with doctors at their preferred CGHS Wellness Centres. This can be done either through the official CGHS website or the mobile app. The use of the digital platform eliminates scenarios such as serpentine queues and long waiting times, boosting patient experience.
Treatments that are not Covered Under the Central Government Health Scheme (CGHS)
While CGHS offers extensive coverage, there are a few exclusions. There are five types of treatments not covered by CGHS. These are cosmetic surgeries, experimental treatments, infertility treatments, and certain dental procedures.
Under typical conditions, spending on personal comfort items, non-prescription drugs, and treatment at non-empanelled hospitals is also not covered.
Central Government Health Scheme Mediclaim Policy
The CGHS Mediclaim Policy is an extra layer of protection beyond the plain-vanilla CGHS coverage. It compensates for expenses even for treatments in non-empanelled private hospitals.
Also, the CGHS Mediclaim policy applies to specific medical procedures or treatments excluded from the basic CGHS benefits. A few of them have been highlighted in the previous sections.
CGHS in Private Hospitals
CGHS beneficiaries can choose treatment at empanelled private sector hospitals. This is allowed only when special care or specific medical treatments are unavailable within the existing CGHS government system. One can seek consultations with specialists, surgeries, diagnostic tests, and hospitalisation at private hospitals. Do note that treatment at private hospitals can start only after the required referral.
Surgeries at Private Empanelled Hospitals under CGHS
Surgeries at empanelled private hospitals are covered by CGHS. The scheme covers a wide range of surgeries. These include orthopaedic, cardiovascular, neurological, and oncological surgeries, among others. For surgeries in private hospitals, pre-authorisation is required.
Applicable Cities Under Central Government Health Scheme – CGHS
The CGHS is available in numerous cities across India. Some of the major cities where CGHS facilities are available include Delhi, Mumbai, Kolkata, Chennai, Bengaluru, Hyderabad, Ahmedabad, and Pune. New cities are being added to the network regularly.
Frequently Asked Questions
What is CGHS Card?
A CGHS card is an identification card issued to beneficiaries of the Central Government Health Scheme. It is proof of eligibility and allows beneficiaries to avail of medical services at CGHS Wellness Centres and empanelled hospitals.
How do I Apply for the Central Government Health Scheme (CGHS) online?
Applying for the CGHS online is simple. Eligible individuals can visit the official CGHS website and go to the online application portal. Fill out the application form, providing personal details, employment information, and relevant documents. After submission, a unique reference number is generated. This number can be used to track the application status.
How do I print my CGHS online card?
After the CGHS application is approved, log into the official CGHS website or mobile app using your valid credentials. Go to the 'Print Card' option under your profile section. Enter the one-time password (OTP) sent to your registered mobile number. Once verified, you can download the e-card as a PDF and take a colour printout.