Central Government Health Scheme (CGHS): Benefits, Eligibility, Features| Ketto

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The Central Government Health Scheme (CGHS) is a pioneering health initiative by the Indian government that provides complete healthcare facilities for its employees and pensioners. This scheme aims to ensure the well-being of central government employees and their dependents by offering access to quality medical services.

In this blog, we’ll delve into the various aspects of CGHS, from its components and features to eligibility criteria and the enrollment process.

Components of Central Government Health Scheme

The CGHS consists of a network of dispensaries, wellness centres, and empanelled Central Government Health Scheme hospitals across India. These establishments work together to provide various healthcare services to CGHS beneficiaries.

Through the Central Government Health Scheme (CGHS), the beneficiaries can take advantage of the following:

Outpatient Department (OPD) Services: Consultations with doctors, diagnostic tests, and medicines at designated CGHS dispensaries and empanelled private clinics.
Indoor Treatment: Hospitalisation coverage for surgeries, diagnostic procedures, and other medical interventions at empanelled hospitals under Central Government Health Scheme.
AYUSH Services: Treatment through traditional Indian forms of medicine like Ayurveda, Yoga, Unani, Siddha, and Homeopathy at designated AYUSH dispensaries.

Central Government Health Scheme Benefits And Features

CGHS offers many features and benefits, including cashless treatment, access to a vast network of healthcare providers, and coverage for various medical systems. The scheme ensures that beneficiaries receive quality medical care without financial strain.

Wide Network of Central Government Health Scheme Hospitals: Access to over 12,000 government and private hospitals across India, ensuring convenient medical care regardless of location.
Cashless Treatment: Avail medical services without upfront payments at empanelled hospitals, minimising financial burden during times of illness.
Comprehensive Coverage: OPD consultations, medicines, diagnostic tests, hospitalisations, and surgeries are covered for a range of medical conditions.
Family Coverage: Spouses, dependent parents, and unmarried children up to 25 years are eligible for coverage under the scheme.
Choice of Doctors: Consult with specialists and qualified doctors at CGHS dispensaries and empanelled private clinics.
AYUSH Integration: Receive treatment through traditional Indian medicine systems alongside conventional therapies.

Eligibility Criteria Of Central Government Health Scheme

To avail of its benefits, individuals must meet specific Central Government Health Scheme eligibility criteria. Generally, central government employees, pensioners, and their dependents are eligible for enrollment. The scheme aims to cover a broad spectrum of individuals associated with the central government.

To determine your eligibility for the Central Government Health Scheme (CGHS), kindly review the following criteria:

A central government employee, including civilian and non-civilian employees, engaged in various ministries, departments, and autonomous bodies.
A retired central government employee, including pensioners drawing pension under the Central Civil Services (CCS) rules.
A family member of a central government employee, such as a spouse, dependent parents, and unmarried children up to 25 years.

Here is the list of all the government employees that are eligible for CGHS:

All Central Government employees, including their families, paid from the Central Civil Estimates (except Railways and Delhi Administration).
Central Government Pensioners (except those belonging to Railways and the Armed Forces) and their families.
Central Government Pensioners retiring with Contributory Provident Fund benefits and their families.
Widows of Central Government pensioners, in receipt of family pension.
Delhi Police personnel and their families, in Delhi only.
Employees of Railway Board.
Civilian employees of Defence paid from Defence Service Estimates (except in Mumbai, where the scheme is in operation).
Child drawing pension on death of a Central Government employee, including minor brothers and sisters of such child.
Ex-Governors and Lt. Governors and their families.
Ex-Vice Presidents and their families.
Central Government employees deputed to semi-government and autonomous bodies receiving substantial grants from or financed by the Central Government.
Central Govt. employees on deputation to statutory/autonomous during the period of deputation.
Military Officers while on deputation to civil departments and getting their emoluments from Central Civil Estimates.
Families of Government servants transferred to a non-CGHS area for a maximum period of six months on deposit of CGHS contribution (for six months) in advance.
Families of IAS Officers in the North-Eastern Cadre who continue to stay back in Delhi even after the repatriation of the IAS Officer to the North-Eastern Cadre provided that they continue to occupy Government accommodation in Delhi/New Delhi, on deposit of CGHS contribution in advance (one to three years). The same also applies to families of IAS Officers of J&K Cadre.
Parliamentary Secretaries of the Central Government and their families.
Members of Parliament and their families.
Ex-Members of Parliament.
Sitting Judges of the Supreme Court and High Court of Delhi and former Judges of the Supreme Court and High Courts.
Work Charged and Industrial Staff working in establishments run by various Ministries/Departments of Central Government immediately from the date of their joining the service.
Employees of Kendriya Vidyalays Sangathan stationed at Delhi & NCR, Kolkata, Chennai, Hyderabad, Mumbai and Bengaluru.
Employees of Ordnance Factory Board Headquarters, Kolkata and Ordnance Equipment Factories Headquarters, Kanpur.
All India Service pensioners who retire while serving under the State at their option.
Freedom Fighters and family members receiving Central Pension under the Swatantrata Sainik Samman Pension Scheme.
Family members of the Deceased Ex-Members of Parliament.
Pensioners of Ordnance factories.
Members of Staff Side of the National Council of the Joint Consultative Machinery, even though not serving as Central Government employees.
Persons employed in semi-government and autonomous bodies are permitted to join the CGHS Scheme.
An Accredited Journalist who produces a certificate from the Press Council of India stating that he is a member of the Press Association, New Delhi (for OPD and at RML Hospital).
Retired Divisional Accountants of the Indian Audit and Accounts Department and those whose pay and pension are entirely borne by the State governments.
PSU absorbees who had commuted 100% of their pension and have been restored 1/3rd portion of their pension after 15 years.
Employees of Statutory Bodies/Autonomous Bodies of Central Govt. (including those who proceeded on deputation initially or were on deemed deputation and then absorbed) who receive Central Civil Pension.
Serving and retired Railway Audit Staff.
Retired Divisional Accounts Officers and Divisional Accountants of the Office of Comptroller and Auditor General of India.
CISF personnel (and their families) and CAPF (Central Armed Police Forces) personnel posted in CGHS cities.
Employees of Supreme Court Legal Services Committee Employees of India Pharmacopoeia Commission, and their families.
Family and dependent members of a Central Govt. employee (a CGHS beneficiary) who stay back in CGHS covered area after the posting of the employee to N.E. region (including Sikkim), Andaman & Nicobar Lakshadweep or Ladakh region and CAPF personnel posted in Left Wing Extremist areas, on payment of annual CGHS contribution in advance.
Defence Industrial Employees of Naval Dockyard Central Ordnance Depot and AFMSD, in Mumbai.

How to Enroll for Central Government Health Scheme

Enrolling in CGHS is a straightforward process. Individuals can register through the official website or visit the nearest dedicated dispensary. The Central Government Health Scheme online registration involves filling out an application form and submitting the necessary documents. To avail of its benefits, eligible individuals can initiate the process of the Central Government Health Scheme card download through the official CGHS website.

Enrolling in CGHS involves the following steps:

Download the application form: The Central Government Health Scheme application form is available on the official website (https://cghs.nic.in/) or can be obtained from designated CGHS dispensaries.
Fill out the Central Government Health Scheme form: Fill the form and attach the required documents.
Submit the form: Submit the completed form and documents to the designated CGHS office based on your location.
Verification and Processing: The CGHS office will verify your documents and process your application.
Smart Card Issuance: Upon approval, you will receive a Central Government Health Scheme smart card, your key to accessing scheme benefits.

Documents Required For Central Government Health Scheme

To complete the enrollment process, applicants need to provide certain documents, including proof of employment, residence, and other relevant details. These documents ensure that only eligible individuals are included in the CGHS network.

Identity proof (Aadhaar card, PAN card, etc.)
Proof of residence (electricity bill, ration card, etc.)
Pension order (for retired employees)
Family relationship documents (marriage certificate, birth certificate, etc.)

Beneficiaries of the Central Government Health Scheme

Central Government Health Scheme extends its benefits to a wide range of beneficiaries, including central government employees, pensioners, and their family members. This inclusive approach ensures that a significant portion of the central government workforce can access quality healthcare services.

The following individuals are eligible to become beneficiaries under CGHS:

Central government employees, both serving and retired.
Spouses of central government employees.
Dependent parents of central government employees.
Unmarried children up to 25 years of age (including adopted and stepchildren) of central government employees.

To explore the specific eligibility criteria and coverage details for beneficiaries, kindly visit the official Central Government Health Scheme website.

Steps to Schedule an Appointment Online

The CGHS website facilitates online appointment scheduling, streamlining the process for beneficiaries. This feature allows individuals to book appointments at their convenience at empanelled hospitals and wellness centres.

CGHS offers online appointment booking through its official website https://cghs.nic.in/ or the CGHS mobile app. Follow these steps:

Login using your credentials.
Select the desired dispensary or hospital.
Choose a doctor and speciality.
Select a date and time slot for your appointment.
Confirm your booking and receive an appointment confirmation email or SMS.

Before seeking medical assistance, beneficiaries of the Central Government Health Scheme are advised to consult the Central Government Health Scheme hospital list on the official website.

Types of Medical Systems Covered

CGHS covers various medical systems, including allopathy, homoeopathy, and Ayurveda. This multi-system approach ensures that beneficiaries can access diverse medical treatments.

CGHS covers a wide range of medical treatments through:

Allopathy: The conventional Western medical system.
AYUSH: Traditional Indian medicine systems like Ayurveda, Yoga, Unani, Siddha, and Homeopathy.
Dental Care: Treatment for dental ailments at designated CGHS dental clinics or empanelled private clinics. To claim reimbursement for dental implants, review the Central Government Health Scheme rules and specific provisions within the scheme.

List of Treatments Not Covered Under Central Government Health Scheme

While CGHS covers a broad spectrum of medical treatments, certain procedures and services may not be included. Beneficiaries must be aware of these exclusions to make informed decisions regarding their healthcare needs.

It’s essential to understand what CGHS does not cover so you can plan accordingly:

Cosmetic surgeries: Procedures primarily intended to improve appearance are not covered.
Dental implants and bridges: While primary dental care is included, implants and bridges fall outside the scheme’s purview.
Organ transplants: Costly organ transplants like kidney or liver are not covered.
Rehabilitation and physiotherapy: Post-operative rehabilitation or physiotherapy are not covered unless explicitly recommended by a specialist.
Alternative and complementary therapies: Treatments like acupuncture or hypnotherapy are not covered under CGHS.
Experimental treatments: Unproven or experimental medical procedures are not covered.

Facilities Offered Under Central Government Health Scheme

CGHS facilities encompass a range of medical services, including outpatient care, inpatient treatment, diagnostic services, and preventive healthcare. The scheme aims to provide holistic healthcare solutions to its beneficiaries.

Beyond OPD consultations and hospitalisations, CGHS offers additional benefits:

Maternity care: Coverage for prenatal checkups, delivery, and postnatal care in designated hospitals.
Emergency medical aid: Reimbursement for emergency treatment taken at non-empanelled hospitals under specific conditions.
Artificial limbs and hearing aids: Reimbursement for the cost of approved artificial limbs and hearing aids.
Preventive and wellness programs: Periodic health checkups and vaccination drives through CGHS dispensaries.

Cost of Central Government Health Scheme Facilities

CGHS offers cost-effective healthcare solutions to its beneficiaries. The scheme operates on a fixed-rate system, ensuring transparency in pricing and preventing any unexpected financial burdens for individuals seeking medical services.

While CGHS minimises financial burden during illness, beneficiaries contribute a portion of the costs:

Contribution rates: Vary based on employee pay scales and family composition. Refer to the official Central Government Health Scheme website or consult your department for specific rates.
Package rates: Empanelled hospitals have pre-determined package rates for specific procedures, minimising out-of-pocket expenses.
Co-payment: A small co-payment may be applicable for certain medications or investigations.

Frequently Asked Questions (FAQs)

What is the Central Government Health Scheme (CGHS)?

It is a healthcare initiative by the central government, providing comprehensive medical services to its employees, pensioners, and their dependents.

Who is eligible for CGHS?

Central government employees, their spouses, dependent parents, and unmarried children up to 25 years can avail of CGHS benefits.

How do I enrol in the Central Government Health Scheme?

Download the application form from the Central Government Health Scheme website, fill it out, and submit it with the required documents to the designated CGHS office.

What is the latest rate for CGHS?

Contribution rates for CGHS vary based on employee pay scales and family composition. Check the official website or consult your department for specific details.

Is CGHS treatment cashless?

Yes, treatment at empanelled hospitals is cashless within pre-determined package rates. Some medications or investigations may involve co-payment.

What is included in the CGHS package?

The CGHS package includes various medical services, from outpatient care to inpatient treatment and preventive healthcare. CGHS packages for hospital procedures cover room charges, doctor fees, nursing care, investigations, and medicines within specified limits. Refer to the CGHS website or consult empanelled hospitals for specific details.

Can CGHS card be used anywhere?

The CGHS card can be used at any empanelled hospital or wellness centre under the CGHS network.

How do I claim my CGHS benefits?

Beneficiaries can claim CGHS benefits by submitting relevant documents and following the prescribed procedures outlined by CGHS. For OPD consultations or medicines at CGHS dispensaries, present your CGHS card. For hospitalisation at empanelled hospitals, inform them of your CGHS coverage for cashless treatment.

How do I get a CGHS card?

The smart cards can be obtained through Central Government Health Scheme online registration on the official CGHS website or by visiting the nearest Central Government Health Scheme dispensary.

Conclusion

Dedicating their lives to serving the nation, government employees deserve unwavering support. That’s why the Government of India established the Central Government Health Scheme (CGHS), offering accessible and comprehensive healthcare coverage to ensure the well-being of these heroes and their families, both during their service and in their golden years.

Its comprehensive coverage, transparent pricing, and widespread network of healthcare providers make it a valuable asset for the well-being of its beneficiaries. As we celebrate the strides made in the healthcare sector, it’s also crucial to recognise the importance of community support.

While CGHS covers a wide range of medical needs, unforeseen circumstances or critical illnesses may require additional financial assistance. Ketto, a crowdfunding platform, helps families raise funds for life-saving treatments and surgeries not covered by the Central Government Health Scheme or exceeding its limits. With its supportive community and dedicated platform, Ketto empowers individuals to overcome financial barriers and access the healthcare they need.

As we appreciate the strides in government healthcare, let’s also acknowledge the power of community-driven initiatives in transforming lives.

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Central Government Health Scheme (CGHS): Benefits, Eligibility & More