Rules and Guidelines for Central Government Health Scheme (CGHS) as per Swamy’s Handbook 2025

Rules and Guidelines for Central Government Health Scheme (CGHS) as per Swamy’s Handbook 2025

Introduction to CGHS

The Central Government Health Scheme (CGHS) is one of the most beneficial healthcare schemes implemented by the Government of India. Designed specifically for Central Government employees, pensioners, and their dependents, CGHS offers a wide network of medical services across major Indian cities. As per the Swamy’s Handbook 2025, the rules and guidelines have been updated to provide better clarity, enhanced accessibility, and improved healthcare services. Let’s walk you through everything you need to know.

Eligibility under CGHS

Who Can Avail CGHS Benefits?

• Central Government employees (excluding railway employees)

• Central Government pensioners

• Dependents of the above

• Members of Parliament

• Former Vice Presidents

• Freedom Fighters

• Journalists accredited with PIB

• Certain autonomous bodies and judiciary employees (on approval)

Dependent Criteria

To be considered a dependent:

• The family member should reside with the employee.

• The income should not exceed the prescribed limit (currently ₹9,000 + DA as per Swamy’s 2025 update).

CGHS Card Issuance Guidelines

How to Apply

Eligible beneficiaries must apply online through the official CGHS portal. For physical submission, forms are available at CGHS wellness centers.

Types of Cards

• Plastic Cards with QR Code: For quick verification

• Temporary Cards: Issued for new joiners and valid for 3 months

Cities Covered under CGHS

As of 2025, CGHS is operational in over 75 cities, including metro and tier-2 cities. Expansion plans are in place to reach semi-urban areas as well.

Services Covered under CGHS

Primary Healthcare

• Consultation with doctors at CGHS wellness centers

• Free prescribed medicines

• Basic diagnostic tests

Specialist Consultation

• Referral system for empanelled hospitals

• Super-specialty treatment in CGHS recognized hospitals

Hospitalization Benefits

• Cashless treatment in CGHS-empanelled hospitals for cardholders

• Indoor treatment with pre-authorization

Empanelled Hospitals and Diagnostic Centres

CGHS ties up with top private hospitals, diagnostics labs, and wellness centers. A regularly updated list is available on the CGHS portal.

Reimbursement Policies

When Reimbursement is Allowed

• In case of emergency treatment in non-empanelled hospitals

• Treatment taken while traveling or in a non-CGHS city

• Non-availability of services in empanelled hospitals

Documents Required

• Medical bills

• Doctor’s prescription

• Discharge summary

• Identity proof

Claims must be submitted within 6 months from the date of discharge.

Online Services and Digitalization

Swamy’s Handbook 2025 emphasizes digital transformation:

• Online appointment booking

• E-referral generation

• Teleconsultation through the eSanjeevani platform

• Mobile app for locating CGHS centers

Contribution Rates (As per 7th CPC)

For Serving Employees

Monthly contribution is based on grade pay:

• ₹250: GP up to ₹1800

• ₹450: GP ₹1801 to ₹2800

• ₹650: GP ₹2801 to ₹4200

• ₹1000: GP ₹4201 to ₹6600

• ₹1250: GP above ₹6600

For Pensioners

• Option to pay yearly/lifetime contribution

• Lifetime card fees range from ₹30,000 to ₹1,20,000 depending on grade pay

Validity and Renewal

CGHS cards must be renewed before expiry. For pensioners, life-time cards are valid until death but must be updated if the address or dependent status changes.

CGHS and Non-CGHS Areas

If an employee or pensioner resides in a non-CGHS city:

• They are entitled to Fixed Medical Allowance (FMA) – ₹1000 per month

• Reimbursement allowed under specific conditions

CGHS for Senior Citizens

Swamy’s Handbook encourages elderly healthcare:

• Priority consultation slots

• Home visits in critical cases (pilot basis)

• Simplified claim processing for pensioners above 75 years

Medical Advance Facility

In case of major surgeries or long-term treatment, medical advance can be availed with:

• Doctor’s recommendation

• Estimate from CGHS hospital

• Approval from competent authority

Wellness Centers and Timings

• Open from 7:30 AM to 2:00 PM (Monday to Saturday)

• Emergency duty doctors available in some centers

• Sunday closed except for emergency cases in selected centers

Important Points as per Swamy’s Handbook 2025

• Aadhaar-based authentication mandatory

• Revised referral process with QR code verification

• Direct online claim submission for pensioners

• Regular health check-ups encouraged annually

Grievance Redressal Mechanism

Have a complaint?

• Use CGHS grievance portal

• Call the toll-free helpline: 1800-208-8900

• Submit written complaints at wellness centers

• Regular monitoring by MoHFW

Conclusion

The Central Government Health Scheme (CGHS) stands as a beacon of welfare for India’s central government workforce. The Swamy’s Handbook 2025 brings much-needed clarity, upgrades, and simplifications that aim to enhance the reach, transparency, and efficiency of the scheme. Whether you are a serving employee or a retired pensioner, understanding and utilizing CGHS to its full potential can secure quality healthcare for you and your family, without the financial strain. Stay informed, use your benefits wisely, and take care of your health — it’s the most valuable asset you’ve got!

FAQs

1. Can I use CGHS if I’m posted in a non-CGHS city?
Yes, you are entitled to FMA, and reimbursement is allowed under emergency or special conditions.

2. How do I book a doctor’s appointment under CGHS?
You can log in to the CGHS portal or mobile app and select your preferred doctor and time slot.

3. Is CGHS cashless for all treatments?
Cashless service is available at CGHS-empanelled hospitals for both serving and retired beneficiaries with a valid CGHS card.

4. What if my CGHS card is lost or damaged?
You can apply for a duplicate card online. A nominal fee may be charged for reissuance.

5. How long does reimbursement take?
Usually, it takes around 60 days if all documents are in order. Pensioners can track the status online.

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