The Complete CGHS Treatment Guide (2026 Rules & Updates)
The Central Government Health Scheme (CGHS) is a comprehensive healthcare program initiated by the Ministry of Health and Family Welfare for serving and retired Central Government Employees. This scheme provides financial coverage for medical treatment, sometimes with no upper cost limit for specific life-saving procedures, and capped package rates apply to standard treatments. Beneficiaries can access various treatments and procedures at any Government hospitals, CGHS Wellness Centers, and empanelled private hospitals.
Eligibility Criteria
According to the Ministry of Health and Family Welfare, individuals must fall in one of the following categories to claim CGHS benefits:
Standard Employees and Pensioners:
- All Central Government employees paid from the Central Civil Estimates (except Railways and Delhi Administration), including their dependent family members residing in CGHS covered areas.
- Pensioners of the Central Government (except pensioners 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.
- Child drawing pension on death of a Central Government employee including minor brothers and sisters of such child.
- All India Service pensioners who retire while serving under the State at their option.
Special Service, Forces and Regional Postings:
- Railway Board employees.
- Civilian employees of Defence paid from Defence Service Estimates.
- CISF personnel (and their families) and CAPF (Central Armed Police Forces) personnel posted in CGHS cities.
- Serving and retired Railway Audit Staff, Divisional Accounts Officers, and Divisional Accountants posted in the Office of Accountant Generals in States.
- Defence Industrial Employees of Naval Dockyard Central Ordnance Depot and AFMSD, in Mumbai.
- Families of Government servants transferred to a non-CGHS area, for a maximum period of six months on deposit of CGHS contribution (for the period of 6 months) in advance.
- Families of IAS Officers on North-Eastern Cadre, who continue to stay back in Delhi even after repatriation of the IAS Officer to the North-Eastern Cadre, provided that they continue to occupy Government accommodation in Delhi or New Delhi, on deposit of CGHS contribution in advance (one to three years).
- Family and dependent members of a Central Government employee who stay back in CGHS covered area after posting of the employee to N.E. region (including Sikkim), Andaman and Nicobar Lakshadweep or Ladakh region and CAPF personnel posted in Left Wing Extremist areas, on payment of annual CGHS contribution in advance.
Dignitaries, Judiciaries and Autonomous Bodies:
- Parliamentary Secretaries of the Central Government, members of Parliament and their families. Ex-Members of Parliament.
- Sitting Judges and former Judges of the Supreme Court and High Court of Delhi.
- Ex-Governors, Lt. Governors, Ex-Vice Presidents and their families.
- Central Government servants who are deputed to semi-government and autonomous bodies receiving substantial grants from, or financed by the Central Government.
- Persons employed in semi-government and autonomous bodies who are permitted to join the CGH Scheme.
- Military Officers while on deputation to civil departments and getting their emoluments from Central Civil Estimates.
- Members of Staff Side of the National Council of the Joint Consultative Machinery, even though not serving as Central Government employees.
- Employees of the Supreme Court Legal Services Committee.
- Employees of India Pharmacopoeia Commission, and their families.
- Work Charged and Industrial Staff working in establishments run by various Ministries or Departments of Central Government, immediately from the date of their joining the service.
Dependents:
- Spouse (exempted from income criteria)
- Parents (or parents-in -law in case of female employees).
- Unmarried son till 25 years of age.
- Dependent unmarried/widowed/divorced/separated daughters and sisters.
- Minor brothers are deemed dependent on the Government employee.
(Note: Excluding spouse, every other dependents are covered only if they are normally residing- with him/her and their income from all sources including pension and pension equivalent of DCRG benefit is less than ₹ 9000 +DA per month)
Rules & Regulation
According to the protocol, beneficiaries can avail OPD consultation from specialists in any government hospital directly without any referrals. But to avail OPD consultation from specialists in a CGHS empanelled hospital, beneficiaries must be referred by the Medical Officer or CMO In-charge of the Wellness Centre. These referrals are valid for three months and six consultations within the period. Senior citizens aged 75 and above are completely exempted from the referral protocol, and are allowed to walk into any empanelled private hospital for specialist consultations directly.
However, in emergency situations no empanelled hospital can refuse to provide treatment, even if the beneficiary doesn’t have a referral document. They may be admitted to any Government or private hospital, but the reimbursement will be as per CGHS rates. When a treatment procedure is done at an empanelled hospital, it usually covers two pre- and two post- operative consultations, room charges as per entitlement, and medicines during admission period.
Treatment Procedures
Treatment costs are covered in two ways: Cashless and Reimbursement.
Under the CGHS framework, cashless treatments are primarily available for pensioner beneficiaries, providing immediate financial relief by shifting the burden of payment entirely away from the patient. Pensioner beneficiaries receive cashless treatment upon presenting a valid CGHS card and an official referral slip. Serving employees can also access cashless treatment at empanelled hospitals after submitting an official permission letter from their respective department before the treatment begins. The hospital then deals with CGHS Bill Clearing Agency directly to settle all the eligible expenses based on fixed government packages.
Whereas, the reimbursement route applies if a beneficiary receives treatment at a non-empanelled hospital or if the serving employee undergoes treatment without prior permission letter. Here all medical expenses must be managed out-of-pocket at the time of care. Later they can claim that money by submitting all the original prescriptions, diagnostic reports, and bills along with a formal medical claim.Only the approved CGHS rate is refunded, any extra expenses must be covered by the patient.
Regular checkups and routine investigation like bp tests, x-ray can be availed without any extra permissions. But, special investigations like MRI, CT, and PET scans which cost over ₹ 3000 require an official department letter or an endorsement slip.
For pharmacy needs, generic medicines prescribed by CGHS specialists are supplied immediately at a CGHS Wellness Center. If a specific medicine is out of stock it will be supplied by the next working day. Further medicines for chronic diseases can be issued for up to 3 months at a time upon presenting a valid prescription.
Updates
To make the healthcare system more efficient, the Ministry of Health and Family Welfare has introduced many major updates. Starting with, mandatory linking of CGHS ID with the ABHA (Ayushman Bharat Health Account) ID for integrated digital health profile.
The system has completely revised the old 2014 schedule to match the current medical costs. Regular OPD consultations are raised to ₹ 350 for general specialists and ₹ 700 for super specialists. Treatment and hospital packages have also been raised to stop private hospitals from denying care due to low payouts.
Male central government employees are allowed a one-time, permanent option to choose either their biological parents or their parents-in-law for medical benefits. This choice becomes permanent and cannot be changed later.
For the latest official notifications, forms, and to check the live empanelled hospital list in your area, visit the official portal at cghs.mohfw.gov.in.
Frequently Asked Questions
Yes, CGHS rates have been increased. The Union Health Ministry implemented a comprehensive rate revision, updating the prices for nearly 2,000 medical procedures.
CGHS is the better and more comprehensive scheme for an eligible individual, as it offers lifelong for both hospitalization and outpatient (OPD) care, including consultations, diagnostics, and medicines. Whereas Ayushman Bharath is designed for vulnerable and low-income families.
Yes, a beneficiary can go directly to a CGHS-empanelled hospital, but the rules depend on the type of care needed. Medical emergencies and OPD can be directly accessed, hospitalization and advanced tests require referral slip.
There is no overall financial limit or maximum cap on the total amount you can spend or claim for medical treatments under CGHS, but it enforces specific item-wise ceilings and procedure rates.
Yes, OPD is fully covered under the Central Government Health Scheme (CGHS).
Food supplements, tonics, cosmetics, or alternative therapies prescribed by allopathic doctors are not reimbursable under CGHS.
Yes, most medically necessary therapeutic injections are reimbursable or provided directly under CGHS if prescribed by a government or CGHS-empanelled specialist.
Yes, surgery is covered under CGHS. Beneficiaries can undergo required surgical treatments at empanelled government hospitals, private hospitals, or diagnostic centres
Yes, knee replacement surgery is covered under CGHS for eligible beneficiaries.
No, the scheme does not cover everything. While it provides coverage for OPD consultations, hospitalization, and diagnostic tests, it excludes purely cosmetic treatments, fertility treatments, genetic testing, and medical bills from treatments taken outside India.
