Central Government Employee Health Scheme {केन्द्रीय सरकार स्वास्थ्य योजना}

Updated on May 22, 2020

The Central Government Employee Health Scheme is a health care facility scheme for the existing and former employees of the Central Government of India. The health care facility is provided in some areas, which are as follows: Allahabad, Ahmedabad, Bangalore, Bhubaneshwar, Bhopal, Chandigarh, Chennai, Delhi & NCR, Dehradun, Guwahati, Hyderabad, Indore, Jaipur, Jabalpur, Kanpur, Kolkata, Lucknow, Meerut, Mumbai, Nagpur, Patna, Pune, Ranchi, Shillong, Thiruvananthapuram and Jammu.

Components

1. The dispensary services, including domiciliary care.

2. Specialists' consultation facilities both at dispensary, polyclinic and hospital.

3. Tests including X-Ray, ECG and Laboratory Examinations.

4. Hospitalization.

7. Purchase, storage, distribution and supply of medicines and other requirements.

8. Health Education and treatment to beneficiaries.

Beneficiaries

1. The current working employees of Central Government and their dependent family members are covered under this scheme.

2. Existing and Former members of the Indian Parliament.

3. Former governors & Lieutenant governors of India.

4. Freedom Fighters of India.

5. Former Vice Presidents of India.

6. Existing and Former Judges of Supreme Court & High Courts of India.

7. Workers and Pensioners of selected autonomous organizations in the Delhi state.

8.Workers of Railway Board.

Eligibility Criteria

1. All employees of the Central Government who receive wages from the Central Government.

2. All dependent family members of Central Government employees

3. Pensioners dependent on the Central Government.

4. Eligible dependent family members of pensioners and family pensioners of the Central Government.

5. Members of Parliament

6. Ex-vice presidents

7. Ex-Governors & Lt. Governors

8. Retired/sitting judges of high courts and Supreme Court.

9. Freedom fighters

10. Employees of the Railway Board

13. Pensioners and employees of individual statutory/autonomous bodies

14. Post and Telegraph Department Employees.

Types of Medical Consultations Covered

The scheme provides health care through the following systems:

1. Allopathic

2. Homoeopathic

3. Indian system of medicine

4. Ayurveda

5. Unani

6. Siddha and

7. Yoga

Facilities Offered

1. OPD Treatment including medicines cost

2. Specialist Consultation at Polyclinic/Govt. Hospitals.

3. Indoor Treatment at Government and selected private hospitals.

4. Investigations at Government and selected private diagnostic centres.

5. The cashless facility shall be made available for treatment in selected private hospitals and diagnostic centres for Pensioners and their dependent beneficiaries.

6. Reimbursement of expenses for treatment availed in government and private hospitals under emergency.

7. Payment of costs as a result of the purchase of hearing aids, artificial limbs, appliances etc.

8. Family Welfare, Maternity and Child Health Services.

9. Medical consultation and dispensing of medicines in Ayurveda, Homeopathy, Unani and Siddha system of medicines (AYUSH).

Cost of Central Government Employee Health Scheme Facilities

The cost of facilities differs for the serving employees and the pensioners of the Central Government of India as per their grades and positions of responsibility.

For Pensioners

In case a pensioner wants to avail the facilities of central government employee health scheme, they will have to contribute according to the grade pay they were entitled at the time of their service. The contribution can be made as a yearly contribution or one-time contribution:

Annual Contribution: Every year, a certain amount of money (as per grade pay) is to be contributed towards this scheme.

One Time Contribution: A pensioner pays a one-time contribution amount towards this scheme for 10 years. This will be counted as a lifetime contribution.

For Serving Government Employees

A central government employee, who is currently serving areas as mentioned before eligible for this scheme. A deduction is made from the salary by their department every month, which depends upon the grade pay of the serving employee.

Required Time to Get the Scheme Card

A temporary printed index card regarding the details of the applicant is on the day of application for the scheme. Later, the final plastic card is issued and sent to the concerned cardholders within 3 weeks of application of the scheme. The cards are sent to the residence of the government employees.

Treatment in Private Hospitals

The scheme beneficiaries can undergo treatment at the selected private hospital without having to provide a referral letter. An order issued by the Health Ministry has stated that selected private hospitals shall perform the treatment on a cashless basis for ex-MPs, pensioners, Freedom Fighters, Regular employees of Ministry of Health & Family Welfare and other categories of the scheme beneficiaries, who are presently eligible for the credit facility.

Treatments Not Covered Under Central Government Employee Health Scheme

Follow-up and In-patient Treatments are not addressed in case of the following:

In case of a declared emergency, the treatment can be done at any hospital. Still, the reimbursement claim can only be submitted to the Additional General, where the scheme card is registered.

In case of reimbursement of medical bills, the beneficiary can be treated at any hospital, and the claim amount will be limited to the rates as per mentioned under the scheme.

Central Government Health Scheme along with Mediclaim Policy

An individual may have a Mediclaim insurance policy also along with the mentioned scheme. If due to some medical emergencies, the applicant is treated in a private hospital, and the insurance company pays some of the bills, the individual will still be able to get the rest of the cover from the scheme.

The medical bills submitted to the insurance company along with the duplicate laws with a certificate from Insurance Company can be claimed from the scheme by the pensioner. The serving employees will have to contact their concerned departments for getting the balance as allotted to the scheme

Surgeries at Selected Private Hospitals under the scheme

Before proceeding for doing surgery, an individual will have to obtain advice from a government specialist or government clinic.

However, to obtain advice, pensioners will have to apply to government clinics Center for getting permission before doing the surgery. However, reimbursement at fixed rates, as mentioned in the scheme shall be made to the respective department/office.

Conclusion

Thus, the Central Government Employee Health Scheme is an important and unique scheme that is introduced in India to help the Government employees in providing medical care.

Frequently Asked Questions

Q. How do I apply for Central Government Health Scheme (CGHS) online?

You can apply for CGHS online by submitting a duly-filled application form available from the official website of cghs.nic.in. This application form can also be availed from any of the listed wellness centres.

Q. How do I print my CGHS card online?

An individual can have a Mediclaim Insurance Policy along with the scheme. If the individual is treated in a private hospital due to some medical emergency and the insurance company pays some of the bills, the individual will still be able to get the rest of the cover from the scheme. The medical bills and the duplicate bills with a certificate from Insurance Company submitted to the Insurance company can be claimed from the scheme by the pensioner.

Q. What is the printed card as given by the scheme?

All government employees are provided with a special plastic card which contains the photo ID and beneficiary ID number. This card is mandatory to furnish at the treatment centre if the beneficiary seeks to avail any of the facilities under the scheme.

Q. Is cash facility available in private hospitals?

The pensioner beneficiaries are entitled to cashless medical treatment only in the mentioned and selected private hospitals. The selected private hospitals under the scheme provide therapy to the pensioners on credit /cashless basis.

Q. Is AIIMS treatment covered under this scheme?

Yes, cashless/reimbursement facilities are provided to scheme beneficiaries at All India Institute of Medical Sciences.


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WRITTEN BYVarsha Verma

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