Central Government Health Scheme

 Central Government Health Scheme

The Central Government Health Scheme (CGHS) is a healthcare initiative in India that provides comprehensive medical services to Central Government employees, pensioners, and their dependents. Established in 1954, the scheme aims to ensure access to affordable and quality healthcare for government personnel across the country.

1. Beneficiaries:

• Active and retired Central Government employees.
• Family members of employees, including spouse, children, and dependent parents.
• Employees of autonomous bodies funded by the Central Government.
• Parliamentarians, freedom fighters, journalists, and other special groups.

2. Services Provided:

CGHS offers a range of medical services, including:

• Outpatient care (OPD) at designated CGHS wellness centers.
• Hospitalization at government hospitals and private hospitals empaneled with CGHS.
• Specialist consultations and diagnostics.
• Prescription medicines at CGHS pharmacies.
• Services such as dental care, physiotherapy, and vision care.

3. Cashless Treatment:

• The scheme provides cashless treatment in empaneled hospitals for beneficiaries, especially for critical and specialized treatments like surgeries, cancer care, and dialysis.

4. Empaneled Hospitals:

• CGHS has a network of both government and private hospitals, laboratories, and diagnostic centers where beneficiaries can seek treatment. These hospitals follow agreed rates for procedures and treatments under the scheme.

5. Wellness Centers:

• CGHS operates wellness centers across major cities where beneficiaries can avail outpatient care, get medications, and consult with doctors.
• These centers form the backbone of CGHS, providing preventive and curative healthcare services.

6. Digital Initiatives:

• CGHS card: Each beneficiary receives a unique CGHS card for easy access to services at hospitals and wellness centers.
• Online services: CGHS offers e-Sanjeevani, an online consultation platform, and other digital services like appointment booking and medicine requests to enhance ease of access.

7. Subscription-Based System:

• Beneficiaries pay a nominal subscription fee depending on their pay level or pension amount. This fee structure ensures affordable healthcare for a wide range of government employees and retirees.

8. Preventive Healthcare:

• In addition to treatment, CGHS focuses on preventive healthcare by providing regular health checkups and wellness programs.

The Central Government Health Scheme (CGHS) is a vital healthcare safety net for Central Government employees, providing affordable, reliable, and quality healthcare services. It continues to evolve through digital innovations and increased coverage, ensuring that government personnel and their families receive the medical attention they need.

FAQs on Central Government Health Scheme (CGHS)

1. What is the Central Government Health Scheme (CGHS)?

CGHS is a comprehensive health care scheme providing medical facilities to employees and pensioners of the Central Government of India. It covers healthcare needs through its various wellness centers and empaneled hospitals across India.

2. Who is eligible for CGHS?

The following individuals are eligible for CGHS benefits:

• Central Government employees and their dependents.
• Pensioners of Central Government.
• Freedom Fighters.
• Ex-Governors and Ex-Vice Presidents.
• Members of Parliament.
• Sitting and Ex-Judges of the Supreme Court and High Courts.
• Employees and pensioners of certain autonomous bodies under the Government of India.

3. What medical facilities are provided under CGHS?

CGHS provides the following services:

• Outpatient Department (OPD) treatment.
• Specialist consultation at government and empaneled hospitals.
• In-patient treatment at government and empaneled hospitals.
• Emergency healthcare.
• Laboratory and diagnostic tests.
• Medicines and medical reimbursement for treatments not available under CGHS.

4. How can I enroll in CGHS?

Eligible individuals can enroll through the CGHS website by filling out an online application and submitting the required documents. You can also apply offline by visiting a CGHS wellness center.

5. What are the CGHS wellness centers?

CGHS wellness centers are health care facilities established across various locations in India to provide outpatient services, medicines, and preventive care to CGHS beneficiaries.

6. How can I access medical facilities under CGHS?

Beneficiaries can access services by visiting their nearest CGHS wellness center or empaneled private hospitals for inpatient treatment, based on the terms and conditions laid out by CGHS.

7. What should I do in case of an emergency?

In emergencies, beneficiaries can seek treatment at any hospital and later submit a reimbursement claim to CGHS for the expenses incurred, provided the treatment is in line with CGHS guidelines.

8. Are there any restrictions on treatments covered under CGHS?

Yes, certain treatments, such as cosmetic procedures and alternative therapies, may not be covered. It’s essential to refer to the CGHS guidelines for a comprehensive list of exclusions.

9. Can CGHS beneficiaries receive treatment in private hospitals?

Yes, CGHS has empaneled various private hospitals. Beneficiaries can avail of treatment in these hospitals, subject to prior approval and adherence to CGHS norms.

10. How are claims for reimbursement processed?

Beneficiaries must submit a claim form along with original bills, receipts, and medical documents to the respective CGHS office within the stipulated time frame for processing reimbursements.

11. How can I obtain medicines under CGHS?

Medicines can be obtained from CGHS wellness centers by presenting a valid prescription from a registered medical practitioner. Certain chronic conditions may require special approvals.

12. Is there any annual subscription fee for CGHS?

Yes, beneficiaries are required to pay an annual subscription fee, which varies based on their pay scale or pension status.

13. Can I get dental treatment under CGHS?

Yes, CGHS covers certain dental procedures; however, beneficiaries should check specific dental treatment guidelines for eligibility.

14. How can I lodge a grievance regarding CGHS services?

Beneficiaries can lodge grievances through the CGHS website, by visiting the nearest wellness center, or by contacting the designated helpline for assistance.

For quiz click on QUIZ 👉

QUIZ-1

QUIZ-2

1. Which of the following KVS employees are eligible for OPD facilities and medicines on a cost-to-cost basis in all CGHS covered cities?

A) Only serving employees

B) Only retired employees

C) Both serving and retired employees

D) Only those posted in Delhi/NCR                                                  Answer: C

2. What is the distance-based coverage limit for CGHS Wellness Centres in cities where demarcations are not specified?

A) 3 km radius

B) 5 km radius

C) 10 km radius

D) Limited to the municipal ward only                                              Answer: B

3. Serving Central Government employees residing outside CGHS covered areas are primarily covered under:

A) KVS Medical Rules

B) CS (MA) Rules

C) State Government Health Schemes

D) ESI Scheme                                                                                   Answer: B

4. A serving employee residing within municipal limits but outside the 5 km radius of a Wellness Centre has what option?

A) Mandatory coverage under CS (MA)

B) Mandatory coverage under CGHS

C) A one-time choice to opt for CGHS

D) No medical benefits until they move closer                                  Answer: C

5. Which group is explicitly excluded from CGHS applicability?

A) Delhi Police

B) Employees paid from Civil Estimates

C) Employees in Railway services

D) Post and Telecom pensioners                                                                     Answer: C

6. Government servants on foreign assignments can avail CGHS facilities during visits to India if:

A) They pay a double subscription

B) They reside in CGHS covered cities and keep their cards active via subscription

C) Only in cases of extreme medical emergency

D) They are not eligible until they return permanently                                   Answer: B

7. PSU absorbees are eligible for CGHS facilities on retirement if:

A) They were in service for at least 20 years

B) They are in receipt of Central Civil Pension

C) They opted for CGHS at the time of absorption

D) They live in Delhi only                                                                              Answer: B

8. The family of a Central Armed Police Forces (CAPF) personnel can avail CGHS if they stay in a covered city while the personnel is posted elsewhere, provided:

A) The personnel is on a field posting

B) They continue to pay the subscription

C) They obtain a special permit from the Director

D) The personnel is in a non-CGHS city                                                        Answer: B

9. Pensioners of which UT Administration (except Delhi/Chandigarh) are eligible for CGHS at par with Central Government pensioners?

A) Ladakh

B) All UTs

C) Only Puducherry

D) Only Lakshadweep                                                                        Answer: B

10. From which month is the Fixed Medical Allowance (FMA) for Puducherry pensioners in CGHS areas discontinued?

A) January 2024

B) February 2025

C) April 2025

D) May 2024                                                                                       Answer: B

11. When do CGHS benefits officially accrue for a Government servant?

A) On the date of joining service

B) On the date the CGHS card is received

C) On the date the servant applies for a CGHS card

D) After one month of salary deduction                                            Answer: C

12. For serving employees, applying for a new CGHS card is:

A) Optional

B) Mandatory to be done online

C) Done automatically by the DDO

D) Only required after probation                                                        Answer: B

13. Retiring employees can apply for a pensioner card how many months before retirement?

A) 1 month

B) 3 months

C) 6 months

D) 12 months                                                                          Answer: C

14. What is the contribution amount for a 'Whole Life' pensioner card for an officer in Pay Level 12?

A) ₹78,000

B) ₹1,00,000

C) ₹1,20,000

D) ₹10,000                                                                                          Answer: C

15. The contribution for a 'Whole Life' pensioner card is equivalent to how many years of existing contribution?

A) 5 years

B) 10 years

C) 15 years

D) 20 years                                                                                          Answer: B

16. What is the validity period of a plastic CGHS card for serving beneficiaries?

A) 2 years

B) 5 years

C) 10 years

D) Until retirement                                                                             Answer: B

17. When should beneficiaries apply for the renewal of their plastic cards?

A) After the card expires

B) 1 month before expiry

 C) 3 months before expiry

D) 6 months before expiry                                                                  Answer: C

18. Which portal is used for the payment of CGHS contribution for pensioner cards?

A) PFMS

B) Bharat Kosh

C) Income Tax Portal

D) KVS Internal Portal                                                                       Answer: B

19. If a beneficiary becomes ineligible, who is responsible for informing the authorities?

 A) The DDO

B) The Main Cardholder

C) The Wellness Centre CMO

D) The Ministry of Health                                                                  Answer: B

20. Who is responsible for deleting the names of employees transferred to non-CGHS areas from the database?

A) The employee

B) The Additional Director

C) The Department/Employer

D) The CGHS Headquarter                                                                Answer: C

 

21. If both husband and wife contribute to CGHS, whose parents can avail the benefits?

A) Only the husband's parents

B) Only the wife's parents

C) Eligible parents of both

D) Only one set of parents as chosen at the start of service                           Answer: C

22. What is the minimum disability percentage required for a permanently disabled unmarried son to be eligible for CGHS?

A) 30%

B) 40%

C) 50%

D) 60%                                                                                                Answer: B

23. How often must a disability certificate be furnished for a disabled dependent?

A) Every year

B) Every 2 years

C) Every 5 years

D) Once in a lifetime                                                                          Answer: C

24. Sons above 25 years are eligible for CGHS as dependents if:

A) They are preparing for competitive exams

B) They are unemployed

C) Disability occurred after attaining the age of 25

D) They are students                                                               Answer: C

25. What is the age limit for minor children of widowed/separated daughters to be considered dependent?

A) 12 years

B) 15 years

C) 18 years

D) 25 years                                                                              Answer: C

26. The monthly income limit for dependency (other than spouse) is:

A) ₹3,500 + Dearness Relief

B) ₹6,000 + Dearness Relief

C) ₹9,000 + Dearness Relief

D) ₹12,000 + Dearness Relief                                                Answer: C

27. "Dearness Relief" for the income limit check refers to:

A) The amount due

B) The amount drawn

C) 50% of the pension

D) Basic pension only                                                             Answer: B

28. If an employee is transferred to a non-CGHS station, for how long can their family avail benefits at the old station?

A) 3 months

B) 6 months

C) 1 year

D) Until the end of the academic year                                               Answer: B

29. Which of the following family members is NOT eligible based on the document?

A) Financially dependent parents-in-law

B) Permanently disabled unmarried brothers

C) Married daughters

D) Minor brothers of a child getting family pension                          Answer: C

30. Dependency eligibility for a disabled son is irrespective of:

A) Residence

B) Financial status

C) Age

D) Marital status                                                                                 Answer: C

31. What is the monthly CGHS contribution for an employee in Pay Level 6?

A) ₹250

B) ₹450

C) ₹650

D) ₹1,000                                                                                            Answer: B

32. What is the monthly CGHS contribution for an employee in Pay Level 7 to 11?

A) ₹250

B) ₹450

C) ₹650

D) ₹1,000                                                                                            Answer: C

33. In the case of a husband and wife both being Central Government servants, the contribution is recovered from:

A) Both

B) Only the wife

 C) Only the one with higher pay

D) Only the one with lower pay                                             Answer: C

34. CGHS contribution is NOT recoverable during:

A) Suspension

B) Period of duty

C) Extra Ordinary Leave (EOL)

D) Leave not exceeding four months                                                 Answer: C

35. If leave exceeds four months, an employee has the option to:

A) Pay double contribution

B) Not pay contribution (foregoing facilities)

C) Request a government waiver

D) Pay only for self                                                                            Answer: B

36. What is the ward entitlement for an officer with a Basic Pay of ₹65,000 in a private empanelled hospital?

A) General Ward

B) Semi-private Ward

C) Private Ward

D) Deluxe Ward                                                                                 Answer: C

37. For a Basic Pay up to ₹36,500, what is the ward entitlement at AIIMS, New Delhi?

A) General

B) Semi-private

C) Private

D) Nursing Home                                                                               Answer: A

38. Nursing Home facilities in Government hospitals are available for those drawing a Pay/Pension of:

A) ₹36,500 and above

B) ₹47,600 and above

C) ₹63,100 and above

D) ₹80,900 and above                                                                        Answer: B

39. What is the income limit for "Others" (non-TB/Mental patients) to receive free diet?

A) Up to ₹36,500

B) Up to ₹44,900

C) Up to ₹50,500

D) Up to ₹69,700                                                                                Answer: B

40. What is the revised OPD Consultation Fee for empanelled hospitals?

A) ₹150

B) ₹250

C) ₹350

D) ₹500                                                                                               Answer: C

41. What is the percentage of Medical Advance allowed for all indoor treatments?

A) 75%

B) 80%

C) 90%

D) 100%                                                                                               Answer: C

42. For outdoor treatment, an advance is granted only if the total estimate exceeds:

A) ₹5,000

B) ₹10,000

C) ₹15,000

D) ₹20,000                                                                                          Answer: B

43. Medical Advance should be released within how many days of receipt of the request?

A) 5 days

B) 10 days

C) 15 days

D) 30 days                                                                                          Answer: B

44. If no CGHS or AIIMS rates exist for a procedure, what rate is considered for an advance?

A) Market rate

B) 50% of the hospital estimate

C) Actual estimate of the procedure

D) Rate of the nearest Government hospital                                      Answer: C

45. Who can nominate a person to claim medical reimbursement in the event of their death?

A) Any family member

B) Only the spouse

C) Principal CGHS cardholder

D) The DDO                                                                                       Answer: C

46. What is the daily ICU charge (inclusive of room rent) for all ward categories?

A) ₹3,000

B) ₹4,500

C) ₹5,400

D) ₹6,000                                                                                            Answer: C

47. For non-NABH accredited hospitals, ICU charges are less by:

A) 5%

B) 10%

C) 15%

D) 20%                                                                                                Answer: C

48. What is the daily Room Rent for a Private Ward in an empanelled hospital?

A) ₹1,500

B) ₹3,000

C) ₹4,500

D) ₹5,400                                                                                            Answer: C

49. Treatment at a specialized non-recognized hospital is admissible if certified by:

A) The Principal of KVS

B) The treating physician

C) Director, CGHS

D) The Ministry of Health                                                                  Answer: C

50. Medicines for chronic illnesses can be issued for up to:

A) 1 month

B) 2 months

C) 3 months

D) 6 months                                                                                        Answer: C