FREQUENTY ASKED QUESTIONS WITH ANSWERS ABOUT CGHS
Who are entitled for CGHS facilitiesAll Central Govt. employees and their dependant family members residing
in CGHS covered areas.
Central Govt Pensioners and their eligible family members getting pension
from Central Civil Estimates
Sitting and Ex-Members of Parliament
Ex-Governors & Lt. Governors
Freedom Fighters
Ex-Vice Presidents
Sitting and Ex-Judges of Supreme Court & High Courts
Employees and pensioners of certain autonomous organizations in Delhi
Journalists (in Delhi )Accredited with PIB
( for OPD & at RML Hospital)
Delhi Police Personnel in Delhi only
Railway Board employees
In how many cities CGHS is presently operative?
CGHS facilities are available in 25 cities in India
1. Ahmedabad 2 Allahabad 3 Bengaluru 4 Bhopal 5 Bhubaneshwar 6.
Kolkata 7. Chandigarh 8 Chennai 9.Dehradun 10.Delhi& NCR
11.Guwahati 12. Hyderabad 13. Jabalpur, 14. Jaipur 15 Jammu 16.
Kanpur 17. Lucknow 18. Meerut 19. Mumbai 20. Nagpur 21 Patna
22.Pune 23. Ranchi 24. Shillong 25. Thirruvananthapuram
For CGHS cards , as dependant , what is the meaningof the word “
family “
The term ‘family’ means and includes:-
“Husband or wife as the case may be and other dependant family
members.
Dependant Family Members:
parents, sisters, widowed sisters, widowed daughters, minor brothers and
minor sister, children and step-children wholly dependent upon the
Government Servant and are normally residing with the Government
Servant”.
Also now include , dependent divorced / separated daughters ( including
their dependant minor children) and step-mother.
The term dependency means that income from all sources including
pensions and pension equivalent of DCRG benefit is less than Rs.3500/-
plus amount of DA on Basic pension of Rs3500/- per month.
However, there is no such clause as dependency in respect of spouse.
What is the procedure to register with the CGHS?
Pensioners:
One can get a CGHS card made from the office of AD/ JD of the City.
Forms can be downloaded from CGHS Website or can be taken from
office of AD / JD of city between 1000 am to 1230 pm.
Documents required
Application in prescribed format
Proof of Residence
Proof of Stay of dependents
Proof of age of son
Disability certificate, if any in case of sons aged25 & above, who
would otherwise cease to be a beneficiary.
Photos of eligible family members
Surrender Certificate of CGHS Card while in service( only in those
cases where CGHS Card was issued while in service)
Attested copies of PPO & Last Pay Certificate
Draft for required amount towards CGHS contribution– in the name
of ‘P.A.O., CGHS New Delhi’ in Delhi-and in the name of ‘AD,
CGHS of the city’.
In case PPO is not ready for any reason there is option to get a
provisional card on the basis of Last Pay Certificate.
The data is entered through computers and entered in data base
and a print out is issued same day for immediate use. Plastic cards
are subsequently sent to the residence of the card holder by post.
Serving employees:-Serving employees submit the forms in prescribed format enclosing
photos of eligible family members and submit to theMinistry /
Department/Office , where he / she is employed. Theapplication
form shall be forwarded by the Ministry / Office /Department to the
office of Addl. Director CGHS of city for preparation of card.
Print out is issued for immediate use and
How long does it take to get the CGHS Cards?
Normally computerized printout of index card is issued on the
same day. Plastic cards are sent to the residence in ‘3’ weeks time.
Whom Should I approach in case the CGHS Card is notissued to me
in the prescribed time?
Contact Joint Director (HQ), CGHS, Bikaner House, New Delhi in
case of Delhi and Addl. Director of City in case ofother cities.
What should I do if I lose my CGHS Cards ?
Application is to be submitted to AD/JD along with two photographs
and a IPO for Rs. 50/- for issue of duplicate card.
Indian Postal Order payable to “ P.A.O. CGHS Delhi”if in Delhi or “
Additional Director of the CGHS City “ in respect of other cities
What should I do if the details on the Card viz. name, date of birth,
entitlement, etc. are wrong?
Kindly bring the anomalies to the notice of Joint Director, CGHS
(HQ), and Bikaner House in Delhi and to the Addl. Director, Joint
Director of concerned CGHS City in other cities.
Is there a colour scheme for plastic cards? What are the details?
CGHS Plastic cards have the following colour at thetop:
Serving Government employees - Blue
Pensioners, ex-MPs , Freedom Fighters, etc., - Green
Member of Parliament - Red
Beneficiaries of Autonomous Bodies / Journalist - Yellow
Whom should I contact if the doctors are not present in the Wellness
Centre / Dispensary?
Contact CMO i/c of the concerned Wellness Centre orAddl.
Director, CGHS of concerned city or Director, CGHS.
Can the CMO or the pharmacist give a different brand than the one
prescribed by the specialist?
Medicines are issued at CGHS Wellness Centres by the same
brand, if available or by generic name or by any available brand
name of equal therapeutic value.
What is the procedure for getting life saving drugs?
In Delhi- through CGHS Medical Store Depot, Gole Market
The documents required are:-
a. Prescription of spl. of Govt.Hospital or CGHS approved private
Hospital.
b. Photocopy of his/ her token card/ plastic card.
c. Copy of permission if his prescription is from CGHS approved
private Hospital.
d. Utilization certificate in original during subsequent visit.
e. Indent is also placed online through CGHS Wellness centre.
In other cities request is to be submitted to the Addl. Director of
City.
What do I do if I am unwell at odd hours, say late in night?
CGHS beneficiaries have the option to go to any of the 24 hr
functional dispensaries in Delhi, a nearby govt. hospital /
empanelled private hospital or even any private hospital , in case of
emergency.
What should I do in case of emergency?
CGHS beneficiaries have the option to go to any of the 24 hr
functional dispensaries in Delhi, a nearby govt. hospital /
empanelled private hospital or even any private hospital
What is the time within which my medical claim is to be reimbursed?
If all documentation is complete medical claims of pensioners are
cleared in 45 days.
What can I do if my claim is unnecessarily delayed?
Pensioner beneficiaries can contact the Additional Directors of
concerned city / zone on any Wednesday between 11 A.M. and 1
P.M.
What should I do if the empanelled hospital refusesto entertain or
give a step-motherly treatment?
Contact CMO i/c of the concerned Wellness Centre orAddl.
Director, CGHS of concerned city or the nodal officer for
grievances.
What should I do if the Wellness Centre/Dispensary does not give all
the medicines?
Contact CMO i/c of the concerned Wellness Centre orAddl.
Director, CGHS of concerned city or Director, CGHS.
How long does it take to get the medicines ?
Medicines available in the dispensary are issued immediately. If
any medicine is not available and is to be indentedthrough
Authorized Local Chemist the same are issued on thenext day.
What are the facilities available to me if I am a pensioner in a non-CGHS area ?
a) Pensioner residing in non- CGHS covered areas have the
option to become CGHS beneficiary and avail CGHS
facilities from the nearest CGHS covered city.
b) Pensioners residing in non-CGHS areas have also the
option to avail Fixed Medical Allowance of Rs300/- per
month and opt not to avail CGHS facility.
c) Pensioners residing in non-CGHS areas have also the
option to avail Fixed Medical Allowance of Rs300/- per
month for OPD treatment and obtain CGHS card from
nearest CGHS covered city for inpatient facilities under
CGHS. No OPD medicines shall be issued in such cases.
d) CGHS pensioner beneficiaries( and their dependant and
eligible family members) who are holding a valid CGHS
Card and residing in a non-CGHS area shall be eligible to
obtain inpatient medical treatment and also followup
treatment from Govt. Hospitals / CS(MA) /ECHS approved
hospitals on proper referral from CGHS dispensary and
submit the medical reimbursement claim to the Addl.
Director/ Joint Director of CGHS of city where the CGHS
card is registered.
In case of medical emergency , treatment may be obtained
from any hospital and medical claim shall be submitted to
AD/JD , CGHS of the concerned city.
Reimbursement shall be limited to the CGHS rates ofthe city
where the card is registered and as per the ceilingrates and
ward entitlements or as per actuals, whichever may be less.
What is the system for the services of specialists in Dispensaries ?
Prior registration is required appointment with theCGHS Wellness
Centre, where specialist services are available.
However, In case of emergency contact CMO i/c of dispensary of
Wellness Centre for consulting specialist without prior appointment.
Are the prescription of specialists of empanelled hospitals binding
on the dispensary ?
Medicines are issued on the basis of prescriptions of government
doctors. However, in permitted cases medicines are issued on the
basis of prescriptions of empanelled hospitals and medicines will be
issued as per the available brand / generic names.
What is the maximum period for which medicines can be given in
one go ?
For treatment of Chronic illnesses medicines upto ‘3’ months are
issued in one go , provided there is a valid prescription.
In case of a beneficiary visiting a foreign country, medicines upto
‘6’ months are issued in respect of cronic illnesses , based on valid
prescription and documentary support of visit to a foreign country.
Beneficiary is required to submit an application for obtaining
permission from AD/JD along with the following documents:-
1. Copy of valid CGHS card/ token card.
2. Valid prescription for six months counter signedby HOD of
Specialty of Govt. Hospital.
3. Proof of station leaving like ticket, Visa etc.
What are the papers to be submitted for any investigation by an
empanelled diagnostic centre?
Original or self attested copy of prescription of CGHS Doctor /
Government specialist
Copy of CGHS Card of the npatient and main card holder (head of
family).
Which are the categories eligible for cashless treatment ?
Hospitals shall provide credit facility to the following categories of CGHS
beneficiaries (including dependant family members, whose names are
entered on CGHS Card):
•Members of Parliament;
•Pensioners of Central Government drawing pension from central
estimates;
•former Vice-presidents, Former Governors and former Prime
Ministers;
•Ex-Members of Parliament;
•Freedom Fighters;
•serving CGHS employees;
•serving employees of Ministry of Health & Family Welfare
(including attached / subordinate offices under theMinistry of
Health & Family Welfare); and
Is there any interactive mechanism at dispensary level?
At the Wellness Centre ‘Local Advisory Committees’ are formed.
CMO i/c holds a meeting with Local Advisory committee members
to discuss local dispensary related issues.
.
Are CGHS facilities free of cost?
For serving employees residing in CGHS covered areaobtaining CGHS
card is compulsory
Deduction from salary is made by the department, every month,
depending upon their pay
w.e.f 1
st
June 2009
Grad Pay Contribution
Upto Rs.1650 /- Rs. 50/-
Rs.1800/-, Rs1900/-
Rs.2000/- , Rs.2400/-
Rs.2800/- Rs.125/-
Rs.4200/- Rs.225/-
Rs.4600/-,Rs.4800/-
Rs.5400/- Rs.6600/- Rs.325/-
Rs. 7600/- and above Rs. 500/-
Pensioners who want to avail CGHS facilities can make contribution either
on yearly basis or one time ( ten yrs ) contribution for whole life validity.
Payment can be made by Demand Draft in favour of “P.A.O. CGHS
Delhi” if in Delhi or “ Additional Director of theCGHS City “
Contribution in respect of Pensioners are calculated on the basis of grade
pay they are entitled had they been in service , but for superannuation.
What are the criteria for Entitlement of Treatment endorsed on CGHS
Card like General ward / Semi-Pvt ward or Pvt. Wardin CGHS
Empanelled Hospitals?
Endorsement of entitlement for general/semi- private/private ward facility
is done according to their basic pay / basic pension as under :
oUpto Rs. 13,950/- per month - Entitlement: General Ward
oRs. 13,960/- to 9,530/- per month -Entitlement: Semi-private Ward
oRs. 19,540/- and above - per month - Entitlement: Private Ward
I am a serving employee residing in a place close to a city covered
under CGHS. Can I get CGHS card issued from the nearest CGHS
city?
There is no provision to avail CGHS facilities in respect of serving
government employees residing in non-CGHS covered areas. They are
covered under CS(MA) Rules 1944.
I retired in 1998 from Central Govt. but, I never made a CGHS card.
Can I get a card now?
Pensioners can apply for CGHS card with relvant documents. However,
the subscriptions as applicable at current rates shall have to be paid.
My husband/wife is also employed under Central Government and is
eligible for a separate CGHS Card. Is it necessary that separate cards
are to be obtained?
No. Spouse drawing higher pay shall make the card and other spouse is
eligible to avail CGHS benefits as member.
I have retired from Delhi. Now I want to settle atcity where no CGHS
facility is available . How to cover my family for medical care?
Pensioners are eligible for CGHS facilities and can obtain CGHS card
from the nearest CGHS covered city.
Shall I get Life Time Valid card
Yes, the ownership of card can be transferred in the name of spouse on
submission of required documents. Addl. Director ofconcerned city shall
transfer the ownership of Card in the computer Database and same
CGHS plastic cards with same Beneficiary ID can be used.
No extra payment to be made, in case of life time cards.
My husband / wife retired in 2002. He /she was paying CGHS
subscription every year. After his death can I get Card on my name.
Do have I to pay extra.
However in other cases one has to pay 10 years subscription for life time
card
For example, if the spouse had contributed for seven years before he
expired , balance payment for the remaining three years is to be paid for a
life time card.
Documents required :
i) Application in prescribed format
ii) Proof of Family Pension with its break up from Bank
iii) Prescribed contribution if, card is not for life time
How to transfer CGHS card from one WC to other in the same city?
If there is any change in residential address , CMOi/c may be approached
with proof of residence for transferring the data from one Wellness Centre
to another in the same city.
CMO i/c of the new Wellness Centre will accept the data of transferred
card.
In respect of serving employees the request is to be forwarded by his/her
office / department.
I am CGHS beneficiary at Kanpur. Visiting Mumbai for 6 months. Can
I get CGHS facilities at Mumbai .Can same card of Kanpur continue
or a separate card to be made. From where to get permission for the
same?
Subsequent to computerization no separate permission is required and
CGHS card is valid for availing facilities from anyCGHS Wellness Centre
in India. For any assistance , Addl. Director of the city may be contacted.
Who is competent to delete name of sons who have crossed age of
25 years?
CMO i/c of Wellness Centre is competent to delete the name of son aged
25 yrs and above. Computer system does not allow sons aged 25 and
above to avail medical facilities.
After retirement in 2007 I got a Life time Pensioner CGHS card made
in Delhi. Now I am shifting to Dehradoon. Can I usethe same card.
Do I pay again?
Pensioners shifting from one CGHS covered city to another, will have to
apply to the Addl. Director of concerned city for transfer of card. The card
shall be transferred online and a receipt will be issued to the beneficiary ,
on the basis of which , Addl. Director of new city ( say Dehradun) shall
receive the data. Same Plastic cards and same Ben ID will be valid. No
contribution is required to be paid in respect of pensioner benfciries
holding life time cards.
I live in Gurgaon but my office is in Saket. Can I avail facilities from
both the places because it is convenient for me.
Yes. Subsequent to computerization CGHS facilities can be availed from
any Wellness Centre in India.
Is there any age limit for sons / daughters as dependant in CGHS
Card ?
Son is eligible till he starts earning or attains the age of 25 years or gets
married whichever is earlier.
However, in case the son is suffering from any permanent disability of any
kind (physical or mental) he is eligible for CGHS benefits even after 25yrs
.
Disability means blindness, low vision, leprosy-cured, hearing impairment,
locomotor disability, mental retardation, mental illness. A disability
certificate from Medical Board is required.
Daughter is eligible till she starts earning, or gets married, whichever is
earlier (irrespective of age)
Are step-children allowed CGHS facilities?
Yes. If they are dependent on card holder: other conditions as in case of
dependant sons and daughters.
Can dependent in-laws be included under family members for CGHS
facilities?
A lady Government servant will be given a choice toinclude either her
parents or parents –in-law for the purpose of availing the benefits under
CGHS subject to the condition of dependence and residence , etc., being
satisfied.
Me and my wife are both central Govt. employees andhave
dependant brothers / sisters and parents. Can we make separate
cards and include family members?
Yes. Your wife can have her parents as dependant inher card.
Can drugs like antibiotics, if not available in WC,be made available
urgently from local Chemist?
Yes, beneficiary can collect drugs from the chemistcounter on the chemist
on the basis of authority form issued by WC
How to get a drug if same is not available in WC & also not supplied
by Chemist(ALC)?
Beneficiary, after authorization by CMO i/c can purchase such drugs
from open market & claim reimbursement from ALC.
What should beneficiary do, if he/ she notice some deterioration in
the quality of drugs?
He /she should return the medicine to WC & get replacement. Samples
can be sent for testing through CMOI/C.
My father is a cancer patient and after operation is bed ridden.
Doctors have advised Protein powder. Can I get fromCGHS?
Dietary supplements are not permissible under CGHS.
I am a CGHS Pensioner.My wife was admitted in pvt hospital in
emergency state. How to get reimbursement of money spent on her
treatment?
Apply to CMO I/c of WC with :
MRC forms duly filled in as per Check list
Copy of Discharge summary
Hospital bills with break-up
Receipts in original
Copy of the valid CGHS Card
Copies of other documents issued by hospital
MRC forms are available with CMO I/c and can also be downloaded from
CGHS Website http://msotransparent.nic.in/cghsnew/index.asp
Serving employee in similar cases shall submit the medical claim to his
department.
My original papers having bills, Receipts of hospital treatment are
lost. Can I claim on duplicate papers?
Yes.With affidavits on Stamp paper.Details of Draftfor Affidavit may be
seen in the instructions sheet appended to MedicalClaim Form available
at http://msotransparent.nic.in/cghsnew/index.aspand CMO i/c.
My husband/wife was a CGHS card holder. He/She was sick and
died while in hospital. How do I get MRC?
Apply to CMO I/c of WC with :
MRC forms duly filled in as per Check list
Copy of Death summary
Hospital bills with break-up
Vouchers in original
Copy of the valid CGHS Card
Death Certificate
Affidavit on Stamp paper of yourself being Legal Heir and NOC
from other legal heirs in favour of claimant
Copies of other documents issued by hospital
Draft for affidavit may be seen in the instructionssheet appended to the
Medical Claim Form available at CGHS Web site at
http://msotransparent.nic.in/cghsnew/index.asp
I retired in Dec 2011. Due to certain reasons I hadto go to my native
place in Uttranchal and could not make pensioner’s CGHS card. In
May 2012 I came to Delhi and had Heart attack. In emergency I was
treated in pvt hospital .I got CGHS Card made afterdischarge but I
have been refused reimbursement of the expenditureincurred.
After retirement three months grace period is givento get CGHS card
made.
(i) The treatment taken and expenditure incurred thereon within the
grace period of three months from the date of retirement will be
allowed and expenditure reimbursable subject to the condition that
the beneficiary has either obtained or applied for CGHS pensioner
card with all documents and requisite CGHS subscription within
one month of expiry of the grace period of three months.
(ii) The expenditure on treatment taken after the grace period of three
months from date of retirement will not be reimbursable unless the
beneficiary has obtained a valid CGHS card or has applied for
CGHS pensioner card with all documents and requisite CGHS
subscription prior to taking such treatment.
I went to Hyderabad to visit my son and had fracture of leg bone. I
received treatment from a pvt hospital. Shall I get full
reimbursement?
Reimbursement for treatment taken in a private hospital under medical
emergency shall be considered as per CGHS rates only.
Is treatment for IVF reimbursable?
IVF treatment is approved under CGHS. The details may be seen as per
Office Memorandum Z.15025/5/2011/CGHS III/CGHS(P) dated
22.11.2011 , which can be downloaded from CGHS Website at
http://msotransparent.nic.in/cghsnew/index.asp
Are ambulance charges reimbursable?
Yes. Ambulance charges are reimbursable within the city , if there is a
certificate from treating doctor that conveyance byany other mode would
definitely endanger patient’s life or would grossly aggravate his/her
condition.
I have a Mediclaim Insurance Policy. Due to emergency received
treatment in a pvt hospital. Some amount was paid by Insurance Co.
can I get balance from CGHS
Yes.First Bills are submitted to Insurance Company.Duplicate bills with
certificate from Insurance Company may be claimed from CGHS by
Pensioner CGHS beneficiaries.CGHS shall consider reimbursement at
CGHS rates or actual whichever may be less. However, the total
reimbursement from both sources should not exceed actual expenditure.
Serving employees shall submit claim to department for reimbursement.
I submitted MRC for Rs. 1 Lac 20 thousand but I wasreimbursed only
Rs. 45,800/-. Why total amount was not reimbursed?
Expenditure for treatment in private hospitals is considered only if the
treatment was taken under emergency at CGHS approved rates.
In emergency who are all entitled to get treatmentat Pvt Empanelled
Hospital
Any beneficiary holding a Valid CGHS card.
I want to get my Cataract Surgery done at Pvt empanelled hospital ?
How can I get it done
Beneficiaries are required to obtain advice from a Govt. Specialist / CMO
i/c for Cataract surgery. Pensioners can apply to CMO I/c of WC for
permission to obtain the treatment at one of the empanelled hospitals of
his /her choice.
Serving employees to apply to his / her Department / office.
Is it necessary that the Govt specialist should write ‘referred to
CGHS empanelled Hospital’ for obtaining permission?
Advice of Government specialist is required only for the specific treatment
procedure / investigation to be undertaken. There is no need to specifically
refer to any empanelled hospital/ diagnostic lab. It is the choice of
beneficiary to under treatment / investigations at any of the empanelled
hospitals / diagnostic laboratories after obtainingpermission from
competent authority.
CMO Incharge does not refer me to Pvt. Hospitals onmy request?
As per CGHS guidelines there is no provision for OPD referrals to private
empanelled hospitals except in satellite towns of NCR
I am an accredited journalist with CGHS Card Can I seek treatment in
Pvt. empanelled Hospitals in emergency and get credit facility?
No. Journalists are entitled only for OPD treatmentfrom dispensaries and
treatment from Dr.RML Hospital. Journalists are notentitled for
reimbursement for treatment from empanelled hospitals.
I am a serving employee of an autonomous body ,holding CGHS
card. who will give me permission for treatment on the
recommendation of Govt. specialist?
Permission for treatment at empanelled hospitals / diagnostic labs shall be
granted by the office of the organization where theemployee is serving.
Is Penfill Injection provided under CGHS
Insulin pen is not supplied under CGHS. But, Insulin Pen Cartridges are
supplied under CGHS.
