CGHS Scheme- Rules, Application and Coverage

What is CGHS?

As the name suggests, a scheme by the Central Government of India for its employees, pensioners and dependent family members across India, the scheme aims to provide comprehensive medical care. The hospital needs to get empanelled with CGHS if it wants to cater to the demand by the CGHS beneficiaries. It covers IPD, OPD, diagnostics, wellness and speciality consultations and Ayush treatment with cashless facility a the empanelled entity. 

Key Eligibility Criteria

The eligibility of CGHS beneficiaries range from currently serving permanent employees, pensioners, members of parliament, retired and current members of high court/supreme court and freedom fighters. Eligible dependents, spouses and dependent children (sons up to age 25 or until employed/married and daughters up to unmarried and in case widowed. Dependent parents are also covered whose total monthly income from all sources do not exceed Rs. 9000 + DA per month. 

How to Check Your Eligibility

1. Verify Official City Coverage: CGHS coverage applies primarily to residents of registered CGHS cities across India.

2. Review Salary/Pension Matrix: Monthly contributions are based on your Pay Level under the 7th CPC (ranging from ₹250/month for Levels 1–5 up to ₹1,000/month for Level 12 and above). Pensioners can opt for a one-time lifetime payment.

3. Check Dependency Rules: For family members, ensure the dependent's monthly income remains within the prescribed limits.

4. Portal Verification: Visit the official CGHS portal (cghs.nic.in) or contact your departmental administrative officer to confirm if your specific cadre/organization is covered under CGHS rules.

Always audit your medical bill before you pay with Empaar.