Central Government Health Scheme (CGHS) - CGHS Beneficiary can claim Health Insurance

CGHS beneficiary can also claim Health Insurance

The Central government employees - serving and retired, who have subscribed to the Central Government Health Scheme (CGHS) in present and in the past, would now be able to claim reimbursement of their actual hospitalization expenses beyond the CGHS package rates. This is mainly on account of the government easing the regulations and the conditions that enable such government employees to utilize healthcare insurance policies for enhanced spending. As a result, this could spur demand for additional insurance policy covers from the concerned government employees. A recent circular from the Ministry of Health and Family Welfare (MOHFW) states that CGHS beneficiaries will be allowed to claim their hospitalization expenses not only from CGHS/ministry but also from Insurance Companies (or Insurers) provided that the reimbursement being claimed by such an employee does not exceed the total medical expenditure incurred by the beneficiary.

Earlier, CGHS beneficiaries could claim the benefits provided under CGHS Act provided that the incurred amount did not exceed prescribed package rates. For this purpose, CGHS has empanelled select hospitals on their list that follow the package rates provided by it. However, the package rates are much lower than the existing or actual market rates.

The proposed move for introduction of Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS) by the Government of India, would help the beneficiary to claim his/her medical expenses from an insurer (or Insurance Company) in case the claim is beyond/exceeds the ceiling of the CGHS package rates.