Central Government Health Scheme (CGHS)

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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.

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CGEPHIS Tuesday, February 28, 2017

Hi All, I am an IT professional and the new proposed scheme looks like the best. CGHS has many draw backs like should be in city to get cards, not all states have good hospitals. Big headache with reimbursement. Modi is doing good job tweet him to support new insurance scheme instead of CGHS which might speed up the process and all employees and retired employees will get insurance cards which never expires in there life time and cashless benifits

docsonia01 Friday, January 20, 2017

can u please clarify about availing the CGHS card facility while on EOL, without pay?

deshmukhbk Friday, January 6, 2017

Can anyone please tell me CGHS package for "Bone Marrow Transplantaion". Please tell me the package number and details of the same. Thanks a lot.

shashibhushantripathi Tuesday, November 3, 2015

Whether Central Ministers/MPs are provided CGHS card or their Identity card is enough.

MAPadmanabhaRao Monday, September 28, 2015

CAN ANYONE PLEASE HELP IN MINISTRY OF HEALTH AT NEW DELHI? MEDICAL BILL SUBMITTED THREE MONTHS AGO. NO REIMBURSEMENT YET. On 1st June 2015 I persanally handed over the file along with a duplicate copy to Dr.BHATIA a lady Medical Officer at CGHS Vikas Puri, New Delhi 110018 for reimbursement of the money spent [nearly Rs 5 lakhs] for total knee replacements to my wife Mrs LEELA RAO (CGHS No 878426) on 1st May 2015 at Saroj Hospital Rohini New Delhi In front of me she kept th file in her office Almirah and was in a hurry to go to R.K.Puram. She did not care to give me any receipt. I did not hear any progress of the fill till date. I am afraid she might have misplaced the file.

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