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Central Government Health Scheme (CGHS)

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Indian Government proposes New Health Insurance Scheme in lieu of CGHS - Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS)

Based on the recommendations made by Sixth Central Pay Commission, Ministry of Health & Family Welfare (MOHFW) under the Government of India, has taken the initiative and efforts to introduce an Insurance Scheme specially designed for the Government Employees Serving officials and Pensioners which has been named as Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS). In this regard, the Government of India has invited Expressions of Interest from Insurers and Health Insurance consultants for the proposed scheme to be introduced in due course across India.

As per the document known as Expression of Interest published on the CGHS website in this regard, Government of India (GOI) has ambitious plans to provide inpatient health care services to wide-spectrum of Central Government employees.

Proposed Beneficiaries of the proposed CGEPHIS

All personnel of the Central Government including All India Service officers, serving, newly recruited, retired and retiring and others who are covered under the existing CGHS (Central Government Health Services) and under CS (MA) [Central Services (Medical Attendance) Rules] Rules shall be offered the proposed Health Insurance Scheme on voluntary or on compulsorily basis.

Proposed Features of CGEPHIS

The proposed features of CGEPHIS are enlisted below:

CGEPHIS shall be compulsory to all the newly inducted Central Government Employees who would be joining service after the introduction of the proposed health Insurance Scheme.

It shall be compulsory to new Central Government Retirees who would be retiring from the service after the introduction of the proposed Insurance Scheme.

It would be available on voluntary basis for the existing Central Government Employees and pensioners serving in CGHS area/covered under the ambit of CGHS. In such cases however, the serving Central Government Employees and Central Government existing Pensioners shall have to opt out of CGHS scheme. In return, such individuals will have the option of choosing both CGHS and Insurance policy. In such cases, the total premium has to be borne by the beneficiary of the proposed beneficiary scheme.

CGEPHIS would also be available on voluntary basis for the existing serving employees and pensioners in non-CGHS areas not covered by CGHS Act. In this case such serving Central Government Employees and existing Pensioners (who have already opted for CGHS facility) shall have to opt out of CGHS scheme. Such individuals will have the option of choosing both CGHS and Insurance policy. In such a case too, the total premium has to be borne by the beneficiary of the proposed insurance scheme.

The proposals relating to sum assured/policy limits, family size, age limit, Insurance coverage are as follows:

a) Sums Insured / Policy Limits

The scheme shall provide coverage for meeting all expenses relating to hospitalization of beneficiary members up to Rs. 500,000/- per family per year subject to stated limits of the proposed insurance scheme on cashless basis through smart cards. The benefit shall be available to each and every member of the family on floater basis i.e. the total reimbursement of Rs. 5 lakhs can be availed by one individual or all members of the family, who are his/her dependants. In addition, there is a proposal from the Government to restrict the medical/healthcare benefits in respect of Domiciliary hospitalization and Maternity up to Rs.50,000/- for each admission.

b) Family Size / Age Limit

Serving Employees: Self, spouse, two dependent children and dependent parents (New-born shall be considered as insured from day one)

Retired Employees: Self, spouse and one dependent child

Additional dependent family member can be covered under the proposed scheme by paying the fixed percentage of premium per additional dependent family member. This premium has to be borne by the beneficiary.

All beneficiaries shall be insured till their survival.

The definition of dependent will be according to the guidelines issued by Central Government of India, New Delhi.

c) Insurance Coverage

In addition to the coverage proposed under a standard medical insurance policy, the following areas shall also be incorporated under the ambit of CGEPHIS:-

Pre-existing diseases

Maternity benefit

Day-one Coverage for all diseases

New-born babies

Pre-hospitalization and Post-hospitalization cover of 30 days and 60 days respectively

Domiciliary Hospitalization

Based on the recommendations and inputs of Sixth Pay Commission provided for implementing an alternative health insurance scheme in place of the existing CGHS, the existing CGHS needs to be totally revamped, the chief reason for this being that CGHS caters to only a miniscule section of Government employees. Since the Central Government employees community are posted in every nook and corner of the country, including remote areas, the existing CGHS is limited only to 26 cities across India. The rest are covered by Central services (Medical Attendance) Rules, which seldom serve the real purpose.

In such a scenario that is widely prevalent across India, the present contemplation of the Indian Government in bringing a new Health Insurance Scheme in the place of existing CGHS and medical treatment under Central services (Medical Attendance) Rules, is a positive and welcome one. The official documents released by the Government for assessing the willingness of the Central Government employees to join in the proposed health insurance Scheme are known as Demand Survey. Such Central Government Employees have been requested to go through the document in a detailed manner and understand its contents. Such individuals have been invited to apply in the given format, provided that such individuals are willing to join as beneficiary in the proposed health insurance scheme, without any pressure or compulsion or bindings of any sort being exerted on them.

The CGEPHIS scheme has been proposed for non-CGHS centers too. The Central Government employees belonging to non-CGHS centers can send their willingness to join the proposed health insurance scheme to the Deputy Director, Ministry of Health and Family Welfare directly (MOHFW).

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I am advised to obtain an essentially certificate for the drugs Jalra 50 mg twice a day and Lamosyn 100 mg twice a day which have to be used along with other drugs used to control diabetes. When the drugs are so important to control the diseases why cannot they be provided by CGHS and why essentiality certificate from NIMS or Gandhi Hospital at Hyderabad are insisted. Is there any form to obtain the essentially certificate?
srideviravi Thursday, March 27, 2014
CGHS Card has been issued in my favor under Kolkata Jurisdiction and availing such facility.Now Issuing of the Plastic CGHS Card is under process but the PIN No. of my residential address is modified recently by State GOVT.[KOLKATA-700157 in place of 700059],KOLKATA-700157 is not covered under CGHS Jurisdiction. How I can be able to get the Plastic Card as well as avail such facility.
adityasinha Tuesday, February 04, 2014
I am central government employee. I am planning to preserve cord blood of my baby. Can i reimburse the cord blood banking charges under central government health scheme ??
sppatel777 Monday, December 09, 2013
I am a CGHS Card holder pensioner retired from CDA[Pension, Kolkata. Can the CGHS clinic refer me to a Damdam Municipal Hospital(which is not shown in the website in empanelled List] Non-Empanelled Hospital for treatment ie.
lilyalld1 Thursday, November 28, 2013
I have to purchase BP apparatus on doctor's prescription kindly guide me the procedure
amarjeetsinghsodhi Thursday, November 14, 2013
is there any further progress on the intended CGEPHIS scheme for which RFP was published in 2010
alagh Saturday, November 02, 2013
CGHS / ESI are the benefits given the govt. I sincerely feel all these facilities are not really giving help to the patients, the long hours of waiting fro the doctors, to collect reports is very hectic. Its not like the work is completed within 1-2 hrs, its a day long process. The way the staff treat as if the patients are beggers. How can a patient alone can go from room to room, floor to floor in search of the doctor, its so indefinite that the doctors will be coming and no information is given. People working in private sector will not get leave if they have to wait for days together its difficult. The plight of the patients is very sad and pathetic. Anyway nothing will happen as long as these corrupted politicians are there but still I wanted to share my views. MY HUMBLE REQUEST IS PLEASE GIVE MERCY KILLING FOR THE PEOPLE WHO ARE SUFFERING at they will die peacefully.
Guest- Thursday, October 10, 2013
I m a defence ministry pensioner[civilian].i m not under CGHS tillnow.how can i get covered under the cghs now i retired in 1993.
B.H.AnanthaMurthy Sunday, September 01, 2013
Respected Sir,
Sir, I retired from PSU[PDIL, Sindri-Noida] and i am pension holder. My age is 65 yrs. Can I get the CGHS benifit? If so kindly help me by citing the process of getting CGHS card and the treatment in which type of hospitals? I am residing in Dhanbad in the state of Jharkhand.

Thanking you,
Sona Ram Rajak

Sona47 Tuesday, August 27, 2013
I am retd GOI officer.Card No. P1882 issued from Lucknow.I was in Mumbai with my son when I fell down on 04nov 12 and brocken FEMUR bone in two parts. Got treatment from Breach Candy Hospital which is nearest to me. Submitted the claim on cghs Lucknow on 4 dec 2012 via regd AD post.Thereafter sent many reminders by email/by post but claim has not been till date.I am not provided with details of my Claim number and date inspite of my repeated requests.Please send address/email of appealate authority.
sharad1940 Monday, July 01, 2013
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