Written by Dr. Sameer Sippy | 

Medically Reviewed by The Medindia Medical Review Team  on Mar 03, 2016

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.


  1. National Portal of India - (india.gov.in/citizen/health/cghs.php)
  2. CGHS - Kolkata - (cghskolkata.nic.in)
  3. CGHS - Mumbai - (http://cghsmumbai.gov.in/)


ajay3015 Monday, March 26, 2018

Respected sir,
one of out official's wife got treated in Max super speciality Hospital , Patparganj during 4.3.2018 to 6.3.2018 towards treatment of 'RT Loower UretericStricture RT secondary PUJO RT Renal Calculus . Where in their billing Hospital has charged for 'Ureteric Catherterisation 50 % is of Rs. 4927/- while as per CGHS Code No. 746 [2014 ] rate is mentioned as Rs. 794/-. The clarification and correct rate is of the procedure may please be given.
Ajay Sharma
Finance HQ
National Productivity Council
Lodhi Road N Delhi

prashanth039 Friday, February 2, 2018

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@Guest Sunday, July 23, 2017

Complain from the TEACHERS of Kendriya Vidyalaya Sangathan KOLKATA REGION.
As a capacity of THE GENERAL SECRETARY, AIKVTA, Kolkata Region, I am complaining against The Additional Director CGHS, Kolkata. Earlier 25 years CGHS facility was continued but now it was stopped from few months and teachers are debarred to avail the CGHS facility. This facility is continued in other metropolitan towns like Mumbai, Delhi, Chennai and other places where this facility is available. We are deducting CGHS contribution every month from salary but By order of The Additional Director CGHS, Kolkata, Wellness Hospitals refused to give treatment. So, I beg for issuing order for treatment of K.V. teachers in CGHS of Kolkata Wellness Center.

anuudeepthi Monday, July 17, 2017

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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

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