Introduction: Central Government Health Scheme

For the last six decades, Central Government Health Scheme (CGHS) is providing comprehensive medical care to the Central Government employees and pensioners enrolled under the scheme. In fact, CGHS caters to the healthcare needs of eligible beneficiaries covering all four pillars of the democratic setup in India namely Legislature, Judiciary, Executive, and Press. CGHS is the model Health care facility provider for Central Government employees & Pensioners and is unique of its kind due to the large volume of the beneficiary base, and open-ended generous approach to providing health care.

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CGHS provides health care through the following systems of Medicine

• Allopathic
• Homeopathic
• Indian system of medicine
• Ayurveda
• Unani
• Siddha and
• Yoga

Eligibility for joining Central Government Health Scheme (CGHS)

• All Central Govt. employees drawing their salary from Central Civil Estimates and their dependant family members residing in CGHS-covered areas
• Central Govt. Pensioners/family pensioners receiving a pension from central civil estimates and their eligible dependent family members
• Sitting and Ex-members of Parliament
• Ex-Governors & Lt. Governors
• Freedom Fighters
• Ex-Vice Presidents
• Sitting and retired Judges of the Supreme Court
• Retired Judge of High Courts
• Journalists accredited with PIB (in Delhi)
• Employees and pensioners of certain autonomous/statutory bodies which have been extended CGHS facilities in Delhi
• Delhi Police Personnel in Delhi only
• Railway Board employees
• Post and Telegraph Department employees

For More Details, Please Visit https://cghs.gov.in/

Facilities available under Central Government Health Scheme (CGHS)

• OPD Treatment includes issues with medicines.
• Specialist Consultation at Polyclinic/Govt. Hospitals.
• Indoor Treatment at Government and Empanelled Hospitals.
• Investigations at Government and Empanelled Diagnostic Centers.
• A cashless facility is available for treatment in impaneled hospitals and diagnostic centers for Pensioners and other identified beneficiaries.
• Reimbursement of expenses for treatment availed in Govt. /Private Hospitals under emergency.
• Reimbursement of expenses incurred for the purchase of hearing aids, artificial limbs, appliances, etc. as specified.
• Family Welfare, Maternity, and Child Health Services.
• Medical consultation and dispensing of medicines in Ayurveda, Homeopathy, Unani, and Siddha systems of medicines (AYUSH)

Plastic identity card:

• The Committee has been informed that plastic identity cards are being issued as part of the computerization process to all the CGHS beneficiaries so that they can avail the medical facilities in any city should they happen to be in that city either on official work or on leave. With the introduction of plastic cards, beneficiaries can get medicines from any wellness Centre across the country without the need of carrying temporary attachments from their respective offices.

Empanelment of Hospitals for Central Government Health Scheme (CGHS)

• As CGHS is spread over 25 cities only, the remote areas are lacking these facilities due to the lack of hospitals under empanelment and the nonavailability of any CGHS Wellness Centre in their area. This leaves the beneficiaries with no choice except to go to the State Government hospitals where they have to undergo numerous hardships like long waiting hours to see the doctor and get treated.
  • The Committee was also informed that for empanelment of hospitals, laboratories, and imaging Centres under CGHS, they have to be accreditated by NABH, NABL, and AERB respectively to ensure good quality health care services including medical and diagnostics services to CGHS beneficiaries.
• Non-NABH / non-NABL, Health Care Organisation (HCO) provisionally impaneled under CGHS shall be inspected by QCI for compliance with the eligibility criteria and other conditions specified in the E-tender documents 2014 and in MOA signed with CGHS.
  QCI will send the recommendation to CGHS preferred within 60 days and not later than 180 days from the receipt of the application at the NABH / QCI office.

Other details:

• The application from the applicant hospital center along with the relevant application fee will be received directly by the QCI office.
• QCI will make recommendations in two categories in the following manner:

1. Recommended for the continuation of CGHS empanelment / not recommended.
2. QCI will display them on its website www.nabh.co the recommendations. Pertaining to all application hospital/center which is provisionally impaneled with CGHS.

• The validity period of inspection would be two years from the date of inspection if recommended.
• Non-NABH / Non-NABH, HCO, which fails to get inspected/recommended by QCI for the continuation of empanelment shall be liable to be their performance bank guarantees would be forfeited.