CGHS – Frequently Asked Questions on Central Government Health Scheme – Ministry of Health and Family Welfare issues a latest compilation of FAQ on CGHS
1. Who are entitled for CGHS facilities
2. In how many cities CGHS is presently operative?
3. For CGHS cards , as dependent , what is the meaning of the word “family “
4. What is the procedure to register with the CGHS?
5. Are CGHS facilities free of cost?
|Grad Pay||w.e.f 1st June 2009 Contribution|
|Upto Rs.1650 /-||Rs. 50/-|
|Rs.1800/-, Rs1900/-, Rs.2000/- , Rs.2400/- and Rs.2800/-||Rs.125/-|
|Rs.4600/-,Rs.4800/-, Rs.5400/- Rs.6600/- Rs.325/- and Rs. 7600/- and above||Rs. 500/-|
6. What is the system for the services of specialists in Dispensaries?
7. Is there any interactive mechanism at dispensary level?
8. How long does it take to get the CGHS Cards?
9. Whom Should I approach in case the CGHS Card is not issued to me in the prescribed time?
10. What should I do if I lose my CGHS Cards ?
11. What should I do if the details on the Card viz. name, date of birth, entitlement, etc. are wrong?
12. Is there a colour scheme for plastic cards? What are the details?
13. I retired in 1998 from Central Govt. but, I never made a CGHS card. Can I get a card now?
However, the subscriptions as applicable at current rates shall have to be paid.
14. My husband/wife is also employed under Central Government and is eligible for a separate CGHS Card. Is it necessary that separate cards are to be obtained?
15. My husband / wife retired in 2002. He /she was paying CGHS subscription every year. After his death can I get Card on my name. Do have I to pay extra. Shall I get Life Time Valid card ?
16. How to transfer CGHS card from one WC to other in the same city?
17. I am CGHS beneficiary at Kanpur. Visiting Mumbai for 6 months. Can I get CGHS facilities at Mumbai .Can same card of Kanpur continue or a separate card to be made. From where to get permission for the same?
Subsequent to computerization no separate permission is required and CGHS card is valid for availing facilities from any CGHS Wellness Centre in India. For any assistance , Addl. Director of the city may be contacted.
18. Who is competent to delete name of sons who have crossed age of 25 years?
19. After retirement in 2007 I got a Life time Pensioner CGHS card made in Delhi. Now I am shifting to Dehradun. Can I use the same card. Do I pay again?
20. I live in Gurgaon but my office is in Saket. Can I avail facilities from both the places because it is convenient for me.
21. Is there any age limit for sons / daughters as dependent in CGHS Card ?
22. Are step-children allowed CGHS facilities?
23. Can dependent in-laws be included under family members for CGHS facilities?
24. Me and my wife are both central Govt. employees and have dependent brothers / sisters and parents. Can we make separate cards and include family members?
25. Can the CMO or the pharmacist give a different brand than the one prescribed by the specialist?
26. What is the procedure for getting life saving drugs ?
27. What should I do if the Wellness Centre/Dispensary does not give all the medicines?
Contact CMO i/c of the concerned Wellness Centre or Addl. Director, CGHS of concerned city or Director, CGHS.
28. How long does it take to get the medicines ?
29. Are the prescription of specialists of empanelled hospitals binding on the dispensary ?
30. What is the maximum period for which medicines can be given in one go ?
31. If some medicines like antibiotics are urgently required and are not available at CGHS Wellness Centre what can be done?
32. How to get a drug if same is not available in WC & also not supplied by Chemist(ALC)?
j. Beneficiary, after authorization by CMO i/c can purchase such drugs from open market & claim reimbursement from ALC.
33. What should beneficiary do, if he/ she notice some deterioration in the quality of drugs?
34. My father is a cancer patient and after operation is bed ridden. Doctors have advised Protein powder. Can I get from CGHS?
35. Is Pen fill Injection provided under CGHS ?
36. What do I do if I am unwell at odd hours, say late in night?
37. Whom should I contact if the doctors are not present in the Wellness Centre / Dispensary?
38. In emergency who are all entitled to get treatment at Pvt Empanelled Hospital ?
39. What should I do in case of emergency?
40. What are the papers to be submitted for any investigation by an empanelled diagnostic centre?
41. What are the criteria for Entitlement of Treatment endorsed on CGHS Card like General ward / Semi-Pvt ward or Pvt. Ward in CGHS Empanelled Hospitals?
Endorsement of entitlement for general/semi- private/private ward facility is done according to their basic pay / basic pension as under :
Upto Rs. 13,950/- per month – Entitlement : General Ward
42. Which are the categories eligible for cashless treatment?
Hospitals shall provide credit facility to the following categories of CGHS beneficiaries (including dependent family members, whose names are entered on CGHS Card):
Members of Parliament; Pensioners of Central Government drawing pension from central estimates;
former Vice-presidents, Former Governors and former Prime Ministers;
Ex-Members of Parliament;
serving employees of Ministry of Health & Family Welfare (including attached / subordinate offices under the Ministry of Health & Family Welfare)
43. What should I do if the empanelled hospital refuses to entertain or give a step-motherly treatment?
44. I am a serving employee of an autonomous body, holding CGHS card. Who will give me permission for treatment on the recommendation of Govt. specialist?
45. What is the time within which my medical claim is to be reimbursed?
46. What can I do if my claim is unnecessarily delayed?
47. I am a CGHS Pensioner.My wife was admitted in pvt hospital in emergency state. How to get reimbursement of money spent on her treatment?
48. My original papers having bills, Receipts of hospital treatment are lost. Can I claim on duplicate papers?
49. My husband/wife was a CGHS card holder. He/She was sick and died while in hospital. How do I get MRC?
50. I retired in Dec 2011. Due to certain reasons I had to go to my native place in Uttranchal and could not make pensioner’s CGHS card. In May 2012 I came to Delhi and had Heart attack. In emergency I was treated in pvt hospital. I got CGHS Card made after discharge but I have been refused reimbursement of the expenditure incurred.
51. I went to Hyderabad to visit my son and had fracture of leg bone. I received treatment from a pvt hospital. Shall I get full reimbursement?
52. Is treatment for IVF reimbursable?
53. Are ambulance charges reimbursable?
54. I have a Medi-claim Insurance Policy. Due to emergency received treatment in a pvt hospital. Some amount was paid by Insurance Co. can I get balance from CGHS ?
Yes. First Bills are submitted to Insurance Company.Duplicate bills with certificate from Insurance Company may be claimed from CGHS by Pensioner CGHS beneficiaries.CGHS shall consider reimbursement at CGHS rates or actual whichever may be less. However, the total reimbursement from both sources should not exceed actual expenditure. Serving employees shall submit claim to department for reimbursement.