How to Use CGHS Card in a Private Empanelled Hospital (Step-by-Step Guide)

The Central Government Health Scheme (CGHS) allows its beneficiaries to take treatment not only in CGHS dispensaries and government hospitals, but also in CGHS-empanelled private hospitals.
However, the process is slightly different from a normal hospital visit—especially when it comes to referrals, approvals, and payments.

This guide explains step-by-step how to use your CGHS card in a private empanelled hospital without confusion.

What Is a CGHS Empanelled Private Hospital?

A CGHS-empanelled hospital is a private hospital that has been officially approved by Central Government Health Scheme to treat CGHS beneficiaries at pre-fixed CGHS rates.

These hospitals are empanelled for:

OPD consultations
Diagnostic tests
Medical procedures
Surgeries and specialized treatments

⚠️ Treatment is allowed only for approved procedures and only at CGHS rates.

Step 1: Check Whether the Hospital Is CGHS-Empanelled

Before visiting any private hospital, confirm its empanelment status.

You can check:

On the CGHS official website
At your CGHS dispensary
By asking the hospital’s reception (but always cross-verify)

Make sure:

The hospital is empanelled for your city
The required treatment/procedure is covered

Step 2: Understand Whether Referral Is Required

This is where many beneficiaries get confused.

When Referral Is Required

Referral from CGHS is mandatory for:

Planned surgeries
In-patient admissions
Costly investigations (MRI, CT scan, etc.)
Specialized treatments

When Referral Is Not Required

Referral is not required for:

Emergency treatment
Life-threatening conditions

In emergencies, you can go directly to the nearest empanelled hospital.

Step 3: Get a Referral Letter (For Planned Treatment)

For non-emergency cases, follow this process:

Visit your CGHS dispensary
Consult the Medical Officer (MO)
MO issues a referral letter specifying:
- Hospital name
- Diagnosis
- Tests or procedure
- Validity period

Carry this referral letter to the empanelled hospital.

Step 4: Carry Required Documents to the Hospital

When visiting the empanelled hospital, keep these documents ready:

Original CGHS card
Photo ID (Aadhaar / PAN / Pensioner ID)
Referral letter (if applicable)
Previous medical records
Emergency slip (if treated in emergency)

Hospitals usually verify your CGHS details at the billing desk before treatment.

Step 5: Treatment and Payment Process

Cashless Treatment (Limited Cases)

Some treatments are cashless if:

Prior approval is obtained
Hospital offers CGHS cashless facility
Treatment falls strictly within CGHS package

Reimbursement-Based Treatment (Most Common)

In most cases:

You pay the bill upfront
Hospital charges CGHS approved rates
You later apply for CGHS reimbursement

Step 6: Emergency Treatment in Private Empanelled Hospital

In emergencies:

Go directly to the empanelled hospital
Inform them you are a CGHS beneficiary
Show your CGHS card as soon as possible

After discharge:

Inform your CGHS dispensary
Submit emergency medical records
Apply for reimbursement (if payment was made)

CGHS generally allows emergency claims even without prior referral, provided the emergency is genuine.

Step 7: Claim CGHS Reimbursement (If Applicable)

If you paid the hospital bill yourself:

Collect all original documents:
- Bills
- Discharge summary
- Prescriptions
- Investigation reports
Submit reimbursement claim at CGHS
Track claim status through CGHS portal or dispensary

Reimbursement is processed as per CGHS rates, not hospital MRP.

Important Points to Remember

Always prefer CGHS-empanelled hospitals
Referral is crucial for planned treatments
Emergency treatment is allowed without referral
Reimbursement is limited to CGHS approved rates
Keep all original documents safely

Frequently Asked Questions (Quick)

Can I use CGHS card in any private hospital?
No. Only in CGHS-empanelled private hospitals.

Is cashless treatment guaranteed?
No. Cashless treatment depends on approval and hospital policy.

Do pensioners and serving employees follow the same process?
Yes, the procedure is largely the same.

Final Word

Using a CGHS card in a private empanelled hospital is simple once you know the rules.
A little preparation—checking empanelment and getting a referral—can save you money, time, and stress.