CGHS beneficiary can also claim Health Insurance now

Central government employees, serving and retired, who have subscribed to the Central Government Health Scheme (CGHS) would now be able to claim reimbursement of their actual hospitalisation expenses beyond the CGHS package rates, with the government easing conditions that enable them to use medical insurance policies to enhance their spending.

This could spur demand for policies from government employees. A recent circular from the Ministry of Health and Family Welfare states that CGHS beneficiaries will be allowed to claim their hospitalisation expenses not only from CGHS/ministry but also from insurance companies provided that the reimbursement being claimed does not exceed the total expenditure incurred by the beneficiary.

Earlier, CGHS beneficiaries could claim CGHS and insurance firms such that the combined amount does not exceed prescribed package rates. CGHS has empanelled select hospitals that follow the package rates provided by it. However, the package rates are lower than the market rates.

This move helps a beneficiary to claim his expenses from an insurer in case the claim is beyond the CGHS package rates.

Download the circular No: S.11011/4/2003-CGHS(P) dated 19.02.09 issued by the Ministry of Health and Family Welfare