Central Government Health Scheme – CGHS Frequently asked questions

45. 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 :

Basic Pay / Basic Pension Entitlement
Upto Rs. 13,950/-   per month General Ward
Rs. 13,960/- to 9,530/-   per month Semi-private Ward
Rs. 19,540/- and above – per month Private Ward

46. Which are the categories eligible for cashless treatment?

Hospitals shall provide credit facility to the following categories of CGHS beneficiaries (including dependant 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;Freedom Fighters;
  • Serving employees of Ministry of Health & Family Welfare (including attached / subordinate offices under the Ministry of Health & Family Welfare)

47. What should I do if the empanelled hospital refuses to entertain or give a step-motherly treatment?

Contact CMO i/c of the concerned Wellness Centre or Addl. Director, CGHS of concerned city or the nodal officer for grievances.

48. 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?

Permission for specific treatment procedure as advised by a Govt. Specialist at private empanelled hospitals shall be granted by the Head of Autonomous body in respect of serving employees as well as pensioners of Autonomous bodies covered under CGHS.

49.  What is the time within which my medical claim is to be reimbursed?

If all documentation is complete medical claims of pensioners are cleared in 45 days.

50.  What can I do if my claim is unnecessarily delayed?

Pensioner beneficiaries can contact the Additional Directors of concerned city / zone on any Wednesday between 11 A.M. and 1 P.M.

51.  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?

Apply to CMO I/c of WC with :

  • MRC forms duly filled in as per Check list
  • Copy of Discharge summary Hospital bills with break-up Receipts in original
  • Copy of the valid CGHS Card
  • Copies of other documents issued by hospital
  • MRC forms are available with CMO I/c and can also be downloaded from CGHS Website http://msotransparent.nic.in/cghsnew/index.asp
  • Serving employee in similar cases shall submit the medical claim to his department.
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