How to use CGHS card at private hospitals: Eligibility & benefits

Central government employees must follow a procedure to claim refunds for medical care

The Central Government Health Scheme (CGHS) is a lifeline for millions of state employees, pensioners and their families. The CGHS, established in 1954, offers a wide range of healthcare services through a network of ‘empanelled’ hospitals, clinics, and wellness centres. But one common question arises: Can you use your CGHS card at private hospitals?

 

What is CGHS?

 

CGHS offers medical care through various wellness centres, empanelled hospitals and diagnostic centres across India. Beneficiaries are required to contribute a small amount, ranging from Rs 250 to Rs 1000, every month based on their monthly income. CGHS runs pharmacies nationwide, where beneficiaries can access medicines prescribed by doctors working with the scheme.

 

Who are entitled for CGHS facilities

 

Central government employees as well as dependent family members living in CGHS-covered areas.

 

Former and existing members of the Indian Parliament

 

Former vice-presidents of India

 

Indian freedom fighters

 

Former governors and lieutenant governors of India

 

Former and serving judges of Supreme Court and High Courts of India

 

Journalists qualified with Press Information Bureau (only Delhi)

 

Delhi Police Personnel

 

Railway Board workers workers and pensioners

 

Delhi’s selected autonomous organisations

 

CGHS cards at private hospitals

 

Private hospitals empanelled under CGHS can offer health care to cardholders. Such hospitals have signed an agreement with the government to provide medical services at CGHS rates, which are usually lower than what regular patients would be charged. This empanelment ensures that CGHS beneficiaries can access specialised treatments that may not be available at government hospitals.

 

What is the CGHS claim process?

 

The claim process involves submitting medical bills and documentation to CGHS offices to obtain reimbursement for medical expenses. A request for a refund on medical expenses must be done within three months. The maximum benefit per family cannot exceed Rs 5 lakh annually

 

How to apply for a new CGHS card?

 

Download the new pensioner CGHS card application form from the CGHS website or collect it from the CGHS office in your city.

 

Complete the application form with all required details.

 

Make the payment of the required CGHS contribution online using the Bharat Kosh portal.

 

Visit Bharat Kosh to make the payment.

 

Once the payment is made, generate a challan as proof of payment.

 

Submit the filled application form along with the payment challan and any required documents (e.g., proof of pension, address proof, etc.) to the Additional Director of CGHS in your city.

 

You can also apply for an electronic CGHS card online.

 

What are the documents the central government pensioner needs to enclose to apply for a CGHS card?

 

Proof of age of son (in case son is a dependent).

 

Self-attested copy of Disability certificate issued by the medical board of government hospital (in case of dependent son aged 25 and above.)

 

Self-attested PPO/provisional PPO or last pay certificate copy of Bharatkosh Challan for CGHS subscription paid.

 

Copy of ID proof of dependent family members (Passport, PAN card, masked Aadhar, voter ID card, etc.).

 

Address proof.

 

Documents proving dependency of family members (wherever applicable).