CGHS Rules Book PDF 2023 Download

CGHS Hand Book 2023 PDF for Pensioners

THE BOOK PUBLISHED CGHS BENEFICIARIES WELFARE ASSOCIATION OF INDIA

Hand Book of CGHS Download PDF – Click Here

The book has been compiled keeping in mind the difficulties faced by the members of CGHS specially the pensioners in getting information about CGHS . Many members do not know about facilities available at CGHS and its functioning. The difficulties are specially faced in matters of getting medicines, referral procedure, investigation and treatment procedures, treatment in case of emergency, list of empanelled hospital and most important reimbursement of medical claims .How to present their grievances and to whom is also a problem.

For the last six decades Central Government Health Scheme is providing comprehensive medical care to the Central Government employees and pensioners enrolled under the scheme. In fact CGHS caters to the healthcare needs of eligible beneficiaries covering all four pillars of democratic set up in India namely Legislature, Judiciary, Executive and Press. CGHS is the model Health care facility provider for Central Government employees & Pensioners and is unique of its kind due to the large volume of beneficiary base, and open ended generous approach of providing health care. Presently approximately 35 lakh beneficiaries are covered by CGHS in 75 cities all over India and the endeavor is to include more cities to improve the accessibility of the services.

CGHS Provides Health care through following systems of Medicine

• Allopathic
• Homoeopathic
• Indian system of medicine

1.Ayurveda
2.Unani
3.Siddha and
4.Yoga

Eligibility for Joining CGHS and Criteria

• All the following persons are eligible for CGHS facilities
• All Central Government employees paid from the Central Civil Estimates (except Railways and Delhi Administration), including their dependent family members residing in CGHS covered areas.
• Pensioners of Central Government (except pensioners belonging to Railways and the Armed Forces) and their families.
• Central Government Pensioners retiring with Contributory Provident Fund benefits and their families.
• Widows of Central Government pensioners, in receipt of family pension.
• Delhi Police personnel and their families, in Delhi only.
• Railway Board employees.
• Civilian employees of Defence paid from Defence Service Estimates.
• Child drawing pension on death of a Central Government employee including minor brothers and sisters of such child.
• Ex-Governors and Lt. Governors and their families.
• Ex-Vice Presidents and their families.
• Central Government servants who are deputed to semi-government and autonomous bodies receiving substantial grant from, or financed by the Central Government.
• Central Govt. employees on deputation to statutory or autonomous during the period of deputation.
• Military Officers while on deputation to civil departments and getting their emoluments from Central Civil Estimates.
• Families of Governments servants transferred to a non-CGHS area, for a maximum period of six months on deposit of CGHS contribution (for the period of 6 months) in advance.
• Families of IAS Officers on North-Eastern Cadre, who continue to stay back in Delhi even after repatriation of the IAS Officer to the North-Eastern Cadre, provided that they continue to occupy Government accommodation in Delhi or New Delhi, on deposit of CGHS contribution in advance (one to three years).
• The same also applies to families of IAS Officers of J & K Cadre.
• Parliamentary Secretaries of the Central Government and their families.
• Members of Parliament and their families.
• Ex-Members of Parliament.
• Sitting Judges of Supreme Court and High Court of Delhi and former Judges of Supreme Court and High Courts.
• Work Charged and Industrial Staff working in establishments run by various Ministries or Departments of Central Government, immediately from the date of their joining the service.
• Employees of Kendriya Vidyalays Sangathan stationed at Delhi and NCR, Kolkata, Chennai, Hyderabad, Mumbai and Bengaluru.
• Employees of Ordnance Factory Board Headquarters, Kolkata and Ordnance Equipment Factories Headquarters, Kanpur.
• All India Service pensioners who retire while serving under the State at their option.
• Freedom Fighters and members of their family receiving Central Pension under the Swatantrata Sainik Samman Pension Scheme.
• Family members of the Deceased Ex-Members of Parliament.
• Pensioners of Ordnance factories.
• Members of Staff Side of the National Council of the Joint Consultative Machinery, even though not serving as Central Government employees.
• Persons employed in semi-government and autonomous bodies who are permitted to join the CGHS Scheme.
• An Accredited Journalist who produces a certificate from the Press Council of India stating that he is a member of the Press Association, New Delhi (for OPD and at RML Hospital).
• Retired Divisional Accountants of the Indian Audit and Accounts Department and those whose pay and pension are entirely borne by the State governments.
• PSU absorbees who had commuted 100 percent of their pension and have been restored one third portion of their pension after 15 years.
• Absorbees of Statutory Bodies or Autonomous Bodies of Central Govt. (including those who proceeded on deputation initially or were on deemed deputation and then absorbed), who are in receipt of Central Civil Pension.
• Serving and retired Railway Audit Staff.
• Serving and retired Divisional Accounts Officers and Divisional Accountants posted in the Office of Accountant Generals in States.
• CISF personnel (and their families) and CAPF (Central Armed Police Forces) personnel posted in CGHS cities.
• Employees of Supreme Court Legal Services Committee.
• Employees of India Pharmacopoeia Commission, and their families.
• Family and dependent members of a Central Govt. employee (a CGHS beneficiary) who stay back in CGHS covered area after posting of the employee to N.E. region (including Sikkim), Andaman and Nicobar Lakshadweep or Ladakh region and CAPF personnel posted in Left Wing Extremist areas, on payment of annual CGHS contribution in advance.
• Defence Industrial Employees of Naval Dockyard Central Ordnance Depot and AFMSD, in Mumbai.

Eligibility Criterion CGHS

Residence alone (and not the Headquarters) is the criterion for determining eligibility of a Central Government servant for availing medical facilities under the Central Government Health Scheme. Thus, Central Government employees and their family members etc. residing in any of the notified cities are covered under the Scheme.

Facilities Available under CGHS

• OPD Treatment including issue of medicines.
• Specialist Consultation at Polyclinic/Govt. Hospitals.
• Indoor Treatment at Government and Empanelled Hospitals.
• Investigations at Government and Empanelled Diagnostic centers.
• Cashless facility available for treatment in empanelled hospitals and diagnostic centers for Pensioners and other identified beneficiaries.
• Reimbursement of expenses for treatment availed in Govt. /Private Hospitals under emergency.
• Reimbursement of expenses incurred for purchase of hearing aids, artificial limbs, appliances etc. as specified.
• Family Welfare, Maternity and Child Health Services.
• Medical consultation and dispensing of medicines in Ayurveda, Homeopathy, Unani and Siddha system of medicines (AYUSH)

CGHS Covered 74 Cities in India

CGHS, presently provides Comprehensive Health Care to more than 35 Lakh Beneficiaries in following Cities:

1. Agartala
2. Agra
3. Ahmedabad
4. Aizwal
5. Ajmer
6. Aligarh
7. Allahabad (Prayagraj)
8. Ambala
9. Amritsar
10. Baghpat
11. Bengaluru
12. Bareilly
13. Berhampur
14. Bhopal
15. Bhubaneswar
16. Chandigarh
17. Chennai
18. Chhapra
19. Cuttack
20. Darbhanga
21. Dhanbad
22. Dehradun
23. Delhi & NCR Delhi, Faridabad, Ghaziabad, Greater Noida, Gurgaon, Indirapuram, Sahibabad
24. Dibrugarh
25. Gandhinagar
26. Gangtok
27. Gaya
28. Gorakhpur
29. Guwahati
30. Guntur
31. Gwalior
32. Hyderabad
33. Imphal
34. Indore
35. Jabalpur,
36. Jaipur
37. Jalandhar
38. Jammu
39. Jodhpur
40.Kannur
41. Kanpur
42. Kohima
43. Kolkata
44.Kochi
45. Kota
46.Kozhikode
47. Lucknow
48. Meerut
49. Moradabad
50. Mumbai
51. Muzzafarpur
52. Nagpur
53. Nellore
54. Panaji
55. Patna
56. Pondicherry
57. Pune
58. Raipur
59. Ranchi
60. Rajahmundry
61. Saharanpur
62. Shillong
63. Shimla
64. Silchar
65. Sonepat
66. Srinagar
67. Varanasi
68. Vijayawada
69. Tiruchirapalli
70. Tirunelveli
71. Tirupati
72. Thiruvananthapuram
73. Vishakhapatnam
74. Kozhikode

Wellness Centre Timings and Online Registration Instruction

CGHS Wellness Centre’s are open from 7:30 AM to 2 PM on all working days from Monday to Saturday except emergency services wherever applicable.

The Wellness Centre’s remain closed on all Central Govt. holidays. However in case of 3 consecutive holidays occurring together, Wellness Centre’s will not be closed for more than 2 consecutive days. Limited Emergency services are available in following 4 WCs only in Delhi.

• South Avenue
• North Avenue
• Zakir Hussain Road and
• Kingsway Camp

Timings of WCs with emergency services are as follows:

WC timing 7:30 AM to 1:30 PM Limited Emergency services 1:30 PM to 7:30 AM.

There are also First Aid Posts (FAP) at following locations in Delhi

• Nirman Bhawan
• Central Secretariat
• Vitthal Bhai Patel House
• Shastri Bhawan
• Narmada House opposite RML Hospital
• Supreme Court and
• Moti Bagh
• PHA- for Honble MPs and Ex. MPs only
• PH- for Honble MPs and Ex. MPs only
• The timings of these FAPs is from 9:00 AM to 5 :00 PM

CGHS Online Registration

The registration of the beneficiaries is done online. This registration is either self registration (seeking prior appointment) or walk in registration (coming to the Wellness center and getting registered at the Registration Counter). The registration starts on opening of the Centre and is stopped 15 minutes before scheduled closing time of the Centre. However, no serious patient is returned back unattended.

Online Appointment (Self Registration) For CGHS

Online appointment with Medical Officer of the Wellness Centre or with Specialist who visits a particular Wellness Center can be booked by visiting CGHS portal cghs.nic.in through the link Book Appointment.

The steps for booking online appointment (Self Registration) are as follows:

1. Visit the website cghs.nic.in
2. Click on the option Book Appointment available on RHS of the screen
3. Enter beneficiary ID and click on Generate OTP.
4. An OTP (One Time Password) will be sent on registered mobile no. of the beneficiary or to the main card holder mobile if that is the only registered number.
5. Enter OTP and click on Proceed.
6. Beneficiary details are displayed on screen. Click on Proceed button if the details displayed on screen are correct otherwise click on NOT YOU. In that case login again and proceed as above.
7. Select Specialty, Dispensary, Doctor as per your choice and click on Proceed button. A beneficiary can select a GDMO (General Duty Medical Officer) or a Specialist of any of the CGHS wellness Centre.
8. A calendar is displayed to choose a date that has the availability of appointment for the selected doctor. Select date for appointment.
9. On selecting date, top of the screen shows the slot timings and the appointments available. A beneficiary can choose the desired slot.
10. Click on Proceed to Book Appointment. One can go back and make changes by using the Change the Specialty button.
11. On clicking the button Proceed to Book Appointment, beneficiary details and the appointment details are displayed on the screen for confirmation.
12. Click on the option Confirm to Book Appointment, Confirmation status page is displayed. One can print the confirmation slip, or book another appointment. System would also send an SMS to registered mobile number.

Appointment for the GDMO can be taken within 72 hours of date of appointment whereas appointment for the Specialist can be taken within 1 month of date of appointment. Online appointment cannot be made for the same day or date. (This window period may change depending upon the decisions taken from time to time)

Senior Citizens above the age of 75 years can book the appointment by calling the CGHS Helpline no 18002088900 from their registered mobile number.

CGHS Contribution and Ward Entitlement

For serving Central Government employees residing in CGHS covered area, obtaining a CGHS card is compulsory. The following deductions from salary of the employees are made by the department, every month, depending upon their pay in the pay matrix of 7th Pay commission (w.e.f. 1/1/2017) Corresponding levels in Pay Matrix as per 7th CPC Contribution per month

Level 1-5: Rs. 250
Level 6: Rs. 450
Level 7-11: Rs. 650
Level 12 and above: Rs. 1000

Contribution to be made by the Pensioners/Family Pensioners would be the amount that they were subscribing at the time of their retirement or at the time of the death of government servant. Pensioners who want to avail CGHS facilities can make contribution either on yearly basis or one time (Ten yrs) contribution for whole life validity.

Pensioners who want to avail CGHS facilities can make contribution either on yearly basis or one time (ten yrs.) contribution for whole life validity. Entitlement of wards in private hospitals empanelled under CGHS (Based on basic pay in pay band) is as follows:

Corresponding Basic pay drawn by the officer in 7th CPC per month.

1. General Ward Up to Rs. 47,600/-
2. Semi Private Ward Rs. 47,601 to 63100/-
3. Private Ward Rs. 63101 and above.

Interactive Online Services For CGHS

Following interactive online services are available to the CGHS beneficiaries through CGHS portal cghs.nic.in

1. Online application for plastic card: At present a beneficiary can fill application for CGHS card online. However online completed application has to be downloaded and the printout is required to be submitted to CGHS Card Section with necessary supportive documents. The facility of complete online application i.e. uploading of necessary supportive documents and online payment of subscription by pensioners is yet not available and is to be started soon.

2. Print your own CGHS card: For self and dependent members a beneficiary can take a print out of CGHS cards through Beneficiary log in.

3. Online appointment: A beneficiary can book online appointment for Medical officer or Specialist.

4. Through Beneficiary login on CGHS Portal cghs.nic.in following services can be availed: View Beneficiary Details for self and dependent family members.

• View Beneficiary Details for self and dependent family members.
• Tracking of medical reimbursement claim: Status of MRC submitted and the level ofprocessing of MRC can be tracked through this facility
• Status of processing of application for plastic card.
• Updation of his and his dependents registered mobile number
• Updation of his and his dependents email ids,
• Updation of his and his dependents Aadhar number.
• History of medicines issued to self and dependent
• History of medicines issued to self and dependents.
• Medical services: Apart from interactive online services mentioned above,
• Medical services like prescription, issuing and indenting of medicines including life saving medicines to CGHS beneficiaries through online Web. Application is available.

24×7 National CGHS Helpline Desk | CGHS Helpline Number

A 24×7 National CGHS Helpline service is available on a toll free number 18002088900. It is a bilingual (Hindi and English) service which is universally accessible ( through landline or mobile of any service provider).

The beneficiaries can seek all CGHS service related information through this Helpline.

The Helpline provides information on queries in the following areas

General information on CGHS: Names and addresses of the Wellness Centers and their timings, addresses of 24×7 Wellness Centers, contact details of the CMOs In charge of these Centers, Contact Details of other officials etc.

Facilities: What all facilities a CGHS beneficiary and his dependents are entitled to if living in a CGHS covered area and a non CGHS area.

CGHS eligibility: Who all are eligible for the CGHS services including the eligibility conditions of dependent family members?

CGHS entitlement: What contribution a beneficiary (serving and pensioner) has to pay according to the pay scale/pension, what is the Ward entitlement of the beneficiary?

Related to Plastic card: What is the procedure for getting a plastic card made for serving and pensioner beneficiary, addition and deletion of names in the card, validity of the card and transfer of the card, loss of the card etc.

Issue of medicines including Life Saving medicines: Procedure of issuing of medicines from the Wellness Center, Authorized Local Chemist, Medical store Depot. Documents required for issuing of life saving medicines, issuing of medicines in emergency, admissible and non admissible items, issuing of medicines for longer durations, procedure for indenting and issuing the medicines not available in the Wellness Center etc.

Permissions for investigations/procedures: Whether the permissions are required or not required, who is the authority for granting the permission, what is the procedure for getting permission, the documents required for permission etc.

Hospitalization: Hospitalization in emergency, CGHS rates for investigations and procedures, entitlement for cashless facility, procedure for referral, permissions for hospitalization etc.

Medical Reimbursement Claims: Documents required to be submitted with the MRCs, procedure for submission of MRC, filling of the MRC, information on procedure to t rack status of a claim, clarifications on non reimbursement of a particular item/claim etc.

Health Care Organization (HCO) empanelment: Names of Health Care organizations on the panel of CGHS, facilities for which empanelled, contact details of the Hospital authorities, the Accreditation status of the HCO etc.

Guidance on grievance redressal mechanism and RTI issues and Any other CGHS related information

The book has been compiled keeping in mind the difficulties faced by the members of CGHS specially the pensioners in getting information about CGHS. Many members do not know about facilities available at CGHS and its functioning. The difficulties are specially faced in matters of getting medicines, referral procedure, investigation and treatment procedures, treatment in case of emergency, list of empanelled hospital and most important reimbursement of medical claims. How to present their grievances and to whom is also a problem.

All the information about CGHS is available on site https://cghs.gov.in/index.php and https://cghs.nic.in/ and other related links. However many senior citizen are not aware of use of computers and specially online work like login , OTP, password etc. Though most of them now know use of Smartphone but find it difficult to operate due to small fonts and vision problem and use is limited to WHATSAPP Group or Facebook