Conceptual · Article 7.2.8

Central Government Health Scheme.

India's Most Comprehensive Cover — For Those Who Serve the State.

Published as on 22 July 2026

The CGHS is one of India's oldest public health benefits — set up in 1954 and run by the Ministry of Health & Family Welfare for Central Government employees, pensioners and their dependants. For a single monthly subscription of ₹250 to ₹1,000 by pay level, it covers outpatient consultations, free medicines, specialist referrals, inpatient hospitalisation, diagnostics, dental and maternity — OPD and IPD together, with no fixed annual monetary cap. Unlike a private policy that stops at a sum insured, or PM-JAY that covers only hospitalisation, CGHS is holistic. But it prices everything at CGHS package rates — and that ceiling, not any annual limit, is the number that decides your out-of-pocket cost.

Est. 1954

India's Oldest Health Scheme

81 cities

342 Wellness Centres

₹250–₹1,000

Monthly · Whole Family

CGHS Rates

The Reimbursement Ceiling

Executive Summary · Page 2

Executive Summary · 6 Findings

CGHS is the most complete health benefit an Indian citizen can hold — but only a defined few can hold it. For a serving officer or a pensioner it answers a rare question: where is the one scheme that pays for the everyday clinic visit, the free monthly medicines, and the ₹6-lakh cardiac surgery, all under a single subscription with no annual cap? The catch is not a rupee ceiling on the year — it is the CGHS package rate on each procedure. Understand that one number and you understand the scheme.

Covers who is eligible and who is not, the pay-level contribution table and the lifetime-membership option, the CGHS card and Wellness-Centre model, what OPD and IPD cover includes, ward entitlement, the all-important CGHS rate ceiling at non-empanelled hospitals, the referral and prior-permission process, the Section 80D deduction under the old regime, the CGHS-versus-PM-JAY-70+ choice, and six questions beneficiaries actually ask.

Key Findings

OPD and IPD in one subscription — with no annual cap.

Established in 1954 under the Ministry of Health & Family Welfare, CGHS covers outpatient consultations and free medicines through Wellness Centres, plus inpatient care at government and empanelled private hospitals. There is no fixed annual monetary limit — coverage is bounded by CGHS package rates, not by a sum insured. This is far wider than any private policy or PM-JAY.

A benefit for those who serve — not the general public.

Eligibility is restricted: serving Central Government employees in CGHS cities, CG pensioners and family pensioners, their dependants, Members of Parliament, sitting and retired judges of the Supreme Court and High Courts, freedom fighters, and PIB-accredited journalists in Delhi. Where both spouses are CG employees, only the higher earner contributes — one subscription covers the family.

₹250 to ₹1,000 a month, by pay level — for the whole family.

The subscription is deducted from salary or pension on the 7th CPC pay matrix: ₹250 at Levels 1–5, up to ₹1,000 at Level 12 and above. One contribution covers the principal beneficiary and every registered dependant. Pensioners may instead pay a lifetime membership — a lump sum of 120 months' contribution — after which cover continues for life.

The CGHS rate ceiling is the one limitation that matters.

At empanelled hospitals, treatment is cashless and capped at CGHS rates — no out-of-pocket cost. At non-empanelled hospitals, reimbursement is still only at CGHS package rates, not at actual charges. Premium private hospitals often bill several times the CGHS rate, and the beneficiary bears the gap. Choosing an empanelled hospital for planned treatment is the single most consequential decision.

CGHS contributions are deductible under Section 80D.

Section 80D explicitly names CGHS contributions as qualifying expenditure — a deduction of up to ₹25,000 a year (₹50,000 where a senior citizen is covered), shared with any private premium and preventive check-ups. Crucially, this deduction exists only under the old tax regime. Unlike PM-JAY, where no premium is paid, CGHS contributions reduce taxable income.

CGHS or PM-JAY 70+ — a senior must choose one.

Beneficiaries aged 70+ are not barred from the PM-JAY 70+ expansion, but they cannot claim both for the same treatment — they must elect one. For most CGHS members, CGHS remains stronger: it covers OPD, free medicines and has no annual cap, while PM-JAY 70+ offers ₹5 lakh a year for inpatient care only.

At A Glance

Metric	Value	Detail
Established	1954	Min. of Health & FW
Who can join	CG employees / pensioners	Not general public
Reach	81 cities	342 allopathy centres
Contribution	₹250–₹1,000/mo	By pay level; whole family
OPD + IPD	Both covered	Free OPD medicines
Annual cap	None	Bounded by CGHS rates
Key limit	CGHS rate ceiling	Non-empanelled gap
Tax (80D)	Deductible	Old regime only

Exhibit 01: Monthly Contribution by Pay Level

Pay Matrix Level	Basic Pay (indicative)	Per Month
Level 1–5	Up to ₹47,600	₹250
Level 6	₹35,400–₹1,12,400	₹450
Level 7–11	₹44,900–₹2,08,700	₹650
Level 12+	₹78,800 and above	₹1,000

Position around FY 2025-26; one subscription covers the principal beneficiary and all registered dependants. Pensioners contribute at the level held at retirement, or opt for lifetime membership at 120 months' contribution — for example ₹650 × 120 = ₹78,000.

The Opening · Page 3

The Opening

CGHS is easy to misjudge, because it does something almost no other health scheme in India attempts. A private policy pays for hospitalisation up to a sum insured, then stops. PM-JAY pays for hospitalisation, for eligible families, up to ₹5 lakh a year. CGHS pays for the whole spectrum — the walk-in fever consultation, the month's blood-pressure tablets handed over free at the Wellness Centre, the specialist referral, and the cardiac surgery — under one deduction from your pay or pension, with no annual rupee ceiling on how much it will spend. For a Central Government employee or pensioner, it is not one option among many. It is the primary benefit.

"CGHS does not cap what it will spend on you in a year. It caps what it will pay per procedure — at CGHS package rates. Go to an empanelled hospital and that ceiling costs you nothing. Go to a premium hospital that is not empanelled, and the gap between its bill and the CGHS rate is yours to bear."
The Ceiling That Actually Bites

The structure. Every eligible household is issued a CGHS card linked to one Wellness Centre — the family's front door for OPD. From there, a medical officer refers you onward to a specialist at a government hospital such as AIIMS or Safdarjung, or to an empanelled private hospital for cashless inpatient care. The model is deliberately layered: routine care at the Wellness Centre, escalation by referral, and prior permission for planned hospitalisation.

The FY 2025-26 context. CGHS now runs across 81 cities through 342 allopathy Wellness Centres and 111 AYUSH units, with 22 more centres approved that will extend the network to 103 cities. Package rates were most recently revised in FY 2025-26. Where there is no Wellness Centre, employees fall under the older CS(MA) Rules — reimbursement, not cashless.

The Honest Boundary: CGHS is NOT open to the general public — eligibility is tied to Central Government service. It is NOT unlimited at any hospital — reimbursement is fixed at CGHS package rates, so a non-empanelled premium hospital can leave you with a large gap. It is NOT a substitute for choosing empanelled care for planned treatment. It IS, for those who qualify, the most comprehensive and lowest-cost health cover available in India — provided you use the referral system and stay within the empanelled network.

Structure

Part I

What CGHS Is, Who Is Eligible & What You Pay

Part II

What It Covers, Ward Entitlement & the Rate Ceiling

Part III

Referrals, Section 80D & CGHS vs PM-JAY vs Private

Part IV

The Verdict: Comprehensive, If You Stay In-Network

Strong For

✓ CG employees & pensioners

✓ OPD + free monthly medicines

✓ No annual cap on treatment

✓ Empanelled & government hospitals

Watch Out When

✕ Treated at a non-empanelled hospital

✕ Posted in a non-CGHS city

✕ Skipping prior permission

✕ Expecting the new tax regime 80D

Part I

What CGHS Is, Who Can Join, and What You Actually Pay

A contributory scheme, not a free one: who qualifies and who is left to the CS(MA) Rules; the pay-level contribution table and the pensioner's lifetime-membership choice; and the CGHS card that links each family to one Wellness Centre.

Part I · Page 4

Who Is Eligible

Category	Covered?
Serving CG employees	In CGHS cities
CG pensioners & family pensioners	Yes
Dependants	Spouse, children, parents*
MPs & ex-MPs	Yes
SC / HC judges (sitting & retired)	Yes
General public	No

Freedom fighters and PIB-accredited journalists in Delhi are also covered. *Dependent parents qualify subject to the income-dependency condition. Where both spouses are CG employees, only the higher earner contributes — a single subscription covers the whole family unit.

The Geographic Catch

CGHS City or CS(MA) Rules

CGHS operates only where there is a Wellness Centre — 81 cities as of FY 2025-26, with 22 more approved (Bhilai, Warangal, Tirupati, Navi Mumbai, Mangaluru and others) taking the network toward 103 cities. Employees posted elsewhere are covered under the Central Services (Medical Attendance) Rules, 1944 — a reimbursement model, not the cashless CGHS one.

What You Pay — and the Card

Pay Level	Per Month	Covers
Level 1–5	₹250	Whole family
Level 6	₹450	Whole family
Level 7–11	₹650	Whole family
Level 12+	₹1,000	Whole family

Deducted from salary for serving employees, from pension for pensioners. It is a single family subscription, not a per-person premium. Pensioners contribute at the level held at retirement — or pay a one-time lifetime membership of 120 months' contribution, after which cover continues for life with no further deduction.

The lifetime-membership maths: a pensioner who retired at Level 7–11 (₹650/month) pays ₹650 × 120 = ₹78,000 once, and never sees another deduction. The break-even is exactly ten years. Beyond that, every additional year of cover is effectively free — which is why members in reasonable health usually prefer it. Each household also holds a CGHS card, linked to one Wellness Centre, listing every registered dependant and the unique CGHS ID. Integration with the ABHA digital health account is rolling out, but the physical card remains the primary access document.

Part II

What CGHS Covers, Your Ward Entitlement, and the Rate Ceiling

OPD and inpatient care under one scheme — free medicines, specialist referrals, surgery, cancer and cardiac care; the ward type your pay entitles you to; and why the CGHS package rate, not any annual limit, decides what leaves your own pocket.

Part II · Page 6

OPD + IPD Under One Scheme

Outpatient — Through the Wellness Centre

General physician consultations (walk-in or booked online), prescribed medicines dispensed free from the centre pharmacy, referrals to specialists at government or empanelled hospitals, and basic diagnostics. A family representative can even collect a referral letter on the patient's behalf.

Inpatient — Government & Empanelled

At government hospitals (AIIMS, Safdarjung, RML) — no charge. At empanelled private hospitals — cashless at CGHS package rates; the hospital bills the government directly. Includes surgery, ICU, cancer care, dialysis, cardiac procedures (CABG, angioplasty), maternity, implants, dental, ophthalmology and hearing aids.

No Fixed Annual Cap

Unlike a sum-insured policy, CGHS sets no annual monetary ceiling. A member can have a ₹6-lakh surgery one year and a ₹4-lakh procedure the next — both covered, provided treatment is priced at CGHS package rates at an empanelled or government facility.

Ward Entitlement by Basic Pay

Basic Pay / Month	Ward	Room Rent*
Up to ₹36,500	General	₹1,500/day
₹36,501–₹50,500	Semi-Private	₹3,000/day
Above ₹50,500	Private	₹4,500/day

*Indicative CGHS room-rent rates, FY 2025-26. Package rates are benchmarked on a semi-private basis, enhanced for private-ward entitlement and adjusted down for general ward.

The CGHS Rate Ceiling — Read This Twice

Empanelled hospital: cashless, capped at CGHS rates — no out-of-pocket cost. Non-empanelled hospital: reimbursed only at CGHS package rates, not actual charges. A premium hospital billing several times the CGHS rate leaves you to bear the difference. For planned treatment, choosing an empanelled hospital is critical.

Emergencies Are the Exception

In a genuine emergency, treatment at any hospital — empanelled or not — is permitted and later reimbursed at CGHS rates for the stabilisation period, with no prior permission. The hospital or beneficiary must inform the CGHS authority within 24 hours.

Part III

Getting Care, the Section 80D Benefit, and How CGHS Compares

The four-step referral and prior-permission path; why CGHS contributions are deductible under Section 80D but only in the old tax regime; and where CGHS stands against PM-JAY and private health insurance — including the 70+ choice a senior must make.

Part III · Page 8

The Referral Path

Wellness Centre first

Any health concern begins with a general physician consultation at your attached Wellness Centre.

Referral letter

If specialist care is needed, the medical officer refers you to a specific department. A representative may collect the letter for you.

Prior permission

For planned hospitalisation at an empanelled private hospital, prior permission from the CGHS authority is required.

Emergency bypass

Emergencies need no prior permission — seek the nearest appropriate hospital and inform CGHS within 24 hours.

The 80D Benefit

Section 80D — Old Regime Only

Section 80D explicitly names CGHS contributions as qualifying expenditure. The deduction is up to ₹25,000 a year (self, spouse, dependent children), rising to ₹50,000 where a senior citizen is covered. CGHS contribution, private premium and preventive check-ups share this same aggregate limit. It applies only under the old tax regime — the new regime offers no 80D deduction.

CGHS vs PM-JAY vs Private

Factor	CGHS	PM-JAY	Private
OPD cover	Yes	No	Add-on
Free medicines	Yes	No	No
Annual cap	None	₹5L/yr	Sum insured
Pre-existing	Covered	Covered	1–4 yr wait
80D benefit	Yes	No premium	Yes
Monthly cost	₹250–1,000	Zero	Market

CGHS reaches 81 cities; PM-JAY and private networks are pan-India. CGHS remains the widest cover for those eligible.

The 70+ Choice

Beneficiaries aged 70+ may opt into the PM-JAY 70+ expansion (Ayushman Vaya Vandana Card, launched 29 October 2024) but cannot claim both schemes for the same treatment. For most CGHS members, CGHS stays stronger — OPD, free medicines, no annual cap — versus PM-JAY's ₹5 lakh inpatient-only cover.

The bottom line on comparison: for someone eligible, CGHS is not competing with private insurance on equal terms — it is broader and cheaper on almost every axis except geographic reach and the non-empanelled rate ceiling. The sensible pairing for many is CGHS as the core, plus a modest private top-up policy to cover treatment at a preferred non-empanelled hospital. Both the CGHS contribution and the top-up premium count toward the same 80D limit under the old regime.

Part IV

The Verdict

The most complete cover in India — if you stay in-network.

Part IV: The Verdict · Page 10

30-Second Summary

CGHS is a contributory health scheme for Central Government employees, pensioners and their dependants — established in 1954, run by the Ministry of Health & Family Welfare, and available across 81 cities. For ₹250 to ₹1,000 a month by pay level, one family subscription covers OPD consultations, free medicines, specialist referrals and inpatient care at government and empanelled private hospitals, with no fixed annual monetary cap. It is the most comprehensive health benefit available to those who qualify.

The one number that governs your out-of-pocket cost is the CGHS package rate. Inside the empanelled network, treatment is cashless and free to you; outside it, reimbursement is capped at CGHS rates and you bear any excess. Contributions are deductible under Section 80D — up to ₹25,000, or ₹50,000 with a senior citizen — but only under the old tax regime. And a beneficiary aged 70+ must choose between CGHS and PM-JAY 70+, not both. Use the referral system, seek prior permission for planned care, and stay in-network.

"CGHS answers the question every family fears — who pays when illness comes? For those who serve the State, the answer is: the scheme does, from the first consultation to the operating theatre, with no annual limit. The only condition it sets is a fair one — be treated where it has agreed a price. Honour that, and CGHS is the most complete cover in the country."
The Final Orientation

The Bottom Line: If you are a Central Government employee or pensioner, CGHS is your primary and most comprehensive health benefit — use it fully. Attach your family to a Wellness Centre, keep the card and dependant list current, and route planned care through referral and prior permission. For any planned procedure, choose an empanelled or government hospital so the CGHS rate costs you nothing. Consider a modest private top-up if you want access to a specific non-empanelled hospital. Claim the Section 80D deduction if you are on the old regime. And if you are 70+, weigh the PM-JAY choice deliberately — for most, CGHS remains the stronger cover.

ADWIZR · July 2026

Decision Rules

Use It Well By

✓ Staying inside the empanelled network

✓ Taking referral & prior permission

✓ Claiming 80D on the old regime

✓ Weighing lifetime membership as a pensioner

Where Cost Leaks In

✕ Planned care at a non-empanelled hospital

✕ Skipping prior permission

✕ Double-claiming CGHS and PM-JAY

✕ Assuming 80D under the new regime

Three Misconceptions

What Beneficiaries Get Wrong

(1) "CGHS pays whatever the hospital charges." No — it pays at CGHS package rates; the non-empanelled gap is yours. (2) "I'll get the 80D deduction anyway." Only under the old regime. (3) "As a senior I can use CGHS and PM-JAY together." You must choose one per treatment, not both.

vs Private Insurance

Broader, Cheaper — but Networked

CGHS: OPD + IPD, free medicines, no annual cap, ₹250–₹1,000/month — but bounded by CGHS rates and 81 cities. Private policy: pan-India, any hospital in-network, but capped at a sum insured with waiting periods. Different tools; a top-up can bridge the gap.

OPD+IPD

Cover

Free OPD medicines

No cap

Annual limit

At CGHS rates

80D

Tax benefit

Old regime only

Beneficiary FAQ

Questions CGHS Beneficiaries Ask

Six questions, answered directly.

Beneficiary FAQ · Page 12

Frequently Asked Questions

Q1 I'm posted to a city with no CGHS Wellness Centre. Am I covered?

Yes, but through a different mechanism. In cities without a CGHS Wellness Centre you are covered under the Central Services (Medical Attendance) Rules, 1944 — the CS(MA) Rules — which are reimbursement-based rather than cashless. You pay bills at approved facilities and claim reimbursement from your office at defined rates, instead of using the cashless CGHS model. As of FY 2025-26 CGHS operates in 81 cities, with 22 further Wellness Centres approved that will extend coverage to 103 cities.

Q2 I retired at Level 10 paying ₹650 a month. Monthly, or lifetime membership?

Lifetime membership is a one-time payment equal to 120 months of your contribution — ₹650 × 120 = ₹78,000 — after which CGHS benefits continue for life with no further deduction. The break-even is exactly 120 months. If you are in reasonable health and expect to live well beyond ten years post-retirement, the lump sum removes the recurring pension deduction and is administratively simpler. If you would rather preserve liquidity, the monthly route costs the same up to the break-even point.

Q3 My father is a 73-year-old CGHS beneficiary. Should he switch to PM-JAY 70+?

For most CGHS beneficiaries, CGHS remains the stronger option — it covers OPD, free medicines and inpatient care with no fixed annual cap. The PM-JAY 70+ cover (Ayushman Vaya Vandana Card) provides ₹5 lakh a year for inpatient treatment only, which is far narrower. A beneficiary cannot draw from both schemes for the same treatment; a choice must be made. Unless your father frequently needs treatment at hospitals not empanelled under CGHS, staying with CGHS is usually the better choice.

Q4 Can I claim Section 80D for both my CGHS contribution and a private premium?

Yes, but within a single shared ceiling and only under the old tax regime. Section 80D explicitly names CGHS contributions as a qualifying expenditure. The limit is ₹25,000 a year for self, spouse and dependent children, rising to ₹50,000 where a senior citizen (aged 60+) is covered. Your CGHS contribution, any private health insurance premium and preventive health check-ups are aggregated against that same limit — it is not a separate deduction for each. Under the new tax regime, the 80D deduction is not available at all.

Q5 The empanelled hospital says the implant costs more than the CGHS rate. My options?

You have two routes. First, accept the implant at the CGHS-empanelled hospital at CGHS package rates and bear any difference the hospital charges above that rate. Second, have the procedure done at a Government hospital such as AIIMS or Safdarjung, where the implant is provided at government rates with no additional out-of-pocket cost in most cases. The Government-hospital route generally eliminates the implant top-up, at the cost of choosing a government facility.

Q6 Can I add my newly married spouse to my CGHS card?

Yes. A newly married spouse is added to your CGHS card by submitting the marriage certificate and the required forms at your attached Wellness Centre. Dependent parents can be added similarly once the income-dependency condition is satisfied. All changes to family composition — additions, deletions, address changes — are processed at the Wellness Centre to which your card is linked.

Key Terms & Definitions

CGHS

The Central Government Health Scheme — a contributory health programme established in 1954 under the Ministry of Health & Family Welfare, providing Central Government employees, pensioners and dependants with OPD and inpatient care under a single monthly subscription. The most comprehensive health benefit available to those eligible.

Wellness Centre

The CGHS primary health facility to which each beneficiary family is attached. It handles OPD consultations, dispenses free prescribed medicines, and issues referral letters to specialists and hospitals. As of FY 2025-26 there are 342 allopathy centres and 111 AYUSH units across 81 cities.

CGHS Package Rate

The pre-agreed price CGHS pays for a given procedure. At empanelled hospitals treatment is cashless at this rate; at non-empanelled hospitals reimbursement is capped at it, so any excess charged by the hospital is borne by the beneficiary. Rates were last revised in FY 2025-26.

Lifetime Membership

A one-time contribution by a pensioner equal to 120 months (10 years) of the monthly rate, after which CGHS cover continues for life with no further deduction. For a Level 7–11 retiree this is ₹650 × 120 = ₹78,000; the break-even is exactly ten years.

CS(MA) Rules

The Central Services (Medical Attendance) Rules, 1944 — the reimbursement-based medical framework covering CG employees posted in cities without a CGHS Wellness Centre. Bills are paid at approved facilities and reimbursed at defined rates, rather than settled cashlessly as under CGHS.

Section 80D

The Income Tax Act provision allowing a deduction for health-related expenditure, which explicitly includes CGHS contributions — up to ₹25,000 a year (₹50,000 with a senior citizen), shared with private premiums and preventive check-ups. Available only under the old tax regime.