Your father retired from a central government job and carries his CGHS card in his wallet like a talisman. But when his knee pain flares up, the questions start. Does he need a referral from the wellness centre, or can he go straight to the empanelled hospital? Will the hospital ask for money? What if it is an emergency at night? And where did that old discharge summary go, the one the new orthopaedic surgeon wants to see?
The Central Government Health Scheme (CGHS) covers more than 40 lakh serving employees, pensioners and their families across 80-plus cities, and it is one of the most generous health schemes in the country. Yet many beneficiaries use only a fraction of what they are entitled to, because the rules feel complicated and keep changing. This guide explains who is eligible, what the CGHS card covers, the current referral rules, how claims work, and how to use the myCGHS app and ABHA linking to keep things simple.
What Is CGHS and Who Is Eligible?
CGHS began in Delhi in 1954 to provide comprehensive healthcare to central government employees and their families. Today it runs a network of wellness centres (dispensaries), polyclinics, labs and AYUSH centres, and it has tie-ups with hundreds of private empanelled hospitals and diagnostic centres.
Who can get a CGHS card
- Serving central government employees posted in a CGHS-covered city
- Central government pensioners and family pensioners, who can choose a CGHS city to register in
- Members and former members of Parliament, former Vice-Presidents and Governors
- Freedom fighters, and serving and retired judges of the Supreme Court and High Courts
- Employees of certain autonomous bodies and some other categories notified by the government, such as accredited journalists in some cities
Which family members are covered
| Family member | Eligibility conditions (summary) |
|---|---|
| Spouse | Covered, whether or not earning |
| Sons | Until age 25, marriage or employment, whichever comes first; permanently disabled sons at any age |
| Daughters | Until marriage or employment |
| Parents | Must be residing with the employee and wholly dependent; one set of parents (own or in-laws) |
| Other dependants | Certain dependent siblings, widowed or divorced daughters and other relatives, subject to rules |
For dependants other than the spouse, the income limit is usually ₹9,000 per month plus the Dearness Relief on that amount. A 2025 order also extended eligibility to dependent transgender children and siblings. Check the latest office memorandum or ask your CGHS wellness centre, since conditions are revised from time to time.
CGHS Contribution Rates and the Lifetime Card
Serving employees pay a monthly contribution through salary, based on their 7th Pay Commission pay level. Pensioners can pay yearly, or pay ten years' contribution once for a lifetime card.
| Pay level | Monthly contribution | Lifetime card for pensioners (10 years) |
|---|---|---|
| Level 1–5 | ₹250 | ₹30,000 |
| Level 6 | ₹450 | ₹54,000 |
| Level 7–11 | ₹650 | ₹78,000 |
| Level 12 and above | ₹1,000 | ₹1,20,000 |
Your ward entitlement in an empanelled hospital (general, semi-private or private) depends on your basic pay or pension, not your contribution level. The thresholds have been revised over time, so check the current order or ask your wellness centre.
How to apply
- Serving employees apply through their office or department. The application, photographs and proof of dependants are forwarded to the CGHS office.
- Pensioners apply to the Additional Director of CGHS in the chosen city, with the pension payment order (PPO), proof of contribution, photographs and dependants' documents. Many steps can now be done online through the CGHS beneficiary portal.
- After registration, you can download your e-card or receive a card for each family member.
What the CGHS Card Covers
CGHS covers almost the entire range of medical care, from a fever to cardiac surgery.
Outpatient care at wellness centres
- Consultations with medical officers at your allotted wellness centre
- Free medicines, including long-term medicines for diabetes, blood pressure, thyroid and heart disease
- Basic lab tests at CGHS labs
- AYUSH (Ayurveda, Yoga, Unani, Siddha, Homeopathy) consultations and medicines at AYUSH centres
Specialist consultations and investigations
- Specialist consultations at CGHS polyclinics, government hospitals and empanelled private hospitals
- Lab tests, X-rays, ultrasound, CT, MRI and other investigations at government facilities or empanelled diagnostic centres
- Cashless investigations for pensioners and other eligible categories when properly referred
Hospitalisation
- Treatment and surgery at government hospitals and CGHS empanelled hospitals, as per approved package rates
- Cashless treatment for pensioners and several other categories on a valid referral or in an emergency
- Serving employees may receive cashless treatment or claim reimbursement through their department, depending on the situation; your office can clarify which applies
Recent changes to fees and package rates
- The consultation fee paid to empanelled hospitals for a specialist was raised to ₹350 in 2023, and a separate rate of ₹700 applies to super-specialists (DM/MCh) from January 2026.
- CGHS package rates for roughly 2,000 procedures were revised from 13 October 2025, the first major overhaul in years, with lower rates for Tier-II and Tier-III cities.
Higher rates were meant to encourage more good hospitals to stay empanelled and to reduce the number of hospitals refusing CGHS patients.
CGHS Referral Rules: When You Need One and When You Don't
Referral rules cause more confusion than anything else in CGHS. Here is a simplified summary based on the revised guidelines of 2024:
| Situation | Referral needed? |
|---|---|
| Routine specialist visit, beneficiary under 70 | Yes, from your CGHS wellness centre medical officer. Referrals can also be obtained via video consultation in many cities. |
| Beneficiary aged 70 or above | No referral needed to consult a specialist at an empanelled hospital. Listed investigations and procedures can be done without further referral. |
| Medical emergency | No referral needed. Go to any empanelled hospital for cashless treatment, or to the nearest hospital if needed. |
| Emergency at a non-empanelled hospital | No referral, but you usually pay first and claim reimbursement at CGHS rates. Shift to an empanelled hospital once stable if the doctors advise it. |
| Non-listed procedures or high-cost items | Usually need prior permission, except in emergencies |
What counts as an emergency?
Conditions such as heart attack, stroke, severe breathlessness, major accidents, serious bleeding, sudden loss of consciousness, high fever with confusion, and similar life-threatening situations. The treating hospital issues an emergency certificate, which is the key document for both cashless treatment and reimbursement. Keep a copy.
Medical Reimbursement Claims and the myCGHS App
Filing a reimbursement claim
If you paid for treatment, for example in an emergency at a non-empanelled hospital or for an item not covered by cashless treatment, you can file a medical reimbursement claim (MRC):
- Pensioners usually submit claims through their CGHS wellness centre or the office of the Additional Director.
- Serving employees submit claims through their own department.
Typical documents include:
- The claim form, filled and signed
- Original bills and payment receipts
- The discharge summary (see our discharge summary guide)
- The emergency certificate, if applicable
- Prescriptions and investigation reports
- A copy of the CGHS card and referral letter, if any
Reimbursement is made at CGHS package rates, not the full amount billed by a private hospital. Before you sign anything at discharge, read our guide on checking and disputing hospital bills. Submit claims promptly, as time limits apply.
The myCGHS app
The official myCGHS app, available on Android and iOS, lets beneficiaries:
- Book and cancel appointments at wellness centres
- View lab reports from CGHS labs
- Check medicine history
- Track the status of reimbursement claims
- View referral details
- Locate nearby wellness centres and empanelled hospitals
- Download the CGHS e-card
Linking CGHS with ABHA
The Health Ministry has made it mandatory to link your CGHS beneficiary ID with your ABHA (Ayushman Bharat Health Account) ID. This is done through the CGHS beneficiary portal using OTP verification. Linking lets your CGHS records become part of your digital health record under the Ayushman Bharat Digital Mission. Our ABHA card guide explains how to create an ABHA ID if your parents do not have one yet.
CGHS and Ayushman Vay Vandana for seniors
The expanded Ayushman Bharat PM-JAY scheme covers all citizens aged 70 and above through the Ayushman Vay Vandana card. Seniors already covered by CGHS, ECHS or similar government schemes generally have to choose between continuing their existing scheme and opting for PM-JAY. For most CGHS pensioners, CGHS offers wider coverage, including free OPD medicines, but compare carefully. Our PM-JAY guide has the details.
Practical Tips for CGHS Beneficiaries and Their Families
- Carry the CGHS card (or e-card) and ABHA details at all times, especially for elderly parents. Save photos on their phone and yours.
- Check the current empanelled list before planned treatment. Hospitals join and leave the panel, and empanelment can be limited to certain specialities.
- Keep every referral slip, emergency certificate and discharge summary. These documents decide whether a claim is paid.
- Ask the hospital to confirm cashless treatment at admission, and inform the CGHS help desk if you face refusal.
- Use the 70+ rule. Parents aged 70 or above can see specialists directly, which saves repeated trips to the wellness centre.
- Escalate problems. If a wellness centre or hospital does not follow the rules, use the CGHS grievance mechanism or the government's CPGRAMS portal.
- Get your annual preventive tests done. Many routine tests are available free through CGHS. See our senior citizen health checkup guide.
Bringing order to scattered reports
A CGHS beneficiary's records are spread across many places: wellness centre prescriptions, CGHS lab reports in the myCGHS app, empanelled lab reports on WhatsApp or email, discharge summaries from private hospitals, and old paper files at home. For adult children managing a retired parent's health from another city, this is a constant headache.
When you upload your reports to MedicalVault, every report, whether from a CGHS lab, an empanelled diagnostic centre or a private hospital, is organised in one place with test values extracted automatically. MedicalVault's trend analysis shows how your parent's HbA1c, creatinine or haemoglobin has changed over the years, which is exactly what a specialist wants to know. The family sharing feature lets siblings in different cities see the same up-to-date records, so whoever takes your father to his next appointment has the full history.
Key Takeaways
- The CGHS card gives central government employees, pensioners and their dependants comprehensive healthcare in 80-plus cities, including free OPD medicines and cashless hospital care.
- Monthly contributions range from ₹250 to ₹1,000 based on pay level; pensioners can buy a lifetime card by paying ten years' contribution once.
- Beneficiaries under 70 need a wellness centre referral for routine specialist care; those 70 and above can see empanelled specialists directly.
- In an emergency, no referral is needed. Keep the emergency certificate, which is essential for cashless treatment and reimbursement.
- CGHS package rates for about 2,000 procedures were revised from 13 October 2025, and super-specialist consultations are paid at ₹700 from January 2026.
- Use the myCGHS app for appointments, lab reports and claim tracking, and link your CGHS ID with ABHA, which is now mandatory.
- Keep every CGHS and private report together in MedicalVault so your family and doctors always have your complete health history.