Central Government Health Scheme (CGHS)

The Central Government Health Scheme (CGHS) is a contributory health scheme of the Government of India, run by the Ministry of Health and Family Welfare through the Directorate General of CGHS, that provides medical care to serving central government employees, central government pensioners and their dependants for a monthly contribution of Rs. 250 to Rs. 1,000 fixed by pay level under Office Memorandum No. S.11011/11/2016-CGHS(P)/EHS dated 9 January 2017. It was established in New Delhi on 1 July 1954. On the reply to Lok Sabha Unstarred Question No. 2470, answered on 13 February 2026, it runs 342 allopathic Wellness Centres and 111 AYUSH units across 81 cities.

CGHS is the medical cover that sits under the pay and pension of a central government employee. Where the pay matrix fixes what the employee earns and the central government pension fixes what the retiree draws, CGHS fixes what either of them pays for medical care: the monthly contribution buys outpatient treatment and free medicines at a Wellness Centre, specialist consultation and diagnostics, and hospitalisation at an empanelled private hospital at the package rates the scheme notifies. For a pensioner in a CGHS city, a one-time payment of 120 months of contribution buys a card valid for life.

Three orders decide almost everything a beneficiary deals with. The contribution slabs come from the Office Memorandum of 9 January 2017, effective 1 February 2017, and have not been revised since. The ward entitlement in an empanelled private hospital comes from the Office Memorandum of 28 October 2022 and turns on basic pay, not on pay level. The package rates the scheme pays come from CGHS Office Memorandum No. 5-16/CGHS(HQ)/HEC/2024(Part I) dated 3 October 2025, which superseded every earlier rate memorandum with effect from 13 October 2025 and rebuilt the rate structure around accreditation, hospital type, city tier and ward.

This article covers what CGHS is and how it grew from sixteen dispensaries in 1954, who administers it, who is covered and who counts as a dependant, the Wellness Centres and the systems of medicine, the contribution and the ward entitlement, the referral rules revised on 28 June 2024, the 2025 package rates, how reimbursement works when treatment is taken outside the network, the card, the pensioner whole-life card, the boundary with the Fixed Medical Allowance, the CS(MA) Rules, the Ex-Servicemen Contributory Health Scheme and Ayushman Bharat, and the income-tax treatment of the contribution under Section 126 of the Income-tax Act 2025. Every load-bearing figure is traced to the order that fixes it.

Two things are most often stated loosely. The contribution is set by pay level while the ward entitlement in a private hospital is set by basic pay, and the two are not the same test. And the pensioner contribution is worked out on the pay level the pensioner held at retirement, not on the pension drawn.

Definition and design

CGHS is a health service, not an insurance policy: it runs its own clinics, empanels its own panel of hospitals, and notifies its own schedule of rates. The beneficiary pays a flat monthly contribution of Rs. 250 to Rs. 1,000 by pay level and draws care from that network. The contribution does not rise with the medical care used, so a beneficiary who spends a month in an intensive care unit pays the same as one who never enters a Wellness Centre.

The scheme delivers care in three main ways. The first is the CGHS Wellness Centre, formerly called the CGHS dispensary, where a beneficiary consults a doctor, collects prescribed medicines free of charge, and is referred onward when specialist care is needed. The second is the network of empanelled private hospitals and diagnostic centres, where a beneficiary is treated at CGHS-approved package rates, usually without paying at the point of care. The third is reimbursement, which covers treatment taken in an emergency or where the network cannot be used, capped at the CGHS rate.

Three features separate CGHS from a private health-insurance policy. It pays for outpatient consultation and the monthly medicines a chronic condition needs, which an ordinary indemnity policy does not; it carries no sum-insured ceiling, because it pays the notified package rate rather than a capped claim; and for a pensioner it continues for life on the one-time payment of 120 months of contribution. Nothing in it is underwritten by age or health history.

History and growth

CGHS opened on 1 July 1954 in New Delhi as the Contributory Health Service Scheme, with sixteen dispensaries serving about 53,000 central government employees. The alternative then in force was the Central Services (Medical Attendance) Rules 1944, which reimbursed medical expenses but ran no clinics of its own, and which still governs serving employees in cities CGHS does not reach.

From that start the scheme spread city by city, as the central government’s presence grew. Wellness Centres opened in the major administrative and industrial centres, then in state capitals and other cities with a concentration of central government staff and pensioners. On the reply to Lok Sabha Unstarred Question No. 2470, answered on 13 February 2026, CGHS runs 342 allopathic Wellness Centres and 111 AYUSH units across 81 cities, and a further 22 Wellness Centres have been approved, at Bhilai, Durg, Narmadapuram, Bahadurgarh, Rewari, Rohtak, Jamshedpur, Sabarmati, Bharatpur, Alwar, Haldwani, Nainital, Dharamshala, Kangra, Patiala, Udupi, Shivamogga, Warangal, Thirupathi, Navi Mumbai, Hapur and Mangaluru.

A new Wellness Centre is not opened on demand. The same reply states the norm: a minimum of 2,500 principal cardholders or 6,000 beneficiaries in the location, subject to the availability of resources, suitable accommodation, and the creation of posts of medical officers, pharmacists, staff nurses and clerical staff, the last of which falls to the Department of Expenditure. That is why the map has widened slowly while the categories covered and the systems of medicine offered have widened faster.

The core design, a contributory clinic-and-panel scheme run by the health ministry, has not changed since 1954. What moves is the money: the contribution slabs and the ward entitlements are revised on the recommendations of each pay commission, most recently the 7th Central Pay Commission, and the package rates were rebuilt on 3 October 2025.

Administration

CGHS is administered by the Ministry of Health and Family Welfare, the health ministry of the Union government, and is delivered on the ground through the Directorate General of CGHS. The Directorate General is headed by a Director General drawn from the Central Health Service, the cadre of government doctors, and it runs the Wellness Centres, manages the empanelment of private hospitals, fixes the package rates, and issues the orders that govern contribution, entitlement and reimbursement.

Policy and rates are set by the ministry through Office Memoranda, the same instrument that governs pay and allowances elsewhere in government. The contribution slabs, the ward entitlements and the empanelment rates are each fixed by a dated Office Memorandum, and it is those orders, rather than any general description, that decide what a beneficiary pays and is entitled to. This article cites the governing order for each figure it states.

The scheme is distinct from the Department of Personnel and Training, which governs service conditions, and from the Department of Pension and Pensioners’ Welfare, which governs pension, although the three interact: the pension department, for instance, governs the Fixed Medical Allowance that a pensioner draws instead of CGHS in a non-CGHS area.

Who is covered

The two largest covered categories are serving central government employees and central government pensioners. A serving employee posted in one of the 81 CGHS cities, and paid from central civil estimates, is covered, and the contribution is recovered from the monthly salary. A central government pensioner is covered on joining the scheme and paying the pensioner contribution, whether the pension is under the Old Pension Scheme or the retiree is a beneficiary under the National Pension System framework.

Beyond serving employees and pensioners, the scheme extends to several other categories: sitting and former Members of Parliament, former Governors and Vice-Presidents, freedom fighters, sitting and retired judges of the Supreme Court and the High Courts, accredited journalists in Delhi, employees and pensioners of certain autonomous bodies, and some others notified from time to time. The common thread is a connection to the central government or to a status the government has chosen to extend the scheme to.

The cover extends to dependants, on a residence test and an income test that is fixed by order rather than left to judgment. Ministry of Health and Family Welfare Office Memorandum No. B-12014/01/2016-JCM dated 5 April 2017 sets the income limit for dependency at Rs. 9,000 a month from all sources including pension and family pension, plus the dearness relief on a basic pension of Rs. 9,000, and applies the same limit under the CS(MA) Rules 1944. At the dearness relief rate of 60% the limit is Rs. 14,400 a month. The dearness relief taken is the amount actually drawn on the date of consideration, not the amount that may later fall due for that date.

The family members who can be added on that test are the spouse, dependent children, and dependent parents, and in defined circumstances a dependent brother or sister, all subject to normally residing with the beneficiary. A son is covered until he starts earning or reaches the prescribed age, a daughter until she marries or starts earning, and a child with a disability carries no age bar at all. The residence condition is what most often defeats a claim for a dependent parent: a parent living in another city on their own pension fails both limbs of the test at once.

Enrolment in service and after retirement

CGHS is entered twice in a career, once on appointment and once at retirement, and the second entry is the one that costs money. A serving employee posted to a CGHS city is enrolled on appointment, the contribution for their pay level is recovered from the monthly salary, and the family is added as dependants. Through the working years the employee and the family use the Wellness Centre and the empanelled network, and the card is valid so long as the employee is in service. The employee’s ward entitlement rises over time, not because the level changes but because basic pay rises with each annual increment and crosses the ward thresholds set by the 2022 order.

At retirement the journey changes gear. The serving-employee card is converted to a pensioner card, and the retiree makes the choice that defines their cover for the rest of life: an annual contribution or the one-time whole-life payment. A pensioner who stays in a CGHS city almost always takes the whole-life card. A pensioner who retires to a place with no CGHS Wellness Centre draws the Fixed Medical Allowance for outpatient care instead, and may hold a CGHS card for hospitalisation at the nearest CGHS city, subject to the current rules. On the death of a pensioner, the family pension continues to a spouse, and the CGHS cover continues with it, so the scheme follows the family through the whole arc of a government career and beyond it.

Wellness Centres and the systems of medicine

The Wellness Centre is where a beneficiary enters the scheme and where every referral into the empanelled network starts. It is the renamed CGHS dispensary, and it is where a beneficiary registers, consults a general-duty medical officer, collects prescribed medicines without charge, and is referred to a specialist or an empanelled hospital when the case needs it. The Wellness Centre also issues and renews the CGHS card, records the beneficiary’s treatment, and is the point from which permission for planned hospitalisation is sought.

The scheme runs allopathic Wellness Centres, AYUSH Wellness Centres and poly-clinics, the last offering specialist consultation under one roof. The count stood at 342 allopathic Wellness Centres and 111 AYUSH units across 81 cities on the reply to Lok Sabha Unstarred Question No. 2470, answered on 13 February 2026, so a beneficiary can choose allopathy or one of the traditional systems, Ayurveda, Yoga, Unani, Siddha or Homoeopathy, at the same contribution. A beneficiary can also consult without attending at all: the Office Memorandum of 28 June 2024 records tele-consultation through e-Sanjeevani 2.0 as an available route.

For a beneficiary the practical value of the Wellness Centre is the outpatient cover: the routine consultations, the repeat prescriptions for a chronic condition, and above all the free medicines, which are the part of medical care that ordinary health insurance does not meet. For a pensioner managing a long-term condition such as diabetes or hypertension, the monthly supply of medicines from the Wellness Centre is often the single largest saving the scheme delivers.

The monthly contribution

The CGHS contribution is a monthly amount fixed by the beneficiary’s pay level, not by the salary or the medical care used. Under the 7th Central Pay Commission the rates were revised by the Ministry of Health and Family Welfare Office Memorandum No. S.11011/11/2016-CGHS(P)/EHS dated 9 January 2017, with the revised rates effective from 1 February 2017. The table below sets out the rates, which remain in force.

For a serving employee the contribution is deducted from the monthly salary, so it appears as a small recovery on the pay slip alongside the other deductions, and it feeds into the take-home salary computation. The amount is the same whatever the medical care used in a given month, which is the essence of a contributory scheme: the healthy subsidise the sick, and the contribution buys access rather than a metered service.

The contribution has not been revised since the 2017 order, so the rates above are current under the 7th CPC regime. They will be looked at again when the 8th Central Pay Commission, constituted by gazette notification on 3 November 2025, makes its recommendations, but no revised CGHS contribution can be stated as fact until that commission reports and the health ministry issues a fresh order.

Ward entitlement in empanelled hospitals

Ward entitlement in an empanelled private hospital is fixed by monthly basic pay, not by pay level, and this is the point most often stated inexactly. The thresholds were revised by Ministry of Health and Family Welfare Office Memorandum F. No. S.11011/11/2016-CGHS(P)/EHS dated 28 October 2022, which lowered the earlier limits and so moved a large number of beneficiaries up a ward class. The thresholds in force are as follows.

Before the 2022 revision the thresholds set by the 9 January 2017 order were higher: a general ward up to Rs. 47,600, a semi-private ward from Rs. 47,601 to Rs. 63,100, and a private ward above Rs. 63,100. The upgrade the 2022 order gives is not automatic on the card. The Ministry of Health and Family Welfare clarification of 22 November 2022 states that a beneficiary, serving or pensioner, eligible for an upgraded ward entitlement on the revised basic-pay slabs may apply for a fresh CGHS card, because the empanelled hospital reads the ward class printed on the card rather than the beneficiary’s current pay. For a pensioner who retired before the 7th CPC came into force the government has said there is no proposal to apply the revised entitlement, so such a pensioner keeps the entitlement fixed at retirement.

The basic-pay test, not a level gloss, is what a hospital applies, and the difference is not academic: two employees at the same pay level fall on different sides of a threshold as their basic pay rises with each annual increment, so a Level 6 employee crosses from general to semi-private during a career without any promotion. Ward class then decides the money twice over. It fixes the room rent the scheme pays, and it scales the package rate for the whole admission: under the Office Memorandum of 3 October 2025 the notified rate is the semi-private rate, a general ward is 5% below it and a private ward 5% above it.

Scope of cover

CGHS pays for outpatient care, medicines, diagnostics and hospitalisation, which is a wider scope than an indemnity health policy carries. At the Wellness Centre it covers outpatient consultation and free medicines, both the everyday prescription and the long-term supply for a chronic condition. It covers specialist consultation, either at a poly-clinic or on referral to an empanelled hospital, and it covers the full range of diagnostic tests, laboratory and imaging, at empanelled diagnostic centres at CGHS rates.

For hospitalisation, the scheme covers treatment at empanelled private hospitals at CGHS-approved package rates, on a referral or permission from the Wellness Centre for a planned admission, and directly in an emergency. The package rate covers the room, the treatment, the surgeon and the standard consumables for the listed procedure, so that a beneficiary admitted for a listed procedure is not billed item by item. Maternity care, surgery, cancer treatment, cardiac care and the other major heads of hospitalisation are all within the scheme, subject to the referral and rate rules.

The care is delivered on a largely cashless basis for pensioners and other specified categories at empanelled hospitals, meaning the hospital bills CGHS directly rather than the beneficiary paying and claiming. For a serving employee the position varies with the category of treatment and the hospital, and in some cases the employee pays and claims reimbursement.

Referral and prior permission

A single referral from any Medical Officer of a CGHS Wellness Centre is valid for three months, covers up to three specialists including the primary specialist, and allows a maximum of six consultations in that period. Ministry of Health and Family Welfare Office Memorandum dated 28 June 2024, issued in partial modification of Office Memorandum No. Z.15025/117/DIR/CGHS/EHSS dated 15 January 2018 and 10 December 2018, replaced the older one-referral-one-consultation practice with that block. The second and third specialists have to be recommended by the primary specialist; the referral is not an open pass.

Treatment at a government hospital needs no referral at all. The same Office Memorandum, continuing Office Memorandum No. Z.15025/18/2020 dated 9 October 2020, provides that “Government hospital” includes every AIIMS, the Institutions of National Importance, the North East institutions, Tata Memorial Hospital and every other medical institution under the central government, and that no referral, permission or endorsement is required for consultation, investigation or a treatment procedure there, including unlisted investigations and procedures. A beneficiary who can reach an AIIMS therefore bypasses the referral system entirely.

Inside the three-month window at a private empanelled hospital, the specialist’s advice carries itself for routine listed investigations and minor procedures that do not need admission: no further endorsement from CGHS is required. Three things still do. A special investigation such as a CT scan, an MRI scan or a PET scan, or any investigation costing more than Rs. 3,000, needs a referral or endorsement, itself valid for three months. Any procedure requiring admission needs an endorsement from a CGHS Medical Officer, again valid for three months. An unlisted investigation or treatment procedure needs permission under the delegated powers, which lie with the Additional Director or Director of CGHS for a pensioner under Office Memorandum No. Z.15025/14/2023/DIR/CGHS dated 27 December 2023, and with the Head of Department or Head of Office for a serving employee under Office Memorandum No. S.12020/4/97-CGHS(P) dated 7 April 1999.

Age relaxes the whole structure. The Office Memorandum of 28 June 2024 lowered the age for the special provision on consultation, investigation and treatment procedures from 75 years to 70 years, in partial modification of Office Memorandum No. Z.15025/35/2019/DIR/CGHS/CGHS(P) dated 29 May 2019, leaving the other conditions unchanged. A beneficiary aged 70 or above therefore approaches an empanelled specialist directly, which for a pensioner managing several conditions removes a Wellness Centre visit before every consultation.

An emergency is the standing exception. In a genuine emergency the beneficiary is admitted first, at the nearest hospital, empanelled or not, and the case is regularised afterwards. The line between a planned admission, which needs an endorsement in advance, and an emergency, which is regularised after the event, is where most reimbursement disputes sit: a planned treatment taken at a non-empanelled hospital without an endorsement and later claimed as an emergency is exactly the case in which reimbursement is refused or cut to the Non-NABH rate of the city.

Empanelled hospitals and package rates

An empanelled hospital or diagnostic centre is a private facility that has signed a Memorandum of Agreement to treat CGHS beneficiaries at the notified CGHS package rate. Empanelment is done city by city, and CGHS publishes the list of empanelled facilities alongside the rate list. The bargain is volume for price: the hospital takes a rate below its open-market tariff in exchange for the flow of beneficiaries the scheme directs to it.

A package rate covers the room, the treatment, the surgeon and the standard consumables for the listed procedure, so a beneficiary admitted for a listed procedure is not billed item by item. Annexures II to VII of the rate memorandum set out what a package includes, the ward categories, ICU and nursing charges, equipment charges, and the admissible and non-admissible items, which is where a disputed bill is usually resolved.

The rate does more than price an admission. It is also the ceiling on reimbursement when treatment is taken outside the network, so a beneficiary who never uses an empanelled hospital is still governed by the rate list. That is why the revision of 3 October 2025 reaches every beneficiary and not only those admitted to a private hospital.

The 2025 revision of package rates

CGHS Office Memorandum No. 5-16/CGHS(HQ)/HEC/2024(Part I) dated 3 October 2025, signed by Dr. Satheesh Y. H., Director (CGHS), notified a fresh rate list in supersession of every previous memorandum on the subject, effective from 13 October 2025. It applies to all healthcare services taken at an empanelled healthcare organisation and to the medical reimbursement claims of serving employees, pensioners and the other eligible categories alike.

The rates are no longer a single number for a procedure. The memorandum rationalised them on four axes at once: accreditation, hospital type, city classification and ward entitlement.

Three things escape the ward loading. Paragraph 2 of Annexure II carves out investigations and radiotherapy, whose rates stay uniform regardless of ward entitlement or admission status unless the test requires admission, so a private-ward beneficiary pays the scheme no more for an MRI than a general-ward beneficiary. Consultation is a flat notified fee under paragraph 7 rather than a ward-scaled one: Rs. 350 for an outpatient or indoor specialist consultation and Rs. 700 for a super-specialist or a psychiatry consultation, each valid for seven days within the same specialty. Critical care is uniform too, at Rs. 5,400 a day under paragraph 3 of Annexure III, across every ward entitlement, city category and hospital type. Day-care and minor procedures are not carved out: they carry package rates and take the 5% adjustment like any other package. For cancer surgery the existing CGHS rules and rates continue unchanged, and the revised rates apply only to chemotherapy, investigations and radiotherapy. The ward loading itself narrowed in 2025: paragraph 4 of the clarification dated 26 November 2014 had set it at 10% down for a general ward and 15% up for a private ward, a spread of 25 percentage points, against the 10 the 2025 memorandum leaves.

The North East region and the Union Territories of Jammu and Kashmir and Ladakh are rated as Y (Tier II) cities regardless of the size of the town, which lifts them 10% above the Z-city figure that the population count alone would produce.

The memorandum also cancelled the empanelment contracts outright. Every Memorandum of Agreement with a private empanelled hospital ceased to be valid at midnight on 13 October 2025, every healthcare organisation had to seek fresh empanelment through the revised Hospital Engagement Module and execute a fresh agreement within 90 days, and any organisation that did not file an undertaking accepting the new terms on or before 13 October 2025 was deemed de-panelled. A beneficiary who had been using one hospital for years should therefore confirm it is still on the list before a planned admission. A clarification on the revised rates followed on 24 March 2026, correcting specific codes for investigations and consultations with effect from the original date.

Reimbursement of medical expenses

Reimbursement for treatment at a hospital that is not empanelled is restricted to the Non-NABH rate of the city concerned, which is 15% below the rate a NABH-accredited hospital would be paid. The Office Memorandum of 3 October 2025 states the rule in terms: in exceptional circumstances, where treatment has been taken from a non-empanelled private healthcare organisation, reimbursement may be considered under the extant instructions, but the rate is restricted to the Non-NABH rate of the concerned city. The scheme pays its own rate, not the bill, and the beneficiary bears the difference.

That rule bites in three situations. A beneficiary falls ill away from a CGHS city; a genuine emergency puts the nearest hospital, which is not empanelled, in the way; or a treatment is not available anywhere in the network. In each the beneficiary pays the hospital and claims reimbursement of the medical expenses from CGHS, and in each the settlement is worked out on the rate list rather than the invoice.

Reimbursement is a fallback, not the main channel. The design routes the beneficiary through the Wellness Centre and the empanelled network, where the rate is applied by agreement and treatment is extended cashless to pensioners and the other specified categories under the 3 October 2025 memorandum. A beneficiary who chooses a non-empanelled hospital for a planned treatment, with no emergency, is in the weakest position of all: the claim is settled at the Non-NABH rate if it is admitted at all.

The beneficiary card

Every CGHS beneficiary holds a card, which is now an individual plastic card carrying a unique beneficiary identification number, backed by a computerised system that records the beneficiary’s entitlement and treatment. Each covered member of the family holds their own card with their own beneficiary ID, linked to the main cardholder. The card is issued and renewed through the Wellness Centre, and it is the document a beneficiary presents at a Wellness Centre or an empanelled hospital to establish entitlement.

The move to a plastic card with a beneficiary ID and an online back end has made the scheme easier to use: appointments at Wellness Centres can be booked online, the beneficiary’s entitlement can be verified at an empanelled hospital electronically, and payments for a pensioner card are made through the government’s Bharatkosh portal. The card states the beneficiary’s entitlement, including the ward class, so that an empanelled hospital can apply the correct package rate.

For a serving employee the card is valid while in service and is surrendered or converted on retirement; for a pensioner the card is issued for the period the contribution covers, annually or, on a one-time payment, for life. The conversion from a serving-employee card to a pensioner card at retirement is a step every retiring employee in a CGHS city has to take, and it is governed by the pensioner-card rules described next.

Adding and removing dependants

The family’s cover is managed member by member, because each covered family member holds a card with their own beneficiary identification number. A beneficiary adds a dependant, a spouse on marriage, a newborn child, or a dependent parent who comes to satisfy the income and residence test, by applying at the Wellness Centre with the supporting documents, on which a fresh card with a new beneficiary ID is issued for that member. A dependant is removed when they cease to qualify, a son who starts earning or a daughter who marries or starts earning, and the beneficiary is expected to report the change.

Keeping the entitlement on the card current matters, because the card states the ward class the beneficiary is entitled to, and an empanelled hospital applies the package rate for the class shown on the card. A change in the beneficiary’s basic pay that moves them across a ward threshold, or a change in family circumstances, should be reflected on the card, and the online system now makes updating and reprinting a card easier than the old paper booklet allowed. For a pensioner the whole-life card, once issued, needs no renewal.

Online enrolment, payment and appointments

Enrolment, the pensioner contribution and Wellness Centre appointments are now handled online, and the pensioner contribution is paid through the government’s Bharatkosh portal rather than by a physical challan. Beneficiaries hold a plastic card with a unique beneficiary ID backed by a computerised database, book Wellness Centre appointments online, and, in the case of a pensioner card, make the contribution through the government’s Bharatkosh payment portal rather than by a physical challan. The online system verifies a beneficiary’s entitlement at an empanelled hospital electronically, so the correct ward class and the CGHS rate are applied without the paperwork the old system needed.

For a pensioner the digital shift has removed much of the friction that once attended the scheme: the whole-life card is applied for and paid for online, the balance-year top-up and the transfer of a card to a spouse are handled through the system, and the beneficiary ID follows the pensioner across CGHS cities so a card issued in one city works in another. The scheme is not fully paperless, and a beneficiary still deals with the Wellness Centre for a referral and a permission, but the routine of enrolment, payment and appointment is now largely online.

Portability between cities and temporary attendance

A beneficiary who moves between CGHS cities carries the entitlement with them, because the beneficiary identification number, not the city, is what the system reads. A serving employee transferred to another CGHS city re-registers at a Wellness Centre in the new city, and the beneficiary ID and the entitlement follow. A pensioner who relocates from one CGHS city to another has the card transferred to the new city rather than buying it afresh. A beneficiary travelling to another CGHS city temporarily can attend a Wellness Centre there as a visiting beneficiary and obtain treatment and medicines, so the cover is not confined to the home city.

The limit of this portability is the map of CGHS cities. A beneficiary who moves to a place with no CGHS Wellness Centre cannot use the scheme’s outpatient care there, which is the situation the Fixed Medical Allowance answers for a pensioner and the CS(MA) Rules answer for a serving employee. Within the network of CGHS cities, however, the entitlement is portable, and the online beneficiary ID is what makes that portability work in practice.

Pensioner enrolment and the whole-life card

A central government pensioner in a CGHS city joins by paying either an annual contribution or 120 months of contribution once, and the second buys a card valid for the rest of life. A central government pensioner in a CGHS city can join the scheme, and the rules for a pensioner card give a choice between paying the contribution year by year and paying once for a whole-life card.

The whole-life option is a one-time payment of 120 months, that is ten years, of contribution, in exchange for a card valid for the rest of the pensioner’s life. The slab used is the contribution the pensioner was paying at the time of retirement, in other words the last pay-level slab, so the one-time amount is worked out on that slab. The table below sets out the four amounts.

The whole-life card is by a distance the better value for a pensioner who expects to remain in a CGHS city, because ten years’ contribution buys cover for a retirement that commonly runs two or three decades, and the medicines alone for a chronic condition usually exceed the one-time payment within a few years. The updated procedure is set out in the Ministry of Health and Family Welfare Office Memorandum No. S.11012/1/2024-EHS dated 27 June 2024, which confirms the whole-life option, provides that payment is made through the Bharatkosh portal, allows a pensioner to top up an existing card by paying only the balance years, and allows a whole-life card to pass to the spouse. A pensioner who bought a whole-life card before the 2017 revision is not asked to pay the difference for the higher current slab.

One condition is important. A pensioner who is drawing the Fixed Medical Allowance must surrender it before taking a CGHS card, because the two benefits cannot be held together. This is the boundary explained in the next section.

Boundary with the Fixed Medical Allowance

A pensioner takes the Fixed Medical Allowance or CGHS outpatient care, not both, and the two answer the same need from opposite ends of the CGHS map. The Fixed Medical Allowance is Rs. 1,000 a month, a fixed sum paid to a pensioner or family pensioner residing in an area not covered by CGHS who does not avail CGHS outpatient care. It was raised from Rs. 500 to Rs. 1,000 with effect from 1 July 2017 by the Department of Pension and Pensioners’ Welfare Office Memorandum No. 4/34/2017-P&PW(D) dated 19 July 2017.

The logic of the boundary is straightforward. A pensioner in a CGHS city can use the Wellness Centre for outpatient care, so no cash allowance is needed. A pensioner in a place with no CGHS Wellness Centre cannot, so the Fixed Medical Allowance gives a flat monthly sum for outpatient expenses instead. A pensioner therefore chooses: the Fixed Medical Allowance for outpatient care where CGHS is not available, or CGHS where it is. The choice can be changed once in a lifetime, under the Department of Pension and Pensioners’ Welfare order of 23 March 2022, so a pensioner who moves to or from a CGHS city can switch.

One combination is expressly allowed, and it is the arrangement that suits a pensioner living outside the 81 CGHS cities. Department of Pension and Pensioners’ Welfare Office Memorandum No. 4/05/2019-P&PW(D) dated 23 March 2022 permits a pensioner to draw the Fixed Medical Allowance for day-to-day outpatient care and hold a CGHS card for hospitalisation only, using the empanelled hospitals of the nearest CGHS city for admissions, and sets the procedure and timeline for changing the option. The prohibited stack is the other one: the Fixed Medical Allowance together with CGHS outpatient care.

Boundary with the CS(MA) Rules and ECHS

CGHS, the CS(MA) Rules 1944 and the Ex-Servicemen Contributory Health Scheme divide central government personnel between them by employment status, location and service: a civilian in a CGHS city, a civilian outside one, and a defence pensioner respectively.

The Central Services (Medical Attendance) Rules 1944, the CS(MA) Rules, are the statutory medical-attendance rules for serving central government employees in cities where CGHS does not operate. Under CS(MA) a serving employee is reimbursed the cost of medical attendance and treatment, broadly at CGHS rates, at government and recognised hospitals. The key limits are that CS(MA) covers serving employees, not pensioners, and applies where CGHS does not; a serving employee within the municipal limits of a CGHS city gets a one-time choice to opt into CGHS instead of CS(MA).

The Ex-Servicemen Contributory Health Scheme, or ECHS, is the parallel scheme under the Ministry of Defence for ex-servicemen and defence pensioners and their dependants. It mirrors CGHS in design, a contributory scheme with polyclinics and empanelled hospitals, but it is a separate scheme with its own network, and defence personnel and pensioners use it and the armed forces medical services rather than CGHS or CS(MA).

The map is therefore: a serving central government civilian employee uses CGHS in a CGHS city and CS(MA) elsewhere; a central government civilian pensioner uses CGHS where available and the Fixed Medical Allowance where not, since CS(MA) does not cover pensioners; and a defence pensioner uses ECHS. Each framework has its own governing rules, and a beneficiary who moves between categories, for instance a serving employee retiring, changes framework at that point.

Income tax on the contribution

The CGHS contribution is deductible under Section 126(2)(a) of the Income-tax Act 2025, and only where tax is computed under the old regime. Section 126(2)(a) allows a deduction for a sum paid to effect or keep in force an insurance on health, or for any contribution made to the Central Government Health Scheme, for the taxpayer, the spouse and dependent children, subject to a ceiling of Rs. 25,000. Section 126(8)(a) substitutes Rs. 50,000 for that ceiling where a senior citizen aged 60 or above is covered, Section 126(3) allows a preventive health check-up inside the ceiling up to Rs. 5,000, and Section 126(4) caps the aggregate at Rs. 50,000 where medical expenditure under Section 126(2)(c) is claimed alongside. The 2025 Act came into force on 1 April 2026 and the corresponding provision for any earlier year is Section 80D of the Income-tax Act 1961, which was amended with effect from 1 April 2014 to name CGHS contributions expressly.

The contribution is not an extra deduction stacked on top of a health-insurance premium: both draw on the same Rs. 25,000 or Rs. 50,000 ceiling. Only the beneficiary’s own contribution qualifies, not any government share. And it is the contribution that is deductible, not the value of the treatment received, so a beneficiary hospitalised three times in a year claims the same figure as one who never attends a Wellness Centre.

The regime choice decides whether any of this is available. Under the old tax regime the Section 126 deduction is allowed in full. Section 202(2) bars it where tax is computed under the new regime in Section 202(1), the default since the financial year 2023-24, which the new tax regime and Section 115BAC articles set out; a pensioner for whom Section 126 is material is one of the narrow cases where the old regime can still be cheaper, worked through in the old versus new tax regime comparison and in income tax for pensioners.

The one-time whole-life payment sits in an unsettled corner of Section 126, and the reason is specific rather than general. Section 126(8)(b) spreads a sum “paid in lump sum in the tax year for more than a year” across the relevant tax years by an appropriate fraction, and Section 126(10) fixes that fraction with a denominator equal to the number of tax years “during which the health insurance remains in force”. A whole-life CGHS card is not health insurance and has no term, so the denominator has no determinate value, and no clarification has been issued applying the fraction to a CGHS lump sum. On the face of Section 126(2)(a) read with the Rs. 25,000 ceiling, a Rs. 1,20,000 payment yields a deduction of Rs. 25,000 in the year of payment, or Rs. 50,000 where a senior citizen is covered, and nothing in the nine years that follow.

AYUSH and preventive health

CGHS ran 111 AYUSH units alongside its 342 allopathic Wellness Centres on the reply to Lok Sabha Unstarred Question No. 2470, answered on 13 February 2026, so a beneficiary can choose Ayurveda, Yoga, Unani, Siddha or Homoeopathy within the same scheme and at the same contribution of Rs. 250 to Rs. 1,000 a month. The AYUSH units treat the chronic and lifestyle conditions for which the traditional systems are often preferred, and they sit alongside the allopathic Wellness Centres rather than replacing them.

The rename from CGHS dispensary to CGHS Wellness Centre was more than cosmetic. It signalled a shift towards preventive and wellness-oriented care, with yoga and lifestyle guidance offered alongside curative treatment. For the scheme’s large pensioner population much of the value is exactly this continuing, preventive management of long-term conditions, the regular consultation and the monthly medicines, rather than the occasional hospitalisation.

Value of the pensioner card

A pensioner on the lowest slab pays Rs. 30,000 once for a card valid for the rest of life, and one on the highest slab pays Rs. 1,20,000, against a retirement that commonly runs two or three decades from a superannuation age of 60. Set against that one-time payment is the cost the pensioner would otherwise bear: the outpatient medicines for a chronic condition, which recur every month for life and which no ordinary health-insurance policy meets, and the hospitalisations of later life at private-hospital rates.

For a chronic condition alone, the monthly medicines supplied free at the Wellness Centre commonly add up, over a few years, to more than the one-time whole-life payment, so the card pays for itself early and then continues at no further cost. Add a single major hospitalisation at CGHS package rates, well below the open-market price, and the scheme’s value over a retirement runs to many times the contribution. This is why converting to a pensioner CGHS card is one of the most consequential financial decisions a retiring employee in a CGHS city makes, and why the whole-life card is almost always the better choice over the annual option for a pensioner who expects to stay in a CGHS city.

Comparison with private health insurance

The two differ on cost basis, not only on cover: a private policy prices the individual, CGHS prices the pay level. A private policy covers hospitalisation up to a sum insured, charges a premium that rises with age and health, is renewed annually, and does not meet outpatient care or routine medicines. CGHS covers outpatient care and medicines as well as hospitalisation, has no sum-insured ceiling on treatment at package rates, charges a contribution of Rs. 250 to Rs. 1,000 fixed by pay level, and, for a pensioner, continues for life on the one-time payment.

Ayushman Bharat and beneficiaries aged 70 and above

A CGHS beneficiary aged 70 or above chooses between CGHS and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, and cannot hold both. The Union Cabinet decision of 11 September 2024 extended AB PM-JAY cover of Rs. 5 lakh a year to every senior citizen aged 70 and above irrespective of socio-economic status, on a distinct card issued under the scheme, and states that senior citizens of 70 and above already availing benefits of other public health insurance schemes such as CGHS, the Ex-Servicemen Contributory Health Scheme and Ayushman CAPF “may either choose their existing scheme or opt for AB PMJAY”. The extension was launched on 29 October 2024 and the card issued under it is the Ayushman Vay Vandana Card.

The same decision draws the line the other way for private cover. A senior citizen of 70 and above holding a private health-insurance policy, or covered by the Employees’ State Insurance scheme, is eligible for AB PM-JAY as well, and faces no election. The choice is imposed only where the existing cover is a public health scheme funded from the exchequer.

For most CGHS pensioners the election is one-sided. AB PM-JAY covers secondary and tertiary hospitalisation up to Rs. 5 lakh a year and does not pay for outpatient consultation or the monthly medicines of a chronic condition, which is precisely where a CGHS card earns its cost, and a CGHS beneficiary who has already paid for a whole-life card recovers nothing by surrendering it. Below the age of 70 the question does not arise: a central government employee or pensioner covered by CGHS falls outside the AB PM-JAY beneficiary base, which for the general population rests on the deprivation and occupational criteria rather than on age.

Grievances and the appeal route

Two complaints account for most of the friction beneficiaries report, and both have a defined remedy. The first is the reimbursement shortfall: a beneficiary treated at a non-empanelled hospital is settled at the Non-NABH rate of the city under the Office Memorandum of 3 October 2025, and a beneficiary billed by an empanelled hospital above the package rate is left with the excess, which is the commonest complaint on the scheme. The remedy the scheme’s own orders repeat is to use the empanelled network on a referral wherever possible, where the rate is applied by arrangement and the treatment is usually cashless, and to keep reimbursement for genuine emergencies.

The second is delay, in a referral, a permission for a listed treatment, or the settlement of a reimbursement claim. CGHS runs a grievance mechanism, with an online portal and a defined escalation, and a beneficiary who faces an unreasonable delay or an incorrect rejection can pursue it there and, failing that, before the Central Administrative Tribunal, since medical reimbursement for a government servant is a service condition the courts have upheld. The practical guidance is consistent: route treatment through the Wellness Centre and the empanelled network, obtain the referral or permission before a planned treatment, and keep the documentation, because most disputes arise where the network and the referral system were bypassed.

Bearing on the 8th Central Pay Commission

The contribution slabs of Rs. 250 to Rs. 1,000 and the ward thresholds of Rs. 36,500 and Rs. 50,500 stay in force until the 8th Central Pay Commission reports and the Ministry of Health and Family Welfare issues a fresh order. The commission was constituted by gazette notification on 3 November 2025 and has not reported, so no revised CGHS contribution slab or ward threshold can be stated.

Two features of the design decide what the commission’s recommendations will change. The contribution is expressed in rupees by pay level, so a revision of the pay matrix alone does not touch it; the health ministry has to issue an order, as it did on 9 January 2017 after the 7th CPC. The ward entitlement is expressed in rupees of basic pay, so a fitment factor applied to the matrix pushes every serving employee across the existing thresholds automatically unless the thresholds are moved with it, which is exactly what happened between 2017 and the correction of 28 October 2022.

Related Articles

• Fixed Medical Allowance
• Reimbursement of medical expenses
• CGHS contribution and ward entitlement
• CGHS for pensioners
• CS(MA) Rules 1944
• Ex-Servicemen Contributory Health Scheme (ECHS)
• Central government pension
• Central government employees in India
• Income tax for pensioners
• Income tax for government employees
• Income-tax Act 2025
• Section 80D deduction
• Ayushman Bharat Pradhan Mantri Jan Arogya Yojana
• Department of Expenditure
• Fitment factor
• Annual increment
• Superannuation
• Old tax regime
• New tax regime
• Old versus new tax regime
• Section 115BAC (default new regime)
• Old Pension Scheme
• National Pension System
• Unified Pension Scheme
• Family pension
• Nursing allowance
• Allowances for central government employees
• 7th Central Pay Commission
• 8th Central Pay Commission
• Pay matrix
• Pay level and basic pay
• Take-home salary for central government employees
• Department of Personnel and Training
• Dearness relief
• PPO and life certificate
• Central government pension calculation

External references

• Central Government Health Scheme (CGHS)
• Ministry of Health and Family Welfare
• Department of Pension and Pensioners’ Welfare
• CGHS Bharatkosh payment portal
• Income Tax Department, deductions for health insurance and CGHS
• National Health Authority, Ayushman Bharat PM-JAY
• e-Sanjeevani tele-consultation

References

1. Ministry of Health and Family Welfare, Office Memorandum No. S.11011/11/2016-CGHS(P)/EHS dated 9 January 2017: revision of CGHS contribution and ward entitlement on the 7th CPC recommendations, effective 1 February 2017.
2. Ministry of Health and Family Welfare, Office Memorandum F. No. S.11011/11/2016-CGHS(P)/EHS dated 28 October 2022: revision of ward entitlement in empanelled private hospitals by basic pay, with the clarification dated 22 November 2022 on applying for a fresh card on an upgraded entitlement.
3. Ministry of Health and Family Welfare, Office Memorandum dated 28 June 2024: revised guidelines for the referral process in CGHS, in partial modification of Office Memorandum No. Z.15025/117/DIR/CGHS/EHSS dated 15 January 2018 and 10 December 2018, with the standard operating procedure dated 2 September 2024.
4. Directorate General of CGHS, Office Memorandum No. 5-16/CGHS(HQ)/HEC/2024(Part I) dated 3 October 2025: CGHS rates applicable for treatment at healthcare organisations, effective 13 October 2025, in supersession of all previous memoranda on the subject; and the clarification dated 24 March 2026.
5. Ministry of Health and Family Welfare, Office Memorandum No. S.11012/1/2024-EHS dated 27 June 2024: guidelines for issue of CGHS cards to serving employees and pensioners, including the whole-life card and Bharatkosh payment.
6. Ministry of Health and Family Welfare, Office Memorandum No. B-12014/01/2016-JCM dated 5 April 2017: revision of the income limit for dependency to Rs. 9,000 a month plus dearness relief on a basic pension of Rs. 9,000, applicable also under the CS(MA) Rules 1944.
7. Department of Pension and Pensioners’ Welfare, Office Memorandum No. 4/34/2017-P&PW(D) dated 19 July 2017: enhancement of the Fixed Medical Allowance to Rs. 1,000 a month with effect from 1 July 2017; and Office Memorandum No. 4/05/2019-P&PW(D) dated 23 March 2022 on the change of option between CGHS outpatient care and the Fixed Medical Allowance.
8. Lok Sabha Unstarred Question No. 2470, answered 13 February 2026: 342 allopathic Wellness Centres and 111 AYUSH units across 81 cities, 22 new Wellness Centres approved, and the norms for opening a Wellness Centre.
9. Union Cabinet decision of 11 September 2024 extending Ayushman Bharat Pradhan Mantri Jan Arogya Yojana cover of Rs. 5 lakh a year to all senior citizens aged 70 and above irrespective of income, launched 29 October 2024.
10. Central Services (Medical Attendance) Rules, 1944.
11. Income-tax Act, 2025, Section 126 (deduction for health-insurance premia and contributions to the Central Government Health Scheme), including Section 126(2)(a), 126(3), 126(4), 126(8)(a), 126(8)(b) and 126(10), and Section 202 (the new regime); replacing Section 80D of the Income-tax Act, 1961, as amended with effect from 1 April 2014.