Reimbursement of Medical Expenses

Reimbursement of medical expenses is the route by which a central government employee or pensioner recovers money spent out of pocket on treatment, under the Central Government Health Scheme or the Central Services (Medical Attendance) Rules 1944, and the governing rule is that the amount paid back is the CGHS rate of the city concerned or the actual expenditure, whichever is lower.

Two tests run in sequence on every claim, and confusing them is why the shortfalls surprise people. The first is admissibility: does this treatment qualify for reimbursement at all, which turns on whether it was an emergency, whether a referral or prior permission was obtained, and whether the hospital was empanelled. The second is rate: once the claim is admissible, how much is payable, which turns on the CGHS rate schedule for that city and that accreditation class. A claim can fail the first test outright and be regretted, or clear it and still be paid at a fraction of the bill.

Reimbursement is the fallback channel of the scheme, not the main one. The design routes a beneficiary to the CGHS Wellness Centre and the empanelled hospitals, where treatment is billed to CGHS at the agreed rate and is usually cashless, and expects payment out of pocket only where the network could not be used. The current rate schedule is Directorate General of CGHS Office Memorandum No. 5-16/CGHS(HQ)/HEC/2024(Part I) dated 3 October 2025, issued in supersession of all previous memoranda on the subject and effective from 13 October 2025, and paragraph 1 applies it both to services taken at an empanelled hospital and to the medical reimbursement claims of serving employees, pensioners and other eligible categories alike.

The rate cap and the variables that set it

The amount reimbursed is the CGHS rate of the city concerned or the actual amount charged, whichever is lower, and the CGHS rate is not a single national figure. Directorate General of CGHS Office Memorandum No. 5-16/CGHS(HQ)/HEC/2024(Part I) dated 3 October 2025 sets the rate schedule in Annexure I and the adjustment rules in paragraph 2, and the applicable figure for a given treatment depends on the city class, the hospital’s accreditation, whether the hospital is a super-speciality, and the ward the patient occupied.

Table: rate adjustment variables under Directorate General of CGHS OM No. 5-16/CGHS(HQ)/HEC/2024(Part I) dated 3 October 2025, effective 13 October 2025. Compiled by salary-calculator.in from paragraph 2 and the annexures of that Office Memorandum.

The shortfall follows from the cap. A private hospital that is not empanelled charges its own rates, which sit above the CGHS rate, and the difference is borne by the beneficiary. A beneficiary billed at open-market rates and reimbursed at the Non-NABH rate of a Z-class city is recovering a figure two steps below the accredited X-city rate, which can be a small part of the bill. This is the design, not a defect in the claim, and it is why the scheme steers treatment to the empanelled network where the CGHS rate is the billed rate.

One phrase in wide circulation does not survive the order. Reimbursement is not paid at “the rates of the nearest CGHS city”: the Office Memorandum of 3 October 2025 restricts a non-empanelled claim to the Non-NABH rate of the concerned city, and the city classification then does the work. What is genuinely a nearest-city rule is a registration rule, not a rate rule, and it appears in Ministry of Health and Family Welfare Office Memorandum No. S.14028/30/2022-EHS dated 12 September 2022: a pensioner living in a non-CGHS area may take CGHS benefits by registering in a nearby CGHS covered city after paying the subscription. The rate that then applies is that city’s rate, because that is where the card sits.

When a claim is admissible, and when it is regretted

Admissibility is decided before the rate is, and the two are separate steps that the orders keep separate. Paragraph 1 of the Office Memorandum of 3 October 2025 states that where treatment has been availed from a non-empanelled private healthcare organisation, reimbursement “may be considered as per extant instructions, but the rate would be restricted to Non-NABH” rates of the concerned city. The rate restriction is what the order does; it creates no power of refusal. The refusal, where it happens, comes from failing the extant instruction that the order points at.

That extant instruction is the emergency limb. Office Memorandum No. Z.15025/79/DIR/CGHS dated 5 October 2016 is the order under which CGHS considers reimbursement at CGHS rates for treatment taken in an emergency from a private hospital that is not empanelled. A planned admission at a non-empanelled hospital, with no emergency and no referral, does not satisfy it, so the claim never reaches the stage where the Non-NABH rate would be applied.

What happens to such a claim is stated in terms. The guidelines enclosed with Ministry of Health and Family Welfare Office Memorandum No. Z.15025/51/2018/DIR/CGHS/EHS dated 6 June 2018 provide that where the criteria are not satisfied, including a regret by the expert committees, the requests may be regretted by the Additional Director of the concerned city, with a covering letter explaining the reasons and referring to the concerned Office Memorandum. A beneficiary is therefore entitled to a written reason naming the order relied on, which is also what makes the refusal challengeable.

Referral validity and who grants prior permission

A referral is what keeps a planned treatment inside the admissible channel, and it has a fixed life. A single referral from any Medical Officer of a CGHS Wellness Centre is valid for three months, covers up to three specialists and six consultations, under the 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 the order of 10 December 2018. Treatment at a Government hospital needs no referral at all.

Prior permission is a different instrument from a referral and is needed for an unlisted investigation or procedure. For a pensioner the authority is the Additional Director or Director CGHS of the city, under Office Memorandum No. Z.15025/14/2023/DIR/CGHS dated 27 December 2023. For a serving employee it is the Head of Department or Head of Office, under Office Memorandum No. S.12020/4/97-CGHS(P) dated 7 April 1999. A special investigation, any investigation costing more than Rs. 3,000, and any procedure requiring admission need an endorsement, and that endorsement is valid for three months.

The original permission letter is a claim document, not merely a preliminary. Item 6 of the current CGHS reimbursement checklist requires the original permission letter or the original emergency certificate to accompany the claim, so a permission obtained and then mislaid costs the beneficiary the same as a permission never obtained.

Emergency treatment and the credit facility

In an emergency a CGHS beneficiary may be admitted to any hospital without prior permission, and an empanelled hospital must treat on credit. Ministry of Health and Family Welfare Office Memorandum No. S.11011/29/2019-EHS dated 13 September 2019 records the extant position that in emergency conditions a beneficiary can get admission in any CGHS empanelled hospital without any prior permission, and then states the hospital’s obligation and the sanction for breaching it.

The sanction is the part worth knowing. The same Office Memorandum states that under the Memorandum of Agreement between the empanelled hospital and the Government of India, refusal to provide treatment to bonafide CGHS beneficiaries in emergency cases on a credit basis, without valid ground, would attract disqualification for continuation of empanelment, and that in an emergency the empanelled hospitals will not refuse admission or demand an advance payment from the beneficiary or a family member and will provide credit facilities to the patient. A beneficiary facing a demand for money at the admission desk of an empanelled hospital has a named order to produce.

Emergency treatment at a hospital that is not empanelled is a claim rather than a credit facility, admissible under Office Memorandum No. Z.15025/79/DIR/CGHS dated 5 October 2016 at CGHS rates. The document that carries it is the original emergency certificate from the treating hospital, required by item 6 of the reimbursement checklist. The rate cap is not relaxed by the emergency: the emergency removes the need for prior permission, and nothing more.

What a package rate covers, and what is paid over it

A CGHS package rate is an all-inclusive lump sum from admission to discharge, and knowing what sits inside it is what tells a beneficiary which line of a hospital bill will never be reimbursed separately. Annexure II to the Office Memorandum of 3 October 2025 lists the contents: accommodation and diet, admission charges, anaesthesia, medicines and consumables, surgical disposables and sundries, consultant visits, dressings, intensive care, injections, monitoring, nursing, oxygen and ventilator support, operation and operation theatre charges, physiotherapy, the surgeon’s fee, registration, routine investigations during the admission, transfusion and blood processing, and equipment including infusion and syringe pumps.

The package assumes a duration, and the duration varies by the kind of treatment.

Table: package duration by treatment class, Annexure II to Directorate General of CGHS OM No. 5-16/CGHS(HQ)/HEC/2024(Part I) dated 3 October 2025.

Implants are the main thing paid over the package. Lenses, stents, meshes and valves are reimbursable in addition to the package rate at CGHS ceiling rates, and an implant with no CGHS ceiling is paid at the actual invoice value or the National Pharmaceutical Pricing Authority rate, whichever is less. Guidewires, catheters and the other consumables and medicines are deemed inclusive and are not separately reimbursable, whatever the hospital bill shows.

Where more than one procedure is done, the rates step down. A second surgery in the same session is paid at 50% and a third at 25% of its own rate, with the first at 100%; identical surgeries at different sites take 50% for the second; and any procedure carried out inside an earlier procedure’s package period is paid at 75%. Consultation is Rs. 350 for a specialist, Rs. 700 for a super specialist and for psychiatry, and Rs. 350 for an indoor consultation, each valid for seven days within the same speciality. The standard intensive care rate is Rs. 5,400 a day, uniform across ward entitlement, city category and hospital type.

One rule closes the commonest gap between the package and the bill. Package rates apply whether the service was provided in-house or outsourced, and a hospital may not bill beyond the package under the pretext of outsourced service provision. Where an empanelled hospital has made a beneficiary buy an item over and above the package rate, Office Memorandum No. Z/1/2022-DIR(CGHS) dated 10 November 2022, drawing on Office Memorandum No. 2-1/201/CGHS/VC/CGHS(P) dated 1 August 2013, provides that reimbursement shall be made to the beneficiary and the amount shall be recovered from the pending bills of the hospital.

Form MRC(S), Form MRC(P) and the documents

CGHS uses two beneficiary-specific claim forms: Form MRC(S) for a serving beneficiary and Form MRC(P) for a pensioner beneficiary. Ministry of Health and Family Welfare Office Memorandum No. S.11011/9/2012-CGHS(P) dated 5 June 2014 introduced them, recording at paragraph 2 that separate forms had been developed for serving and pensioner beneficiaries with the requirement of the minimum information needed for processing the claims, and naming them at paragraph 3. Both are current, downloadable from the CGHS site, and named in the current reimbursement checklist. No portal has replaced the paper claim: what moved online is tracking, through a computer-generated claim number and an SMS at each stage.

The document set is longer than most claimants expect, and an incomplete claim is returned rather than partly paid. Beyond the form, the current checklist requires a self-explanatory letter signed by the main card holder and forwarded by the Chief Medical Officer in charge, setting out the sequence of events, the justification, and the reason for going to a hospital that is not empanelled where that is what happened; a self-attested copy of the CGHS card verified by the Chief Medical Officer; a mandate form with a cancelled cheque or a passbook copy showing the main card holder’s name; the original permission letter or original emergency certificate; the final consolidated bill in original together with its break-up, an interim bill not being valid; the discharge summary, prescriptions and investigation reports; and an invoice specifying the batch number and specifications for any implant or device.

Two situations have their own paperwork. Where an original receipt has been lost, an affidavit on non-judicial stamp paper is required, in the form of Annexure I to the claim form. Where an advance was taken, the claim must state so and carry a utilisation certificate from the hospital confirming the advance was spent.

Several items carry their own governing orders, and a claim for one of them is settled against that order rather than against the general rate list. Ambulance charges are allowed only for the journey to hospital in an emergency, not after discharge, within city limits, on a certificate from the treating doctor, under Office Memorandum No. S-4924/2010/CGHS(R&H)/CGHS(P) dated 17 January 2011. Hearing aids are capped at Rs. 8,000 for a digital behind-the-ear aid and Rs. 9,000 for a digital in-the-canal or completely-in-canal aid per ear, inclusive of GST and with a three-year warranty, under Office Memorandum No. S.11011/37/2019-EHS dated 1 December 2020. Medicines for seven days on discharge are covered under Office Memorandum No. S-11011/09/2014/CGHS(HEC)/CGHS(P) dated 20 June 2014, read with Office Memorandum No. S-11018/6/95-CGHS(P) dated 24 July 1995, and outpatient medicines are not reimbursable at all unless permitted in writing by the Chief Medical Officer in charge. A special nurse, ayah or attendant is reimbursable only in a Government hospital or a private recognised hospital with prior permission, never domiciliary, under Office Memorandum No. S-11011/7/88-CGHS(P) dated 3 August 1988.

Where the claim goes, and the 30-day timeline

A pensioner submits Form MRC(P) to the Chief Medical Officer in charge of the CGHS Wellness Centre, and there is now a choice of which one. The CGHS reimbursement circular directs the claim to the Wellness Centre where the CGHS card is registered or where the treatment has been taken. Office Memorandum No. Z.15025/2/2023/DIR/CGHS dated 8 May 2023 is the order behind the second limb: a pensioner may submit the claim in the city where the treatment was taken, whose Additional Director processes it and reimburses the admissible amount, while the option of submitting in the home city is retained. The older statement that a claim must go to the office holding the beneficiary’s record is no longer accurate as a general rule.

What the Wellness Centre does on receipt is verify against the checklist and generate an acknowledgement with a claim number in the computer module, after which the status is viewable by that number and an SMS is sent at each stage. The claim then goes to the Office of the Additional Director CGHS of the city, which passes the admissible amount, and from there to the Pay and Accounts Office for payment. A serving employee does not use this chain at all: the claim goes to the employee’s Department or Ministry, which processes it through the head of office.

Settlement has a prescribed timeline, which the beneficiary can hold the office to. The guidelines enclosed with Office Memorandum No. Z.15025/51/2018/DIR/CGHS/EHS dated 6 June 2018 state at paragraph 1 that the timeline prescribed for settlement of normal medical claims is 30 days from the date of submission to the payment by the Pay and Accounts Office, and that every effort must be made to avoid delay at any stage. The dated acknowledgement matters here for a second reason beyond the time limit: it is what fixes the date from which those 30 days run.

The six-month time limit and condonation

A final claim must be submitted within six months of the date of completion of medical treatment or discharge of the patient from hospital. Ministry of Health and Family Welfare Office Memorandum No. 1-60/2017-CGHS/C&P/EHS dated 1 June 2020 made that change, recording at paragraph 1 that the existing limit under the CGHS guidelines was three months and that it had been decided to revise the time limit for submission of final claims to six months. The three-month figure that still circulates is the pre-2020 position.

The CS(MA) side moved to six months five years earlier, which is a distinction the two rule sets are often collapsed on. Office Memorandum No. S.14025/19/2015-MS dated 27 May 2015 made the identical change for claims under the Central Services (Medical Attendance) Rules 1944, superseding the three-month rule laid down in Office Memorandum No. F.29-40/68-MA dated 15 October 1968.

Beyond six months the claim is not lost but must be condoned. Paragraph 2 of the Office Memorandum of 1 June 2020 provides that only cases where the bills are submitted after six months from the date of completion of treatment or discharge are required to be taken up for condonation, and that the power of condonation and the other terms and conditions remain the same as those set out in Office Memorandum No. S.14025/8/99-MS dated 25 May 1999. What the beneficiary must do is stated in the current CGHS reimbursement circular: the reasons justifying the delay must be stated in a forwarding letter, with a request for condonation, and checklist item 2 requires the same.

The medical advance

A medical advance of 90% of the admissible amount is available, and it covers outpatient and indoor treatment alike. Office Memorandum No. 14025/18/2015-MS/EHSS dated 17 October 2016 is titled for the grant of a medical advance for all treatment, outpatient and inpatient, under the CGHS and the CS(MA) Rules, so the advance is not a concession confined to a list of major illnesses and is not confined to hospitalisation.

The base on which the 90% is calculated follows a cascade, set out in Office Memorandum No. F-No. Z.15025/8/2021/DIR/CGHS dated 22 September 2021. Where a package rate exists for the procedure, that is the base. Where the procedure has no package rate, the admissible amount is calculated item-wise at CGHS rates; for any item with no CGHS rate, the AIIMS rate is used; and where there is neither a CGHS nor an AIIMS rate, the actual estimate for the procedure is considered. Paragraph 3 of that Office Memorandum then provides that 90% of the admissible rates so arrived at is what is granted.

The estimate comes from the hospital, not from the patient. The same paragraph requires the hospital seeking the advance to provide an item-wise break-up of the estimate so that the request can be processed, which means a lump-sum estimate on hospital letterhead is not enough to move the file. On the closing side, item 13 of the current checklist requires the final claim to state whether an advance was taken and, if it was, to carry a utilisation certificate from the hospital that the advance amount has been utilised.

Why claims are reduced, and the calculation sheet

Most reductions are the rate cap doing its work rather than a defect in the claim. A claim from a hospital that billed above the applicable CGHS rate is passed at that rate, and the beneficiary carries the balance; a non-empanelled hospital is cut further to the Non-NABH rate of the city under the Office Memorandum of 3 October 2025; a consumable the hospital billed separately is disallowed because Annexure II puts it inside the package; and a procedure done inside an earlier procedure’s package window is paid at 75%.

The rest are procedural and avoidable: a claim filed past six months without the condonation request and the reasons; an emergency claim with no original emergency certificate; an admission that needed prior permission which was not obtained; an interim bill in place of the final consolidated bill; and a claim without the mandate form and cancelled cheque, which leaves the office with nowhere to send the money.

Where the amount passed is less than the amount claimed, the beneficiary has a right to see the arithmetic. Paragraph 1 of the guidelines enclosed with Office Memorandum No. Z.15025/51/2018/DIR/CGHS/EHS dated 6 June 2018 requires that a proper calculation sheet must be prepared in the file, so that it can be shared with the beneficiaries if there are requests for reasons for the deductions. Asking for that sheet is the first step in any dispute, because it converts an unexplained shortfall into a set of specific deductions that can each be answered.

Full reimbursement and the High Powered Committee

Two routes exist for reimbursement beyond the CGHS rates, and both come from the same order. Ministry of Health and Family Welfare Office Memorandum No. Z.15025/51/2018/DIR/CGHS/EHS dated 6 June 2018 was issued in compliance with the directions of the Supreme Court in its judgment in Shiva Kant Jha versus Union of India, WP (Civil) No. 694 of 2015, delivered on 13 April 2018, and the guidelines enclosed with it set out both routes.

The first is full reimbursement in seven defined situations, examined outside the High Powered Committee. They are: an unconscious or severely incapacitated patient admitted by others for a prolonged period; a prolonged admission for head injury, coma, septicaemia or multi-organ failure; advanced malignancy; higher accommodation taken because entitled rooms were unavailable; higher accommodation taken for isolation; a strike in Government hospitals; and an emergency arising while on official tour to a non-CGHS area. The file is examined by an expert committee under the Additional Director General of Health Services, recommended by the Additional Director, submitted to the Director CGHS, taken to the Integrated Finance Division for concurrence after the approval of the Additional Secretary and Director General CGHS, and then approved by the Secretary, Health and Family Welfare.

The second is the High Powered Committee, for anything outside those seven. It is chaired by the Special Director General, with the Director General CGHS or a nominee, the Additional Director CGHS (Headquarters) or the Additional Deputy Director General (Headquarters), the Additional Director CGHS (Rates and Hospitals) as Member Secretary, and one Government specialist of the speciality concerned. It meets monthly, takes up requests received up to the 15th of the month, and acts within seven days. It considers air fare with or without an attendant, full reimbursement in special circumstances, and relaxation of the rules, and it is open only to a beneficiary who held a valid CGHS card at the time of treatment. Office Memorandum No. Z.15025/38/2018/DIR/CGHS/EHS dated 22 May 2018 carries the same criteria and the same committee.

A medical insurance claim alongside CGHS

A beneficiary holding a medical insurance policy in addition to CGHS or CS(MA) may claim from both, and the order permitting it is old and unambiguous. Ministry of Health and Family Welfare Office Memorandum No. S.11011/4/2003-CGHS(P) dated 19 February 2009 allows reimbursement from both sources subject to the condition that the reimbursement from such sources should not exceed the total expenditure incurred by the beneficiary on the treatment, and it expressly removed the package-rate cap that the orders of even number dated 8 January 2004 and 27 February 2004 had imposed on the combined claim.

The sequence is fixed and cannot be run the other way. The beneficiary makes the first claim to the insurance company and the second claim to CGHS or the Ministry concerned, because the CGHS claim has to be assembled out of what the insurer returns. That means the CGHS claim carries duplicate bills stamped and verified by the insurance company in place of the originals the insurer has kept, and a certificate from the insurer stating the amount credited, both of which are required by item 12 of the current checklist.

Reimbursement under the CS(MA) Rules 1944

A serving central government employee in a city where CGHS does not operate is covered by the Central Services (Medical Attendance) Rules 1944, not by CGHS. Rule 1(2) applies the rules to all Government servants other than those in railway service and non-gazetted staff stationed in or passing through Calcutta, when on duty, on leave, on foreign service in India, or under suspension. Railway employees are outside these rules because the Indian Railway Establishment Code carries their own medical provisions.

The route runs through the authorised medical attendant, a defined office rather than a doctor of the employee’s choosing. Rule 2(a) defines the authorised medical attendant by three grades of appointment. Rule 3(i) entitles a Government servant, free of charge, to medical attendance by the authorised medical attendant, and Rule 3(ii) provides for reimbursement of any amount paid, on production of a certificate in writing by that attendant. The claim is routed through the head of office, the six-month limit set by the Office Memorandum of 27 May 2015 applies, and reimbursement runs on CGHS rates: the rate schedule of 3 October 2025 governs CGHS and CS(MA) beneficiaries alike for the ceiling items, and the medical advance order of 17 October 2016 is a joint CGHS and CS(MA) order.

The boundary that matters most is at retirement. Note 2 below Rule 2 of the Central Services (Medical Attendance) Rules 1944 provides that retired Government officials are not covered by the rules, and Ministry of Health and Family Welfare Office Memorandum No. S.14028/30/2022-EHS dated 12 September 2022 restates that position at paragraph 1 and, at paragraph 3, directs ministries to defend cases on that rule position before the Central Administrative Tribunals and the courts without referring back to the Ministry. A retired employee has no CS(MA) claim.

A pensioner outside a CGHS city

A pensioner in a non-CGHS area has three options, and the Ministry has set them out in its own words rather than leaving them to practice. Office Memorandum No. S.14028/30/2022-EHS dated 12 September 2022 gives them as: the Fixed Medical Allowance in lieu of outpatient care; or CGHS benefits for both outpatient and indoor treatment by registering in a nearby CGHS covered city after making the required subscription; or the Fixed Medical Allowance for outpatient care together with CGHS for indoor treatment.

The third option is the one most pensioners in a non-CGHS area actually use, and it is what connects this article to the two figures that govern a CGHS hospitalisation. The contribution and ward entitlement attach to the card taken out in the nearby CGHS city, and the rate that applies to the indoor claim is that city’s rate under its X, Y or Z classification, not a rate imported from where the pensioner lives.

Treatment outside India

Treatment abroad is available to a serving Government servant and is closed to a pensioner. The Ministry of Health and Family Welfare letter on the extension of CGHS facilities to beneficiaries outside India, dated 2 March 2021, states that under Rule 11 of the Central Services (Medical Attendance) Rules 1944 a Government servant and the family members are eligible to obtain medical treatment outside India, or to claim reimbursement of the cost of medical treatment obtained inside or outside India, and that the term Government servant denotes all serving central government employees, CGHS and CS(MA) beneficiaries alike.

The same letter closes the door for the retired. Because the CS(MA) Rules do not apply to pensioners, the provisions relating to treatment abroad are not applicable in their case, which follows directly from Note 2 below Rule 2 and is the practical consequence of the CS(MA) exclusion described above.

A claim after the beneficiary’s death

The claimant after a death is fixed by the checklist, and it is not the person who paid the hospital. Where the CGHS card holder has died, the living spouse is the eligible claimant, irrespective of who met the bills. Where the family pensioner has died, any living child may claim, on an affidavit of legal heirship with no-objection certificates from the other heirs, in the form of Annexure II to the claim form, and some cases additionally need a succession certificate.

One administrative step decides whether the claim survives at all. The standing instruction in these cases is that the CGHS card must not be deleted until final payment has been made, because the claim is processed against a live card. A family that surrenders or cancels the card promptly on a death, which is the intuitive thing to do, can find the pending claim blocked by the deletion.

Income tax on medical reimbursement

Reimbursement of medical expenses is excluded from the value of perquisites by Section 17(2) of the Income-tax Act 2025, which is a sub-section of the Act and not a proviso. Section 17(2)(a) excludes the value of any medical treatment provided to an employee or a family member in any hospital maintained by the employer. Section 17(2)(b)(i) excludes any sum paid by the employer for expenditure actually incurred by the employee on treatment, of the employee or a family member, in any hospital maintained by the Government or a local authority, or any other hospital approved by the Government for the purposes of medical treatment of its employees, which is the limb a CGHS Wellness Centre and a CGHS-empanelled hospital fall under. Section 17(4)(d) defines hospital to include a dispensary, a clinic and a nursing home.

The two limbs are not interchangeable, and the second approval route is narrower than it is usually described. Section 17(2)(b)(ii) covers treatment in a hospital approved by the Principal Chief Commissioner or Chief Commissioner having regard to the guidelines issued in that behalf, but only in respect of prescribed diseases or ailments. It is not a general power to bless a hospital for all purposes, and a claim outside the prescribed diseases does not reach it.

The carve-out survives the default regime, and the reason is structural rather than a matter of the kind of relief it is. Section 202(2)(a) of the Income-tax Act 2025 is a closed list of what is withdrawn where income tax is computed under Section 202(1): Schedule III Table serials 5, 6, 7, 8, 11 and 17, serials 12 and 13 other than as prescribed, serial 1 of the Section 19(1) Table, Section 22(1)(b) for Section 21(6) properties, Sections 33(8), 45(3), 46, 47(1)(a), 48 and 49, and the whole of Chapter VIII other than Sections 124(1), 124(2), 125(2) and 146. Section 17(2) appears nowhere on that list, so it applies in both regimes. Section 202(2)(c), which withdraws an exemption or deduction for an allowance or perquisite provided under any other law in force, does not reach Section 17(2) either, because Section 17(2) is in this Act.

A pensioner is covered, but only through a provision the article previously skipped. Section 15(2) of the Income-tax Act 2025 provides that for the purposes of the charge on salary, employer includes a former employer, and Section 16(b) provides that salary includes any annuity or pension. A CGHS reimbursement paid to a pensioner by the Government as former employer is therefore a perquisite under the head salaries in the first place, and is then carved out by Section 17(2). Without Section 15(2) the chain does not close.

A family pensioner is outside all of this. Family pension is not salary: it is charged under income from other sources, with the deduction of one third or Rs. 25,000 under Section 93(1)(d) read with Section 202(1), and Rs. 15,000 in place of Rs. 25,000 in any other case. There is no employer or former employer, so Section 17(2) has nothing to attach to, and any analysis that treats a family pension recipient as an employee for this purpose is reasoning from the wrong head of income.

The standard deduction is a separate relief and is now in the Act itself. Serial 2 of the Section 19(1) Table allows Rs. 75,000 or the salary, whichever is less, where income tax is computed under Section 202(1), and Rs. 50,000 or the salary, whichever is less, in any other case. Section 202(2)(a)(iv) withdraws only serial 1 of that Table, which is professional tax, so serial 2 stands in the default regime. The standard deduction is not the authority for the medical carve-out and does not interact with it: the two operate at different stages of the computation.

One historical point is worth keeping straight, because it is still repeated as current law. Until the financial year 2017-18 a salaried employee could receive up to Rs. 15,000 a year of general medical reimbursement free of tax under the Income-tax Act 1961, and the Finance Act 2018 withdrew that exemption together with the transport allowance exemption with effect from the financial year 2018-19, replacing both with the standard deduction. That is a statement about the repealed Act, which ceased to have effect on 1 April 2026 under Section 536(1) of the Income-tax Act 2025. There is no Rs. 15,000 medical limb in the Income-tax Act 2025, and no separate medical reimbursement exemption exists today outside Section 17(2).

Related Articles

• Central Government Health Scheme (CGHS)
• CGHS contribution and ward entitlement
• CGHS for pensioners
• Fixed Medical Allowance
• CS(MA) Rules 1944
• Ex-Servicemen Contributory Health Scheme (ECHS)
• Central Government Employees Group Insurance Scheme
• Constant attendant allowance
• Nursing allowance
• Hospital patient care allowance
• Hospital leave
• Central Administrative Tribunal
• Income-tax Act 2025
• Income tax for government employees
• Income tax for pensioners
• Standard deduction
• Old tax regime
• New tax regime
• Section 80D deduction
• Form 16
• TDS on salary
• Rebate, deduction and exemption: the difference
• Central government pension
• Family pension
• Disability pension
• Invalid pension
• Extraordinary pension
• Dearness relief
• Pay and Accounts Office
• Head of office
• Bhavishya
• Railway employees
• Indian Railway Establishment Code
• Allowances for central government employees
• Central government employees in India
• Take-home salary for central government employees
• 7th Central Pay Commission

External references

• Central Government Health Scheme
• Ministry of Health and Family Welfare
• Department of Pension and Pensioners’ Welfare
• Pensioners’ Portal
• Department of Expenditure
• Income Tax Department

References

1. Directorate General of CGHS Office Memorandum No. 5-16/CGHS(HQ)/HEC/2024(Part I), dated 3 October 2025, revising CGHS rates in supersession of all previous memoranda with effect from 13 October 2025, and restricting reimbursement for treatment at a non-empanelled private hospital to the Non-NABH rate of the concerned city (paragraph 1, paragraph 2, Annexure I and Annexure II).
2. Ministry of Health and Family Welfare Office Memorandum No. S.11011/9/2012-CGHS(P), dated 5 June 2014, revising the Medical Reimbursement Claim form and introducing Form MRC(S) for serving beneficiaries and Form MRC(P) for pensioner beneficiaries.
3. Ministry of Health and Family Welfare Office Memorandum No. 1-60/2017-CGHS/C&P/EHS, dated 1 June 2020, revising the time limit for submission of final medical reimbursement claims from three months to six months, and Office Memorandum No. S.14025/19/2015-MS, dated 27 May 2015, making the same change for CS(MA) claims in supersession of Office Memorandum No. F.29-40/68-MA dated 15 October 1968.
4. Ministry of Health and Family Welfare Office Memorandum No. S.14025/8/99-MS, dated 25 May 1999, governing condonation of delay in the submission of medical reimbursement claims.
5. Ministry of Health and Family Welfare Office Memorandum No. S.11011/29/2019-EHS, dated 13 September 2019, on emergency treatment at CGHS empanelled hospitals, the credit facility, and disqualification for continuation of empanelment on refusal; and Office Memorandum No. Z.15025/79/DIR/CGHS, dated 5 October 2016, on emergency treatment at non-empanelled private hospitals.
6. Ministry of Health and Family Welfare Office Memorandum No. Z.15025/51/2018/DIR/CGHS/EHS, dated 6 June 2018, with enclosed guidelines, issued in compliance with the judgment of the Supreme Court in Shiva Kant Jha versus Union of India, WP (Civil) No. 694 of 2015, delivered on 13 April 2018, prescribing the 30-day settlement timeline, the calculation sheet, the seven full-reimbursement criteria and the High Powered Committee; and Office Memorandum No. Z.15025/38/2018/DIR/CGHS/EHS, dated 22 May 2018.
7. Ministry of Health and Family Welfare Office Memorandum No. 14025/18/2015-MS/EHSS, dated 17 October 2016, on the grant of a medical advance for all treatment, outpatient and inpatient, under the CGHS and the CS(MA) Rules; and Office Memorandum No. F-No. Z.15025/8/2021/DIR/CGHS, dated 22 September 2021, setting the cascade for the admissible amount and the 90% figure.
8. Ministry of Health and Family Welfare Office Memorandum No. S.11011/4/2003-CGHS(P), dated 19 February 2009, permitting a claim on a medical insurance policy and on CGHS or CS(MA) together, subject to the total not exceeding the expenditure incurred.
9. Central Services (Medical Attendance) Rules, 1944, Rule 1(2), Rule 2(a), Rule 3 and Rule 11, with Note 2 below Rule 2 excluding retired Government officials; read with Ministry of Health and Family Welfare Office Memorandum No. S.14028/30/2022-EHS, dated 12 September 2022, on reimbursement of medical claims to pensioners under the CS(MA) Rules.
10. Income-tax Act, 2025 (Act No. 30 of 2025), Sections 15(2), 16(b), 17(2), 17(4)(d), serial 2 of the Section 19(1) Table, Section 93(1)(d) and Section 202(2).