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CGHS explained: who it covers, referrals, empanelled hospitals and the 2026 changes

By Faz · Updated 2 Nov 2026 · Not reviewed by a doctor · General information, not medical advice

On this page
  1. What changed recently
  2. Who is covered
  3. Contribution
  4. How to apply
  5. Wellness Centres: where care starts
  6. Referrals: how they work now
  7. Empanelled hospitals: check before you go
  8. Rates: what a hospital can charge CGHS
  9. Emergencies
  10. Complaints and help
  11. Common questions
  12. Sources

Quick answer. CGHS covers central government employees, pensioners, their dependants and some other groups. Start at a Wellness Centre, which can refer you to an empanelled hospital for 3 months. In an emergency you need no referral. Since September 2026 distance no longer limits serving employees, and many hospitals have left the panel, so check status first.

The Central Government Health Scheme (CGHS) looks after central government employees, pensioners and their families. The rules have changed a lot in the past year, including who can join and which hospitals are on the panel. This guide sets out what the scheme offers and how to use it, with the dates of the latest orders. It is general information. Your Additional Director’s office or the helpline can confirm your own case.

What changed recently

DateChange
17 Sep 2026The geographical limit for serving employees was removed. Those outside a covered area can make a one-time choice to join.
16 Sep 2026Hospitals that did not renew or were found ineligible stood de-empanelled. City lists followed, including 99 hospitals in Delhi and NCR.
1 Sep 2026Dependent sons and brothers with critical or terminal illness may be covered for life, subject to dependency rules and a Medical Board. Some approvals were decentralised.
17 Jul 2026CGHS was linked with the Bhavishya pension portal for retiring employees.
24 Mar 2026A clarification to the rate list, including who counts as a super specialist for the higher consultation rate.
13 Oct 2025New rates took effect, and all old agreements with private hospitals ended.

Who is covered

The CGHS Citizen Charter lists central government employees, pensioners and their dependent family members, along with others such as Members of Parliament, Supreme Court judges, former High Court judges and former MPs. Eligible autonomous institutions and PIB accredited journalists have their own instructions. The CGHS website says about 42 lakh beneficiaries are covered in 80 cities.

Serving employees

Under the order of 17 September 2026:

  • If you live or are posted within the covered area, meaning the limits of a district headquarters with a Wellness Centre, you must be under CGHS. You cannot opt out in favour of the CS(MA) Rules, 1944.
  • If you are on CS(MA) only because you are outside the covered area, you may make a one-time, final choice to join CGHS. It applies to all your dependants, and you pay the contribution wherever you live.
  • You cannot claim under both systems. No travel allowance is paid for treatment or for collecting medicines under CGHS.

Pensioners

The CGHS FAQ on cards sets out the options. If you live in a CGHS area, you register after paying the contribution, and you can use out-patient and in-patient services, but you do not get Fixed Medical Allowance. If you live outside a CGHS area, you can take the allowance, or register at the nearest CGHS city, or take the allowance for out-patient care and use CGHS only for in-patient care.

Dependants

The FAQ counts a spouse, plus dependent family members whose income from all sources is below Rs 9,000 plus DA a month. The spouse is an exception to the income test. Family members can include parents or parents-in-law (one set or the other), children and step-children, and certain sisters and minor siblings who normally live with you. A son is covered until 25, marriage or earning, whichever is first, or beyond 25 with a qualifying permanent disability. A daughter is covered until she marries or starts earning, and widowed, divorced or separated daughters can also qualify.

Contribution

Serving employees pay a monthly amount deducted from salary. Pensioners make a one-time payment for a whole-life card, equal to 120 months of the rate at retirement, through Bharatkosh. The 2025 FAQ also mentions a yearly option, so ask your Additional Director’s office.

Pay level (7th CPC)Monthly (serving)Whole-life card (pensioner)
Level 1 to 5Rs 250Rs 30,000
Level 6Rs 450Rs 54,000
Level 7 to 11Rs 650Rs 78,000
Level 12 and aboveRs 1,000Rs 1,20,000

The ward entitlement goes by basic pay: general ward up to Rs 36,500, semi-private from Rs 36,501 to Rs 50,500, and private from Rs 50,501. It is printed on your card.

How to apply

  1. Serving employees: apply online for a temporary reference number, print and sign the form, attach photographs, and hand it to your department. Your department sends it to the Additional Director. You will need your pay slip, ID proof for each family member, and a disability certificate if relevant.
  2. Pensioners: submit the application to the Additional Director of your city with the Bharatkosh challan, your PPO or last pay certificate, ID proof and photographs.
  3. Retiring employees: you now have an extra route through the Bhavishya portal. Your pension details pre-fill, and the card is generated after your pension papers are verified and the contribution is paid. The older route stays available.
  4. Once approved: an electronic card is valid through the Beneficiary Login, myCGHS app or DigiLocker. A replacement plastic card costs Rs 100. A digital renewal or reissue is free.

Start at Apply for CGHS card on the official website.

Wellness Centres: where care starts

Wellness Centres are the first stop. The Citizen Charter lists out-patient treatment and medicines, referrals, tests, maternity and child health services, and care in Ayurveda, Homoeopathy, Unani and Siddha. It counted 341 allopathic and 107 AYUSH units when last issued. Your card works at any Wellness Centre, not only the one you registered with.

Referrals: how they work now

The referral order of 28 June 2024 is the main rulebook.

SituationWhat you need
Specialist at a private empanelled hospitalA referral from a Wellness Centre doctor, valid for 3 months. It covers up to 6 consultations in that time, with up to three specialists if the first one recommends it.
Routine listed tests and minor procedures the specialist advisesNo further endorsement within the 3 months.
CT, MRI, PET and any test costing over Rs 3,000A referral or endorsement from CGHS, valid for 3 months.
Any procedure needing admissionA referral or endorsement from a CGHS doctor, valid for 3 months.
Unlisted tests or proceduresPermission from the CGHS Additional Director or Director (pensioners), or Head of Department (serving employees).
Government hospitals, AIIMS, Institutes of National Importance, Tata MemorialNo referral. The September 2026 order repeats this for central and state government institutions.
You are aged 70 or aboveYou may see a specialist at a private empanelled hospital directly, with no referral. The rule began at 75 and was lowered to 70 in 2024.
EmergencyNo referral. See below.

Empanelled hospitals: check before you go

The panel has changed a great deal. Old agreements ended on 13 October 2025, and hospitals had to apply afresh. Existing empanelment was extended only until 15 September 2026. So a hospital that took your card last year may not take it today.

Look up the hospital under Empanelled Hospitals and Labs. You can filter by state, city, tier and accreditation, and the list shows current status and validity dates, with empanelled, suspended and de-empanelled hospitals marked. Please do this before any planned treatment. You can then see the hospital’s details on our hospitals pages.

Cashless treatment is for pensioners and other identified beneficiaries. Serving employees and their dependants, and members of autonomous bodies, generally claim reimbursement instead.

Rates: what a hospital can charge CGHS

The office memorandum of 3 October 2025 sets the rates, and you can search them on the CGHS Rate List. They vary as follows:

FactorEffect on the rate
City tierTier II is 10% lower and Tier III is 20% lower than Tier I. Tier II rates also apply in the North-East, Jammu and Kashmir, and Ladakh.
AccreditationNon-NABH and non-NABL hospitals are 15% lower than accredited ones.
Super speciality hospitals15% higher than NABH rates for the matching super specialities.
WardThe list is for semi-private. General ward is 5% lower and private ward is 5% higher.
Same rate for all wardsConsultations, radiotherapy, tests, day care and minor procedures with no admission.

In the Tier I list, a specialist out-patient consultation is Rs 350, and a super specialist or psychiatry consultation is Rs 700. For a planned procedure, ask the hospital which rate applies and whether anything you may be asked to pay falls outside it.

Emergencies

In an emergency you can go to any empanelled hospital without prior permission. The hospital must not refuse admission or demand an advance, and refusing eligible beneficiaries on credit without valid grounds can cost it its empanelment. If you end up in a non-empanelled private hospital in exceptional circumstances, reimbursement may be considered, but only up to the non-NABH rate for that city. Keep the emergency certificate, bills and discharge summary.

Complaints and help

  • Helpline: 1800-208-8900, toll free and open 24×7.
  • Online: the CGHS grievance portal, or CPGRAMS, the central public grievance system.
  • In person or by letter: the Additional Director of your city.

Attach your card details, referral or permission letter, and any emergency certificate. The charter promises a final reply on most grievances within about a month. Keep your complaint number.

Common questions

Can a 70-year-old use both CGHS and Ayushman Vay Vandana?

No. Seniors already on CGHS may either keep it or opt for PM-JAY. See our PM-JAY guide, and ask CGHS how a switch would affect your card before you decide.

How long is a referral valid?

Three months, under the June 2024 order.

I have lost my card. What now?

Apply to the Additional Director with Form AA or BB and a Rs 100 Bharatkosh challan for a new plastic card. You can also print your own from the CGHS site, or use the digital card.

My hospital says it is no longer on the panel. What should I do?

Check its status on the CGHS website. The August 2026 order told such hospitals to display a notice. If you are mid-treatment, speak to your Wellness Centre or the helpline about next steps.

Sources