The Central Government Health System (CGHS) is a health insurance scheme for present and retired central government employees, pensioners, as well as their dependents. It was first introduced in Delhi in 1954.The scheme has been offering all-inclusive medical care to enrolled central government employees and pensioners for approximately 70 years. The Legislative, Judiciary, Executive, and Press—the four pillars of India’s democratic system—are all served by CGHS in terms of meeting the healthcare needs of eligible beneficiaries.
Due to the enormous number of beneficiaries and its open-ended, liberal approach to providing healthcare, CGHS is the premier healthcare facility for Central Government employees and pensioners. In 71 cities across India, the CGHS currently covers about 35 lakh beneficiaries, and efforts are being made to expand this number to include more cities in order to increase service accessibility.Family members of Central Government employees are also eligible to use the health scheme’s services under the CGHS.The cost of CGHS facilities varies for the central government of India serving employees and pensioners.
Currently, CGHS beneficiaries have access to the following facilities:
- OPD (Outpatient Department)treatment and medications from CGHS Wellness Centers.
- Hospitalization in hospitals with CGHS and government accreditation.
- Investigations at authorized diagnostic facilities run by the government.
- Specialist consultations in polyclinics and government hospitals.
- The recipient may visit any CGHS wellness center in the nation.
- Reimbursement of costs paid for the purchase of hearing aids, hip or knee replacements, artificial limbs, pacemakers, ICDs (Implantable Cardioverter Defibrillator) or combo devices, CPAP (Continuous Positive Airway Pressure), BiPAP (Bilevel Positive Airway Pressure), oxygen concentrators, etc., in accordance with CGHS ceiling rates and standards.
- CGHS beneficiaries can receive medical care in an emergency at any hospital, whether it is affiliated with the scheme or not.
- In the event of an emergency, reimbursement for medical expenses incurred at private, unaccredited hospitals is provided.
- Allopathic, Homeopathic, and Indian systems (Ayurveda, Unani, Siddha, and Yoga) of medicinal consultations and medication administration (AYUSH).
- On the basis of a valid government specialist’s prescription, medications may be issued for up to three months of chronic illness treatment.
- At hospitals and diagnostic centers with impaneled status, pensioners and other identifiable beneficiaries have access to cashless treatment.
- Family Welfare, Maternity, and childcare services.
For current employees
If an existing employee wishes to apply for CGHS, they must submit an application form in the required format to the ministry, department, or office where they are presently employed, along with the necessary family member photos and documentation. The contacted office will give the additional director of CGHS in that city the application form of the current central government employee. On the same day, the employee will receive a printout and a plastic card in the mail.
For government employees
A central government employee is required to accept the CGHS card if they are currently working in an area that is covered by the system. The serving central government employees’ salaries are deducted each month by their department. This reduction is based on the serving employee’s grade pay.
A person must donate to CGHS if they wish to use the services provided by that organization. A pensioner must additionally pay a payment if they wish to use the CGHS’s services. Individuals are able to contribute in one of the two ways listed below.
- Annual Contribution: Pensioners will be able to make an annual contribution to CGHS of up to a specific amount.
- One-Time Contribution: A pensioner will be able to donate their entire 10 years’ worth of savings to CGHS in one lump sum. It will be regarded as a contribution to life.
Demand drafts will be accepted for contributions from pensioners.A pensioner will be required to make contributions in accordance with the grade pay to which they were entitled during their employment.
For retired government employee
A retired government employee or pensioner can obtain a CGHS card by submitting the appropriate paperwork along with the CGHS application form. The retiring employee will, however, be required to pay the subscription costs at the current price.
Facilities provided to CGHS beneficiaries living outside of CGHS-covered regions:
Pensioners who live in non-CGHS-covered regions are qualified to receive CGHS benefits and have the option of getting a CGHS card from a nearby CGHS-covered city.Due to the difficulties these CGHS beneficiaries encounter, they are now able to receive inpatient care, hospitalization, and follow-up care from CS (MA)/Central Services Medical Attendance and ECHS (Ex-Servicemen Contributory Health Scheme) impaneled hospitals (as well as government hospitals), and then submit a claim for reimbursement at CGHS rates to the AD/JD (Additional & Joint Director) of the pertinent CGHS city where their CGHS card is registered.
Treatment without payment under CGHS
Hospitals are required to offer specific groups of staff, including their dependent family members, credit options or cashless services. The central government’s freedom fighters, pensioners, former vice presidents, former governors, former prime ministers, former MPs, and MPsare entitled to receive cashless care. Moreover, cashless treatment should be made available in case of emergency to current Ministry of Health & Family Welfare personnel, including those at subordinate offices under the ministry.
Beneficiaries of the CGHS have a lot to be happy about with the scheme. Risk pooling is made possible by mandatory and means-based enrollment in service areas. There is no budgetary cap on the coverage, which is extensive. It provides access to a variety of prescription drugs as well as referrals to preferred private facilities. The scheme adheres to a broad definition of family, which includes dependent parents and young children of daughters who are widowed, separated, or divorced. Another significant aspect of the programme is the cashless facility provided to seniors.
It takes thorough evidence production, planning, participation of stakeholders, and progressive execution to make systemic changes to an existing scheme. A thorough description of the need for and components of the proposed reform is likely to persuade key stakeholders, including the MoHFW (Ministry of Health and Family Welfare) leadership, subscribers, and participating hospitals, of its impending necessity and the enormous prospects it presents.In order to move India’s health system closer to the objective of universal health assurance, the new Delhi government must first take on the problem of overhauling CGHS. The suggested changes might be tested in CGHS dispensaries in one zone, and the lessons learned could be applied to wider, systemic changes.
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