The Central Government has made changes to the eligibility rules under the Central Government Health Scheme (CGHS), providing greater flexibility to certain central government employees who live or work outside areas currently covered by the scheme.
The revised rules remove the earlier geographical restrictions linked to an employee’s place of residence or posting. The change is aimed at addressing difficulties faced by eligible employees located outside the existing CGHS coverage areas.
What Has Changed Under the New CGHS Rules?
Under the revised provisions, eligible central government employees living or working outside CGHS-covered areas can now opt to become members of CGHS, provided they meet the applicable conditions and make the required contribution.
However, the decision to opt for CGHS will be permanent and cannot subsequently be withdrawn.
Employees choosing CGHS coverage will also have to provide a declaration confirming that neither they nor their eligible family members will claim medical benefits under both CGHS and the Central Services (Medical Attendance) Rules, 1944.
For employees who live or work in areas already covered by CGHS, CGHS coverage will continue to be mandatory. Such employees cannot choose medical benefits under the CS(MA) Rules instead.
Government Warns Against False Medical Claims
The government has also issued a warning against submitting incorrect or misleading information to obtain medical benefits.
Employees found providing false information or wrongly claiming healthcare benefits may face disciplinary action. The government can also recover benefits that were obtained improperly.
The provisions are intended to ensure that medical benefits are claimed only according to the applicable rules and eligibility conditions.
What Is the Central Government Health Scheme?
The Central Government Health Scheme is a healthcare programme for serving and retired central government employees, along with their eligible family members.
CGHS was launched in Delhi on July 1, 1954. Its initial objective was to provide medical facilities and make the reimbursement process for outpatient treatment easier for central government employees.
Over the years, the scheme expanded beyond Delhi to several cities across the country. Its services are provided through wellness centres, polyclinics, laboratories and empanelled hospitals.
The coverage has also expanded over time to include eligible pensioners and other categories of beneficiaries.
According to the Ministry of Health and Family Welfare’s Annual Report for 2024-25, CGHS had expanded its services to 81 cities and was serving approximately 46.87 lakh beneficiaries.
Disclaimer
This article is provided for general informational purposes and summarises the CGHS rule changes and information available in the cited government material. The exact eligibility, contribution requirements and medical benefits applicable to an individual may depend on the relevant government rules and official notifications. Employees should verify their specific situation with the appropriate government authority before making any decision regarding CGHS coverage.