The Central Government Health Scheme (CGHS) has long provided healthcare services to eligible Central Government employees, pensioners and their families. The government has now changed the eligibility framework for serving Central Government employees, giving eligible employees outside the existing CGHS geographical coverage an opportunity to opt for CGHS facilities.
The Ministry of Health and Family Welfare announced the revised provisions on September 17, 2026. The changes are expected to affect around 42 lakh CGHS beneficiaries across 80 cities in the country.
CGHS Eligibility Rules Changed
Under the earlier arrangement, CGHS eligibility for serving Central Government employees was linked to geographical coverage. Employees generally had to live or work within a 5-kilometre radius of a CGHS Wellness Centre to access CGHS facilities.
The Additional Director of CGHS in the concerned city was responsible for notifying the areas served by CGHS Wellness Centres where such boundaries had not already been specified. Employees covered under the Central Services (Medical Attendance) Rules, 1944, who lived within the limits of the relevant Municipal Corporation but outside the 5-kilometre radius could also choose CGHS facilities.
The Ministry of Health and Family Welfare has now reviewed the geographical restriction after considering difficulties faced by serving Central Government employees who were posted or residing outside CGHS-covered areas or in cities where CGHS was not available.
The ministry said it has decided to completely remove the existing geographical criterion for determining the eligibility of serving Central Government employees to avail themselves of CGHS facilities.
As a result, eligible serving Central Government employees who currently depend on the CS(MA) Rules, 1944 because they live or work outside CGHS geographical coverage can exercise a one-time option to become CGHS beneficiaries. They must, however, satisfy all other applicable eligibility requirements and pay the prescribed CGHS contribution or subscription.
Employees who live or work within an existing CGHS-covered area remain required to come under CGHS under the applicable rules and cannot choose medical facilities under the CS(MA) Rules instead.
The ministry has also warned that providing false, incorrect, suppressed or misleading information to obtain or continue CGHS benefits can lead to disciplinary action under the Central Civil Services (Conduct) Rules, 1964, and other applicable rules. Any benefits wrongly obtained on the basis of such information may also be recovered.
Conditions for Choosing CGHS
The new provision comes with several conditions that employees need to understand before exercising the option.
The choice to move to CGHS is available only once. Once an employee exercises the option, it becomes final and binding, subject to the applicable eligibility conditions.
The employee’s eligible dependents will also be covered under the same selection. The family cannot be divided between CGHS and the CS(MA) system.
An employee who opts for CGHS will continue to be responsible for paying the applicable CGHS contribution or subscription, irrespective of their place of residence or posting.
Employees and their covered family members cannot simultaneously claim medical benefits under both CGHS and CS(MA). Similarly, a person covered under CGHS cannot claim facilities under the CS(MA) Rules.
Under CGHS rules, treatment and procurement of medicines will not attract TA or DA.
The employee must also submit an undertaking confirming that neither they nor their eligible family members will claim benefits under both healthcare systems. Any inadmissible benefit received under either scheme can be recovered according to the applicable rules.
Employees who decide not to exercise the CGHS option will continue to remain governed by the CS(MA) Rules, 1944, wherever applicable.
CGHS provides healthcare services through multiple systems of medicine, including Allopathy, Homoeopathy, Ayurveda, Unani, Siddha, Yoga and other Indian systems of medicine.
Source: cghs.mohfw.gov.in
CGHS vs CS(MA): How the Two Systems Differ
CGHS and CS(MA) provide healthcare support through different mechanisms. CGHS operates through a structured network that includes Wellness Centres, government hospitals, laboratories and empanelled private hospitals. Eligible beneficiaries can access services such as outpatient consultations, medicines, diagnostic tests and hospitalisation through the CGHS system.
CS(MA), on the other hand, primarily follows a medical attendance and reimbursement model. Employees generally pay for treatment and medicines and subsequently seek reimbursement according to the applicable rules, approved rates and procedures.
One of the key differences is the way treatment costs are handled. CS(MA) does not provide a cashless treatment facility, meaning employees generally have to pay the expenses first before seeking reimbursement. Depending on the treatment, the process may involve documentation, approvals and reimbursement procedures.
Under CGHS, eligible beneficiaries can receive cashless treatment at empanelled private hospitals, subject to the prescribed procedures and authorisations.
For employees who regularly require hospitalisation, specialist consultations, diagnostic services or medicines, the practical difference between the two systems may therefore be significant.
Rishi Agrawal, CEO and Co-founder of TeamLease RegTech, said employees should consider their own circumstances before exercising the one-time option.
“Employees should look at where they and their dependents live, the hospitals and specialists they are likely to use, their regular requirement for medicines or diagnostics, the availability of CGHS facilities in those locations, and how comfortable they are managing CS(MA)’s reimbursement process,” Agrawal said.
He added that because the decision is final and binding, employees should consider it as a long-term healthcare decision rather than simply completing an administrative procedure.
What Employees Should Consider Before Switching to CGHS
The decision should not be based only on an employee’s current posting. The September 2026 changes remove the earlier geographical restriction for eligible serving Central Government employees, but the option can be exercised only once and cannot subsequently be changed.
Employees should therefore consider their possible future transfers, deputations and changes in residence. The location of spouses and dependents should also be taken into account, particularly where family members live in different cities.
Healthcare requirements are another important consideration. Employees should assess their family’s likely need for regular medicines, specialist consultations, diagnostic tests and hospitalisation and compare those requirements with the services and reimbursement process available under CS(MA).
The financial side of the decision also needs attention. Apart from the prescribed CGHS contribution, employees living outside CGHS-covered locations may have to consider the cost of travelling to access CGHS services. Depending on the circumstances, this could involve transportation, accommodation and additional time spent travelling.
The decision should therefore be considered from a longer-term family healthcare perspective rather than based solely on whether CGHS is useful at the employee’s current location.
No CGHS Centre Nearby? Accessibility Could Affect Costs
Removing the geographical eligibility restriction allows eligible employees posted or residing outside CGHS-covered cities to choose CGHS. However, eligibility does not necessarily mean that CGHS services will be equally accessible from every location.
CGHS continues to function through its network of Wellness Centres, dispensaries, government hospitals, laboratories and empanelled healthcare facilities. Employees living in areas without a nearby Wellness Centre therefore need to consider how easily they can reach the available CGHS network.
Regular travel for consultations or medicines could result in additional transportation expenses and, in some cases, accommodation costs. The time required for such travel should also be considered.
Agrawal said employees should take these expenses into account because travelling to obtain CGHS treatment or medicines does not itself become a reimbursable entitlement under the new undertaking.
He suggested comparing the annual CGHS contribution and likely access-related expenses with the healthcare costs and reimbursement experience that the employee would reasonably expect under CS(MA).
For employees who may move to a CGHS-covered city or regularly use healthcare facilities within the CGHS network, the practical calculation could be different from that of employees who expect to remain in locations with limited CGHS access.
What If Family Members Live in Different Cities?
The new provision is particularly important for employees whose family members live in different cities or states because the CGHS choice applies to the eligible family rather than allowing different members to use separate systems.
For instance, an employee could be posted in one city while their spouse works elsewhere and dependent parents live in another location. If CGHS access varies across those places, the practical usefulness of the scheme may also differ for different family members.
Employees should therefore examine where their family actually receives healthcare instead of considering only their own place of posting.
This is especially relevant for families with elderly dependents or members who need regular medicines, specialist consultations or diagnostic services. The availability of empanelled facilities and the travel involved in accessing them should be considered along with the formal healthcare entitlement.
Since family members cannot be split between CGHS and CS(MA), employees should evaluate the decision at the household level before submitting the required undertaking.
Is the CGHS Contribution Worth It for Employees Outside CGHS Areas?
The CGHS contribution should be considered alongside the actual healthcare requirements and accessibility of the scheme. The value an employee receives from CGHS will depend on how frequently the employee and family members can realistically use its network.
Employees can assess the decision by considering the annual contribution, expected family healthcare requirements, availability of CGHS facilities and the cost of travelling to those facilities.
Those who regularly need outpatient consultations, medicines, diagnostic services or specialist treatment may find the CGHS network relevant, particularly if they or their dependents live in or frequently travel to locations with CGHS facilities.
For employees who permanently live away from the CGHS network, however, the calculation should also include the additional time and expenses required to access CGHS services.
Agrawal said employees should evaluate the decision over their expected remaining period of service rather than looking only at the contribution for a single year.
“The real question is whether the combination of CGHS access, healthcare requirements and family circumstances justifies the recurring contribution and any additional access costs they may incur,” Agrawal said.