Government to introduce a new Medical Scheme

Government introduce a new Medical Scheme for Central Government Employees and Pensioners as in the name of Central Government Employees and Pensioners Health Insurance Scheme (CGEPHIS). In all over India, pensioners are getting meager amount of Rs.100 as Medical Allowance (except CGHS beneficiaries). It is estimated that approximately 17 lakh serving employees and 7 lakh pensioners shall be offered this Scheme and Government plan to enroll all serving employees and pensioners on compulsory / optional basis.

Some key points regarding the scheme:-


CGEPHIS shall be compulsory to new Central Government Employees who would be joining service after the introduction of the Health Insurance Scheme.

CGEPHIS shall be compulsory to new Central Government retirees who would be retiring from the service after the introduction of the Insurance Scheme.

CGEPHIS would be available on voluntary basis for the following:
Existing Central Government Employees and Pensioners who are already CGHS beneficiaries. In this case they have to opt out of CGHS scheme. They will also have the option of choosing both CGHS and Insurance policy. In such case the total insurance premium has to be borne by the member.

Existing Central Government Employees and Pensioners who are not CGHS beneficiaries but are covered under CS (MA)

In-patient benefits – The Insurance Scheme shall pay all expenses incurred in course of medical treatment availed of by the beneficiaries in an Empanelled Hospitals/ Nursing Homes (24 hours admission clause) within the country, arising out of either illness/disease/injury and or sickness.

NOTE: In case of organ transplant, the expenses incurred for the Donor are also payable under the scheme.

Pre & Post hospitalization benefit: Benefit up to 30 days Pre Hospitalization & up to 60 days Post Hospitalization respectively which would cover all expenses related to treatment of the sickness for which hospitalization was done.

Serving/Retired Employees: Self, Spouse, Two dependent children and up to Two Dependent Parents. New born shall be considered insured from day one till the expiry of the current policy irrespective of the number of members covered subject to eligibility under maternity benefit.

Any additional dependent member in addition to above [Sr. No. 5 (1)] can be covered under the Scheme by paying the fixed amount of premium. This additional full premium shall be borne by the beneficiary.

Beneficiaries shall be identified by a “Photo Smart Card” issued by the insurer to all beneficiaries which would have all personal details, medical history, policy limits etc. of the CGEPHIS members. This card would be used across the country to access Health Insurance Benefits. The photograph embedded in the chip of the Smart Card will be taken as the proof for determining the eligibility of the beneficiaries.

The Scheme shall provide coverage for meeting all expenses relating to hospitalization of beneficiary members up to Rs. 5, 00,000/- per family per year in any of the Empanelled Hospital/Nursing Home/Day Care Unit subject to stated limits on cashless basis through smart cards. The benefit shall be available to each and every member of the family on floater basis i.e. the total reimbursement of Rs. 5.00 lakh can be availed by one individual or collectively by all members of the family.

Entitlements for various types of wards: CGHS beneficiaries are entitled to facilities of private, semi-private or general ward depending on their pay drawn in pay band / pension. These entitlements are amended from time to time and the latest order in this regards needs to be followed. The entitlement is as follows:-

Pay drawn in pay band/Basic Pension – Entitlement
Rs. 13,950/-(up to)……………………………… General Ward
Rs. 13,960/- to 19,530/- …………………… Semi-Private Ward
Rs. 19,540/- and above ……………………… Private Ward

The Insurer has to ensure that all CGEPHIS members are provided with adequate facilities so that they do not have to pay any deposits at the commencement of the treatment or at the end of treatment to the extent as the Services are covered under the Scheme. The service provided by the Insurer along with subject to responsibilities of the Insurer as detailed in this clause is collectively referred to as the “Cashless Access Service.”

The services have to be provided by the Empanelled Hospitals/Nursing Homes/Day Care Clinics to the beneficiary based on Photo Smart Card authentication only without any delay. The beneficiaries shall be provided treatment free of cost for all such ailments covered under the Scheme within the limits/sub-limits of defined package rates and sum insured, i.e., not specifically excluded under the scheme.
The process of enrolment shall be as under:
Serving Employees:
1. Departments and offices will call for options from employees to join voluntary CGEPHIS with or without existing CGHS/CS (MA) benefits.

2. Head of Department of the Administrative Ministry/Department would be the contact point for the Insurance Companies.

3. Enrolment forms giving details about self and family and authorization to the department for recovery of premium on a monthly basis would be consolidated by the Administrative Ministry / Department. The data of the beneficiary and dependent members to be covered along with 2 recent passport size photo and copy of enrolment form will be forwarded to Insurance Company on monthly basis.

4. Insurance Company will issue Smart Cards on the basis of information received of the beneficiaries for enrolment.

5. Such Smart Cards along with the enrollment kit shall be sent by the insurers directly to the insured persons at their respective mailing addresses at insurer’s cost within 7 days.

Insurance Premium:-
The beneficiary will have to pay an annual premium which will be determined after the formal introduction of the Scheme. It will vary according to the grade pay of the officer. The estimated annual premium for a standard family size will be in the range of Rs.8000 to Rs.12000 p.a. It is however proposed to be subsidized by the Government to a considerable extent.


  1. I am a holder of CGHS benificiary Card and resident of Calicut, Kerala. Where can I get cash less treatment in Calicut.

  2. Hi,
    My grandmother( wife of deceased central government employee) has undergone heart surgery recently. Whether is eligible for any central government health insurance policy. If so, kindly let me know how claim the expense incurred for her surgery.

  3. It will be a welcome measure for the pensioners who are not staying in CGHS covered areas, like different districts of Kerala, like Wayanad, Calicut, Kasargod etc. Hoping to hear further.

  4. Arun Chandra Panda says
    April 21,2018 at 20. 55hrs

    Let me know the present status of the CGEPHIS Scheme. I am a retired central government employee.Retired from service on 30.4..2013. I am residing in non CGHS station. I am still awaiting for enrollment in CGEPHIS scheme. what are the procedures for enrollment after retirement.

    April 21,2018 at 20.45 hrs

    Let me know the present status of the CGEPHIS scheme. I am a retired central Government employee, retired on 30.4.2018.I am residing in non CGHS station. I am still awaiting for the CGEPHIS SCHEME FOR ENROLLMENT.


  6. This is a good scheme when this will be introduce. I retire as Income tax Officer on 31-12-2008 I am still waiting for this scheme I have still not enrolled myself in CGHS as Im residing in non CGHS station.

  7. Sir, day and night I have been waiting for execution of this scheme.I am cghs beneficiary but settled in non-CGHS area.I therefore earnestly request for schemes implementation.If implemented this will benefit thousands pentioners like me who r settled in non cghs areas.its implementation has been inordinately .delayed

  8. Kindly let me know when the scheme will be commenced/operational
    The cost of medical treatment is increasing with passing of days

    I am retired

  9. We are expecting implementation of this CGEPHI Scheme for the last more than five years. The previous govt. spent several thousand crores Rs on various schemes.They deliberately ignored the cry of the retired old people. The latest information available was that the scheme is under consideration of the planing commission. Now the planing commission itself is in ICU. The Big Babus and the Staff side leaders do not have any interest in this I hope They all are from the CGHS covered area. The reason for delayI hope is the mindset of concerned people which Hon. PM rightly
    said in the historic Red Fort speach ” Mujhe Kya ?, Mera Kya ?. Cry friends and Cry till you die.

  10. Policy is very good and hope the new government will take the decision at earliest to implement this very good health scheme…………………….

  11. The old masters got their reward for deliberately denying implementation of the CGEPHIS to the senior citizens. Expect they will never come to power in the next 100 years. Now let us hope for the best from the new masters.

  12. My I know from the Ministry of Health and FW when the waiting for introduction of CGEPHIS will be come to an end for the Retired Central Government pensioners who are not covered under CGHS and CS(MA)Rules and to depend on Rs.300 p.m. for medical expenses in their old age. Thanks.

  13. request for suitable job in tamilnadu[thanjavur]CGEPHIS


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