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. Dear pensioner friends, we are writing our grievances on ice blocks. We are doing it for the last two years. The masters do not open their eyes. The Hble minister already informed that no time frame can be given about its implementation. So no scope of a further question. It will come when it comes. Do not get frustrated. In a democracy you will get your chance sharply within a time frame to respond. Your agony of waiting for years and living with Rs.300 p.m.medical protection should work out at this appropriate time. Thank god you are at least getting your pension in a time frame now.

  2. It is high time the govt introduces the CGEPHIS scheme.It is more than 2 years since the scheme has been proposed and the govt is sitting/sleeping over this important matter of health of its employees.The pensioners not covered by CGHS have to manage with rs 300 pm given as medical allowance.Before a few thousand pensioners die because of the delay let the govt act fast.
    T.R.Subramanian 5th dec 2012 navi mumbai


  4. My mother is a family pensioner of Telecom Department from Kozhikode,Kerala . I want to know how my mother can apply to join CGEPHIS scheme.Kindly guide and send application form to e-mail address

  5. Once Government has decided to introduce the CGEPHIS, then why the government is not taking immediate steps to introduce the same. Delay in coming up the scheme causing mental agony to the retired employees who are residing the areas not covered under the CGHS as retired persons are not covered under CS(MA) Rule and they are to be depend only on Rs.300 p.m. granted by government with pension.

  6. i am retired central govt employee not covered under cghs scheme whom i have to contact at the time of introduction of the scheme

  7. My friend is going to retire on June 2012. Can someone guide him how to avail CGEPHIS facility. He is a CGHS(out patient) benificiary but being far away from employer,where CGHS is not available, being a member in CGHS scheme can he get benefits after retiremtn?. If he availed medical treatment in private hospital or private doctor ? Whether he will get reimbursement by govt? What is the procedure for the same?

  8. I am a retired central government employee, having retired on 30/9/1996. Can someone guide me how to avail CGEPHIS facility. I am a CGHS(in patient) benificiary but being far away from Trivandrum, where CGHS is available, being a member in CGHS scheme does not benefit me much as I am settled at CALICUT(KERALA). Is there any hospital in Calicut(Kozhikode) approved by CGHS where i can avail medical treatment? Will any be kind enough to give some guidance on the above two points.

  9. I like to introduced this a very good scheme for the Central Govt. employee as early as it can be. After retirement the income is getting down and the other living as well as medical expenses goes up. If this scheme is implemented, which I am optimistic, it will give great releif to old retiree.

  10. CGEPHIS is very helpful to the Pensioners who are not residing in CGHS area and getting only Rs. 300 p.m. May I know from the Heallth Ministry when this Scheme will be implemented. I am eagerly waiting to join this Scheme.

  11. This is very good scheme for the people of India. After retirement the income down and the medical expenses goes up. If this scheme is implementef, which I am optimistic, it will give great releif to old people, who will not become a burdon to their children. I wish success to this scheme.


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