CGHS empanelment — RTI to check hospitals, rates & your claim

Ramesh, a retired central government employee in Pune, took his wife to a “CGHS-empanelled” hospital for a knee replacement. At the billing counter he was told the hospital was no longer on the CGHS list since May 2026, and the package rate had changed in October 2025. He paid from his own pocket and filed a reimbursement claim that sat silent for months. He did not know which hospital was valid, what the correct rate was, or who to ask.

This is the gap an RTI fills. The Central Government Health Scheme (CGHS), run by the Ministry of Health & Family Welfare since 1954, gives cashless treatment to central government employees, pensioners, and dependents. But empanelment lists change, rates are revised, and claims get stuck. A focused RTI gets you written proof — and written proof forces a stalled file to move.

CGHS is a central government body, so its information is governed by the Right to Information Act 2005. Under section 6(1), any citizen can ask the Central Public Information Officer (CPIO) for records. Under section 7(1), the CPIO must reply within 30 days — and within 48 hours where the information concerns the life or liberty of a person (for example, a denied emergency admission).

The Ministry of Health & Family Welfare has nominated CPIOs and First Appellate Authorities (FAA) for each CGHS section. The nomination order for the Department of Health & Family Welfare is dated 07-05-2024, and the Director (CGHS) is the First Appellate Authority for CGHS I/II/III/IV sections. So if your first application is ignored or refused, you have a named officer to appeal to — not a void.

There is also a court-tested basis for disclosure. In CIC/MH&FW/A/2017/171037-BJ (S.K. Verma v. Ministry of Health & Family Welfare, decided 19 February 2019, Information Commissioner Bimal Julka), the Central Information Commission directed the CPIO to suo motu upload the relevant submission on the website within 15 days under section 4(2) of the RTI Act. In plain terms: CGHS rate and empanelment information is supposed to be public already, and an RTI is the lever when it is not.

The broader right behind this is the right to health as part of the right to life under Article 21, affirmed in Paschim Banga Khet Mazoor Samity v. State of West Bengal, (1996) 4 SCC 37 — a landmark case on emergency medical aid.

The earlier version of this article cited “Revised CGHS rates 2024” and a fabricated case number. Both are now corrected.

Revised package rates — 03.10.2025 OM. The CGHS revised package rates were notified by OM F.No.5-16/CGHS(HQ)/HEC/2024(Part-I) dated 03.10.2025, digitally signed by Dr. Satheesh Y.H., Director CGHS, effective from 13.10.2025. The rate structure uses three city tiers:

• Tier I (X cities) — full rate.
• Tier II (Y cities) — 10% lower.
• Tier III (Z cities) — 20% lower.

Within each tier, non-NABH / non-NABL healthcare organisations are paid 15% lower than NABH/NABL-accredited ones, and super-speciality hospitals are paid 15% higher than the NABH rate.

Headline rates under this OM (as extracted from the official OM): ICU / critical care Rs.5,400/day; ward charges General Rs.1,500/day, Semi-private Rs.3,000/day, Private Rs.4,500/day; specialist OPD consultation Rs.350; super-specialist / psychiatry OPD Rs.700. *(Caveat: the rate PDFs are scanned images; these figures were extracted consistently from the official OM by multiple independent secondary sources. Always cross-check the exact procedure code against the OM.)*

This OM suppressed 10 earlier CGHS rate OMs (listed in Annexure VI, running from 26.11.2014 to 01.05.2023). So any “2024 rates” reference is now superseded. From 13.10.2025, all existing Memoranda of Agreement (MoAs) ceased to be valid and hospitals had to seek fresh empanelment.

Fresh empanelment — 22.12.2025 OM. Fresh empanelment of private hospitals was notified by OM F.No.5-34/CGHS/HEC(HQ)/2025 dated 22.12.2025. Applications are submitted through the HEM portal (hem.nha.gov.in) — the CGHS Hospital Engagement Module. A fresh Performance Bank Guarantee valid for 42 months is mandatory. HCOs that are ABDM M3-compliant get a 20% reduction in the PBG amount. The original MoA execution deadline was 31 March 2026; it was extended to 30 April 2026 by an OM dated 28.03.2026 because of HEM 2.0 portal glitches. Hospitals that did not comply faced de-empanelment from 1 May 2026.

Who runs the empanelment in your city? The Additional Director (AD) of CGHS for your city chairs the Hospital Empanelment Committee. The AD scrutinises documents, conducts inspection, receives the signed MoA / Performance Bank Guarantee / Hospital Policy, and issues the empanelment notification within 24 hours of creating system logins. This is why the AD is the right RTI addressee.

Step 1 — Find the correct PIO. The CPIO for CGHS matters sits in the office of the Additional Director (AD), CGHS, for your city (Delhi has multiple AD zones; other cities have one). Check the MoHFW RTI nomination page for the named CPIO and FAA. For a deeper guide, see how to find the correct PIO for health/hospital RTIs.

Step 2 — Draft a focused application. Ask specific, written-answer questions. Vague “give me all records” requests get rejected.

Step 3 — Pay the fee. The RTI fee for central government PIOs is Rs.10, payable by Indian Postal Order / bankers cheque / demand draft / court fee stamp, or cash against a receipt at the PIO counter. Do not send cash by post.

Step 4 — Submit. Hand it in at the CGHS AD office, or send by registered post. Keep the receipt. The 30-day clock starts when the CPIO receives it.

Step 5 — If no reply in 30 days, file a First Appeal with the FAA (for CGHS I/II/III/IV, the Director (CGHS)) within 30 days of the deadline. If the FAA also fails, go to the Central Information Commission.

To: The Central Public Information Officer (CPIO),
    Office of the Additional Director, CGHS — [your city]

Subject: Application under section 6(1) of the RTI Act, 2005

1. Empanelment status of [hospital name], [address], as on [date] —
   whether currently empanelled under CGHS, effective from / till when,
   and the MoA reference number.

2. The applicable CGHS package rate (with procedure code) for
   [treatment / procedure name] at the above hospital as per
   OM F.No.5-16/CGHS(HQ)/HEC/2024(Part-I) dated 03.10.2025.

3. The city tier (X / Y / Z) and accreditation category
   (NABH/NABL or non-NABH/non-NABL) applied to the rate billed to me.

4. Status of my reimbursement claim No. [..] (CGHS card No. [..]) —
   present stage, pending queries, and the action taken with dates.

5. A certified copy of the empanelment notification and the rate sheet
   applicable to [hospital name] on the date of my treatment.

Fee of Rs.10 paid by [IPO No. / DD No. / court fee stamp / cash receipt No. ..].

Name: ..
Address: ..
CGHS beneficiary ID / card No.: ..
Contact: ..

1. Empanelment status of a named hospital — disclosable (public interest).
2. Applicable package rate for a procedure — disclosable; the 2019 CIC order (above) confirms CGHS rate information belongs in the public domain.
3. Your own claim file — disclosable to you as the person concerned.
4. A third party's claim details — may attract section 8(1)(j) (personal information); ask instead for process status and timelines, not another person's medical or financial data.

1. **CPIO (CGHS AD office)** — 30-day reply.
2. **First Appellate Authority** — Director (CGHS) for CGHS I/II/III/IV sections; file within 30 days of the CPIO's deadline or adverse reply.
3. **Central Information Commission** — second appeal within 90 days.
4. **Parallel grievance** — lodge on the CPGRAMS / MoHFW grievance portal at the same time. A grievance moves the file administratively; the RTI gets you the proof. See [[file-rti-online-india|the general how-to-file-an-RTI guide]] for the online filing route.

If the dispute is about a reimbursement that was wrongly refused or underpaid at a non-empanelled hospital, the RTI gets you the rate sheet and the status — then follow the reimbursement procedure in how to claim CGHS medical reimbursement at non-empanelled hospitals. For the card itself (issue, renewal, dependent add-on), see the sister article CGHS card / claim RTI and the full application guide at the 2026 CGHS card application guide.

• RTI for government vendor / agency empanelment — the same transparency pattern, applied to procurement empanelment.
• RTI to verify a hospital's licence / registration — checks the state licence that sits underneath the CGHS empanelment.

• Q: Where do I check if a hospital is still empanelled? The official searchable list is at cghsnew.nic.in/reports/view_hospital.jsp (also via cghs.mohfw.gov.in), searchable by hospital name and city. Because the list changed on 1 May 2026 after the fresh-empanelment deadline, confirm in writing through the RTI above before a planned admission.
• Q: A hospital says it was de-empanelled from 1 May 2026 — can I still get the old rate? No. From 13.10.2025 the old MoAs were void and from 1 May 2026 non-compliant hospitals were de-empanelled. Treatment at a now-de-empanelled hospital is on reimbursement at the CGHS rate, not cashless — verify the hospital's current status first.
• Q: Do I file RTI locally or at MoHFW Delhi? File with the CPIO at the CGHS AD office of your city — that office holds the empanelment and claim records. The MoHFW Delhi CPIO is for policy-level questions.
• Q: Out-of-state treatment — is it covered? Yes, at CGHS rates in any empanelled hospital across cities. The tier (X/Y/Z) of the city where you take treatment decides the rate.

If this helped, two things keep this work going:

• Download the RTI Playbook — ready-to-use templates and the full escalation ladder for health, pension, and reimbursement RTIs, so you never start from a blank page.
• Support this work — a small donation keeps these verified, plain-language guides free for every citizen who needs written proof from the government.

1. CGHS revised rates OM F.No.5-16/CGHS(HQ)/HEC/2024(Part-I) dated 03.10.2025, effective 13.10.2025 — official OM reproduction.
2. Fresh empanelment OM F.No.5-34/CGHS/HEC(HQ)/2025 dated 22.12.2025; deadline extension OM dated 28.03.2026 (MoA execution to 30 April 2026; de-empanelment from 1 May 2026).
3. MoHFW — RTI Act for Ministry: CPIO / FAA nominations, order dated 07-05-2024; Director (CGHS) as FAA for CGHS I/II/III/IV.
4. CIC/MH&FW/A/2017/171037-BJ, S.K. Verma v. Ministry of Health & Family Welfare, decided 19 February 2019 (Bimal Julka, IC) — suo motu website upload under section 4(2).
5. Paschim Banga Khet Mazoor Samity v. State of West Bengal, (1996) 4 SCC 37 — right to emergency medical aid under Article 21.
6. CGHS empanelled hospital search: cghsnew.nic.in/reports/view_hospital.jsp.
7. HEM portal for empanelment applications: hem.nha.gov.in.
8. RTI Act fee and timelines: cic.gov.in (section 6(1), 7(1)).

Last reviewed: 3 July 2026.