CGHS covers around 44 lakh beneficiaries (CGHS Annual Report 2023-24) across 80 cities through 350+ Wellness Centres. The MR (Medical Reimbursement) bucket — non-empanelled and emergency claims — accounts for about 8-12% of total CGHS claims but contributes disproportionately to grievances. The single biggest issue is the gap between actual hospital bills and CGHS approved rates, which is statutorily unrecoverable — beneficiaries should choose CGHS-empanelled hospitals for planned procedures whenever possible.

The Central Government Health Scheme was launched on 1 July 1954 under the Ministry of Health & Family Welfare (MoHFW) for central government employees and their dependents. It is governed by:

• CGHS Manual 2024 (revised) — the operational rulebook; covers eligibility, package rates, MR procedure, escalation.
• MoHFW Office Memoranda issued from time to time — fixing CGHS rates for procedures (the “CGHS approved rate” list), revising package rates for surgeries, and updating empanelment criteria.
• Section 17(2)(viii) of the Income Tax Act 1961 — exempts medical reimbursement (treatment at govt or empanelled hospital) from “perquisite” tax.
• Article 21 — Supreme Court has held in State of Punjab v. Mohinder Singh Chawla (1997) and Confederation of Ex-Servicemen Associations v. UoI (2006) that emergency healthcare is part of the right to life; reasonable reimbursement at non-empanelled hospitals in emergencies is a constitutional obligation.

• Central Government employees in Delhi/NCR + 80 covered cities, plus all-India for entitled categories.
• Central Government pensioners (with valid CGHS pensioner card; one-time/lifetime contribution paid).
• Family members — spouse + dependent children (up to age 25 or until employed/married) + dependent parents (income limit applies — currently ₹9,000/month + DA per OM 2024).
• Sitting MPs and family (Diplomatic Wing).
• Specified autonomous bodies' employees (per separate OMs).
• Ex-Governors / former Vice Presidents / former Judges of SC and HC (specified categories).

You must hold a valid (active) CGHS card. If your card has expired or you've shifted cities without transferring the card, the Wellness Centre can refuse the MR submission.

• Cashless at CGHS-empanelled hospital — first preference. No reimbursement claim needed; the hospital bills CGHS directly. Use cghs.gov.in → “Empanelled Hospitals” search.
• Planned treatment at non-empanelled hospital — allowed only with prior permission from the AddDir CGHS, granted when (i) specialty unavailable in CGHS empanelled list locally, or (ii) surgeon-specific request with justification. MR claim filed after treatment.
• Emergency at any hospital (CGHS or non-CGHS) — full MR claim, no prior permission needed. The hospital must certify “treatment was emergency in nature” in the discharge summary.
• Treatment outside India — requires special MoHFW sanction (super-specialty cases only).
• Cosmetic procedures, infertility treatment beyond IVF (capped), dental cosmetic work — NOT reimbursable.
• Treatment at unrecognised / non-allopathic facility without specific CGHS recognition — NOT reimbursable.

This is what determines whether your claim succeeds:

• Inform the hospital you are a CGHS beneficiary at admission (some empanelled hospitals will switch you to cashless).
• For emergency: ask the treating doctor to write “emergency in nature” explicitly in the admission note and discharge summary, with reasons.
• Ask for itemised bills — separate room rent, OT charges, surgeon fees, consumables, investigations, drugs.
• Collect all original cash memos (every test, every drug — even pharmacy slips). Photocopies are NOT accepted at CGHS.
• Ask for the discharge summary with all diagnoses (ICD-10 codes if possible) and procedures performed.
• If implants used (stents, lenses, prostheses): get the batch number stickers + invoice of the implant separately.

• Go to cghs.gov.in → “Forms” → download Annexure-A — Medical Reimbursement Claim Form.
• Fill in CGHS card no., beneficiary name, employee/pensioner ID, hospital name, dates of admission/discharge, total bill amount, treatment summary.
• Attach: original bills + discharge summary + investigation reports + prescriptions + payment receipts + (if applicable) prior permission letter + (for death) death certificate + cancelled cheque of bank account where reimbursement should be credited.

The 90-day window starts from the date of discharge. Submission options:

• CGHS Wellness Centre of your registration. Take the original packet; the dispensary clerk verifies and gives an acknowledgement with file number. They forward to the city's CGHS office.
• Online at cghs.gov.in → Beneficiary Login → “Medical Reimbursement Claim” → upload scans (originals to be submitted physically within 7 days).
• Office of the Additional Director CGHS for your city — direct submission for high-value or escalated cases.

If you miss the 90-day window, file with a delay-condonation request explaining the reason (continued hospitalisation, family bereavement, document delays from hospital). Condonation is granted by the AddDir on case-by-case basis but is not guaranteed.

• Wellness Centre clerk → Chief Medical Officer (CMO) of WC → AddDir CGHS for sanction.
• Calculation done at CGHS approved rates (not actual bill). Procedure rates from the latest MoHFW package-rate OM apply.
• Investigation reports cross-checked; queries (if any) raised in writing to beneficiary.

• Sanction order issued; copy goes to PAO (Pay & Accounts Office for serving employees) or directly to bank for pensioners.
• Credit to your registered bank account in 7-15 days post-sanction.
• Standard end-to-end SLA: 30-60 days. In practice 60-120 days is more common for non-empanelled hospital cases.

• The “gap” between hospital bill and CGHS rate is statutorily unrecoverable — section 17(2) tax exemption applies up to actual reimbursement only.
• If you believe the rate applied is wrong (e.g., a newer OM rate not used), file a re-consideration application within 30 days of sanction order.
• For excluded items (consumables, certain implants), refer to the latest MoHFW OM list of permissible items.

+---------------------------+-------------------------+----------------------+
| Item                      | Specifics               | Source / Anchor      |
+---------------------------+-------------------------+----------------------+
| Eligibility               | Central Govt employee + | CGHS Manual 2024     |
|                           | pensioner + family      | (revised)            |
|                           | (income-tested parents) |                      |
+---------------------------+-------------------------+----------------------+
| Filing window             | 90 days from discharge  | CGHS Manual 2024 §57 |
|                           | (extendable on cause)   |                      |
+---------------------------+-------------------------+----------------------+
| Prior permission needed?  | Yes for planned non-    | CGHS Manual 2024     |
|                           | empanelled; NO for      |                      |
|                           | emergency               |                      |
+---------------------------+-------------------------+----------------------+
| Claim form                | Annexure-A (MR Claim)   | cghs.gov.in / WC     |
+---------------------------+-------------------------+----------------------+
| Reimbursement basis       | CGHS approved rates,    | MoHFW package-rate   |
|                           | NOT actual bill         | OMs (latest)         |
+---------------------------+-------------------------+----------------------+
| Settlement SLA            | 30-60 days (60-120 days | CGHS Citizen Charter |
|                           | typical for non-empan.) |                      |
+---------------------------+-------------------------+----------------------+
| Credit mode               | Direct bank credit to   | -                    |
|                           | beneficiary account     |                      |
+---------------------------+-------------------------+----------------------+
| Tax on reimbursement      | Exempt up to actual     | §17(2)(viii) IT Act  |
|                           | reimbursement           |                      |
+---------------------------+-------------------------+----------------------+
| Helpline                  | City CGHS HQ + 011-2306 | cghs.gov.in          |
|                           | 1611 (Delhi)            |                      |
+---------------------------+-------------------------+----------------------+
| RTI to PIO CGHS           | ₹10 IPO. BPL = free.    | RTI Act 2005         |
+---------------------------+-------------------------+----------------------+

• Filed beyond 90 days without a condonation request — rejected.
• Non-empanelled hospital used for planned (non-emergency) treatment without prior permission — rejected outright; only the consultation/diagnostic part may be partially reimbursed.
• Emergency not certified by hospital — claim re-categorised as planned and rejected.
• Investigation reports missing or illegible — query memo issued; if you don't reply, claim auto-closed at 90 days from query.
• Cash memos not original (only photocopies attached) — rejected.
• Diagnosis code dispute — hospital coded one way (higher CGHS rate), CGHS internal medical board re-codes lower; reimbursement reduced.
• Implant invoice / batch number missing — implant cost not reimbursed.
• Items in “Excluded list” under MoHFW OMs — disposables, comfort items, room-rent above entitlement — not reimbursed.
• CGHS card not active at the date of treatment (lapsed pensioner card; non-renewed contribution) — claim refused.
• Bank account details incorrect on Annexure-A — sanction issued but credit fails; needs reissue request.

Visit the WC where you submitted. Ask for the file noting and the last action date. Sometimes the issue is a simple missing document already in your possession.

Each city has an Additional Director CGHS. Write to / visit the office. Phone numbers and emails on cghs.gov.in → “Contact Us” → city directory. Carry your acknowledgement and original documents.

Address: Office of the Director, Central Government Health Scheme, R.K. Puram, Sector-12, New Delhi - 110022. Email: dircghs[at]nic[dot]in. For high-value or systemic disputes.

cghs.gov.in → “Grievance” → online ticket. SLA 30 days. Tracks better than internal escalations.

pgportal.gov.in → MoHFW → CGHS. Routes to Joint Secretary's office. Higher visibility; useful when AddDir is non-responsive.

If you are a serving central govt employee and your MR claim is rejected unfairly, file an Original Application before the CAT bench having jurisdiction. Filing fee ₹50; matter decided typically in 12-18 months.

CGHS is part of the Ministry of Health & Family Welfare and is a public authority under §2(h) of the RTI Act 2005. Each city's CGHS office has a designated PIO (usually a Joint Director or AddDir).

RTI helps here when:

• MR claim has been pending beyond 60 days and CGHS internal portal shows no progress — RTI for the file noting + dealing officer + last date of action.
• Reimbursement was significantly less than the bill — RTI for the rate calculation worksheet and the specific MoHFW OM and package code applied.
• Query memo allegedly issued but you never received it — RTI for the dispatch register entry and content of the query memo.
• Sanction order issued but credit not received — RTI to the PAO / disbursing authority for the disbursement schedule.
• You want to know how similar past claims were processed — RTI for anonymised reimbursement decisions for the same procedure code in the last 12 months (helps benchmark whether you are being short-paid).
• Prior permission for non-empanelled was applied for and decision pending — RTI for the file noting + reason for delay.

For the actual one-page RTI template, see RTI in 12 simple steps.

RTI does NOT help here when:

• You want the actual hospital bill reimbursed in full (above CGHS rates) — the rate ceiling is statutory; RTI cannot lift it.
• Your treatment was at a non-empanelled hospital without prior permission and not an emergency — the rejection is on merits; RTI surfaces the reason but doesn't change it.
• You missed the 90-day window without a condonable cause — late filing rejection stands.
• For disputes on procedure exclusions (cosmetic, certain experimental therapies) — these are scheme exclusions; RTI gets you the rule but not the money.
• For a CA's tax position on the reimbursement amount — that is professional advice.

Q. My CGHS card expired the day before treatment. Can I still claim?
Pensioner cards lapse on non-payment of contribution; serving-employee cards lapse on retirement (then convert to pensioner card). If lapsed at treatment date, claim is generally rejected — renew immediately and seek condonation citing the urgency.

Q. Apollo charged ₹2.85 lakh for angioplasty; CGHS will pay ₹1.95 lakh. Can I claim the gap from anywhere else?
No formal route at CGHS. Some employees carry top-up health insurance (private mediclaim, employer's group policy) which can cover the gap on cashless or reimbursement basis. Pensioners often opt for a private senior-citizen plan to bridge this.

Q. The hospital is on the CGHS empanelled list but refused cashless. What can I do?
File a complaint with the AddDir CGHS of your city — empanelled hospitals are contractually bound to cashless for entitled CGHS beneficiaries. Repeated refusal can lead to de-empanelment.

Q. Can I claim reimbursement for my dependent parent's treatment?
Only if your parent's monthly income (pension + interest + rent) is below ₹9,000 + DA (per latest OM 2024) and they are listed as a dependent on your CGHS card. Otherwise, no.

Q. I'm a serving employee posted in a non-CGHS city. What are my options?
You're covered under CS(MA) Rules 1944 (Central Services Medical Attendance Rules) — similar reimbursement structure but administered through your DDO/PAO directly, not CGHS. CGHS Wellness Centres outside the 80 covered cities don't exist; CS(MA) rates apply.

Q. Got a query memo asking for additional documents. How long do I have?
Typically 30 days from the date of memo. If you cannot comply, request an extension in writing. Failure to reply auto-closes the claim.

Q. Is the reimbursement taxable?
No, up to the actual reimbursement amount under §17(2)(viii). The gap that you bear out-of-pocket can be claimed as a §80D / §80DDB deduction in some specific scenarios (consult a CA).

Q. The discharge summary doesn't mention “emergency”. Can the hospital amend it?
Yes — many hospitals will issue an amended discharge summary on request, especially if the admission note mentioned emergency. Get the amendment within the 90-day window.

• RTI in 12 simple steps — for first-time filers
• All Indian government helplines — one master directory
• RTI forms + state-wise fee chart
• RTI for stuck PF withdrawal — copy-ready template
• All "money & schemes" RTI guides

Last reviewed: 26 April 2026 by RTI Wiki editorial team. CGHS rates and package OMs are revised periodically by MoHFW — verify the latest at cghs.gov.in or write to admin@bighelpers.in if you spot a stale figure.