CGHS card or claim stuck? File one RTI

CGHS beneficiaries are precisely the people least able to fight queues: pensioners, the chronically ill, and families mid-crisis. The scheme's machinery — Wellness Centre, Additional Director's office, Chief Medical Officer, PAO — is document-driven, which is good news for the RTI route: somewhere in that chain there exists, on paper, an exact answer to “where is my card” or “why is my claim halved”. The Act turns that internal answer into a reply you can hold.

The Citizen's Charter on the CGHS portal describes the route plainly: medical reimbursement claims received from Wellness Centres are scrutinised, the admissible amount is worked out as per CGHS guidelines and the rate list, financial approval is taken from the competent authority, and the bill goes to the Pay and Accounts Officer for ECS credit to the claimant. The charter's indicative timeframe is 30 days, longer only where a file needs expert opinion or higher approval.

That single paragraph is your RTI's backbone — every stage it names is a record you can ask about by name.

• Pensioner monthly contribution — by pay level, per the charter: Level 1-5 Rs 250; Level 6 Rs 450; Level 7-11 Rs 650; Level 12 and above Rs 1,000. Whole-life and lump-sum contribution options exist at the higher levels.
• Plastic cards — issued against a contribution; the charter lists Rs 250 for Levels 1-5, with corresponding amounts at higher levels.
• Wellness Centre services — free consultation and medicines at the counter against the card.
• Empanelled hospitals — treatment on cashless basis for planned procedures where referral procedures are followed; non-empanelled emergency treatment is reimbursable at CGHS rates.

Dr. Shrawan Kumar Pathak, a retired central government doctor, submitted a reimbursement claim after cardiac treatment at an empanelled hospital. Four months of “under sanction” later, he filed a short RTI to the Additional Director's office: current status and stage; the admissible-versus-claimed amount and the reason for any deduction; the date the claim completed scrutiny; and the officer holding the file. Within the statutory period the reply showed scrutiny complete and the file awaiting financial approval for weeks. The sanction followed shortly, and the amount arrived by ECS. As he put it: the scheme was never refusing him; it had simply never been asked to say where his file was, in writing.

To:
The Public Information Officer,
Office of the Additional Director, CGHS [city]

Subject: Application under section 6, RTI Act 2005 —
CGHS card / reimbursement claim status

Sir/Madam, in respect of CGHS beneficiary ID [NUMBER],
[card issue / dependent addition / reimbursement claim
No. ___, dated ___], kindly provide:

1. Current status and stage as on the date of reply.
2. If a reimbursement: the amount claimed, the amount
   found admissible, and the reasons for each deduction.
3. The date the claim completed scrutiny and the date it
   was sent for financial approval, with file movement.
4. Name and designation of the officer with whom the
   file is presently lying, and since when.
5. The indicative timeframe prescribed in the CGHS
   Citizen's Charter for this service, and the reason
   for delay beyond it.
6. If pending with the PAO: the date it reached the PAO
   and the expected ECS date.

Application fee of Rs. 10 paid as per central rules.

Yours faithfully,
[Name, address, phone]

Grievances can also be lodged on the CGHS portal under “Grievances” — the charter acknowledges them within 1-3 working days and aims at a final reply within a month — and the toll-free helpline is 1800-208-8900. Use the portal for speed, the RTI for accountability; the RTI reply is the document you attach to everything else.

• Day 30, no reply — first appeal within 30 days under section 19(1); the FAA must decide within 30 days, extendable to 45.
• Adverse or empty reply — second appeal to the Central Information Commission within 90 days under section 19(3), since CGHS is a central scheme.
• Claim wrongly reduced — the RTI reply itemising deductions is the basis for a representation to the Additional Director asking for the rate-list entry applied.

Emergency treatment at a non-empanelled hospital is reimbursable at CGHS rates, not at the hospital's bill — the deduction surprises most claimants. Ask by RTI for the rate-list entries applied to your bill when the sanctioned amount looks wrong.

Broadly: spouse, dependent children and income-dependent parents, per CGHS guidelines. Dependency proofs — income certificates for parents, student status for sons — are where most additions stall; ask by RTI exactly which document the office found deficient, and on what date.

Where the information sought genuinely concerns life or liberty, section 7(1) proviso requires a reply within 48 hours — but most card and claim matters do not qualify, so do not overclaim; precision serves better than urgency theatre.

Central. CGHS runs under the Ministry of Health and Family Welfare, so appeals that fail at the departmental level lie to the Central Information Commission.

• How to claim CGHS reimbursement — full guide
• EPF claim stuck? Make EPFO answer
• Atal Pension Yojana issue? File one RTI
• Birth certificate stuck? Make the Municipal CRS answer
• Encumbrance certificate stuck? Make the Sub-Registrar answer
• The RTI Playbook book — drafting and escalation from application to second appeal.

Last reviewed: 26 August 2026.