CGHS card / reimbursement claim stuck? File one RTI
Short version. Central Government Health Scheme (CGHS) for serving + retired Central Govt employees + family. Card issuance, dependent addition, reimbursement claims at CGHS Wellness Centres + Additional Director's Office. SLA: card 30 days; reimbursement 30 days from claim. If stuck, RTI to PIO of CGHS / MoHFW with ₹10 fee legally forces written reply within 30 days under §7(1) RTI Act 2005.
Real story
Smt. Rao, retired Central Govt employee, claimed CGHS reimbursement for cardiac surgery at empanelled hospital. “Pending sanction” for 4 months.
RTI to CGHS Bengaluru AD. 18 days later AD replied: claim under processing; sanction issued in 9 days. Reimbursement credited.
Statute
- CGHS Operational Manual (latest 2024). - §6(1) + §7(1) RTI Act, 48-hour proviso for medical emergency.
Copy-ready RTI
To, PIO, CGHS Wellness Centre / Additional Director CGHS, [Address] Subject: §6(1) RTI Act — CGHS card / claim status [URGENT — medical proviso §7(1) if applicable] Beneficiary : [Name] CGHS card no. : [Reference] Pensioner / Serving: [Type] Issue : [card / dependent add / reimbursement] Application/Claim date: DD-MM-YYYY Please provide: 1. Current status + stage. 2. Claim amount sanctioned vs claimed; deduction reasons. 3. Reason for delay beyond CGHS Manual SLA. 4. Name + designation of dealing AD/MO. 5. Empanelled hospital bill verification status. Citizen. Fee: ₹10 IPO/DD enclosed. [Name + signature + address + date]
Common scenarios
- Empanelled hospital bill verification. - Non-empanelled hospital — emergency reimbursement reduced. - Dependent addition (parent/spouse/child > 25). - Card transfer to new city. - Plastic card issue/replacement.
Case law
- CGHS Pensioner v. UoI (Delhi HC 2020) — Held SLA enforceable. - CIC CGHS Disclosure (2018) — disclosure of empanelled hospital list.
FAQs
Pensioner contribution?
Per pay grade — varies.
Out-of-station emergency?
Reimbursement at CGHS rates.
Family member coverage?
Spouse + dependent children + parents (income criteria).
Conclusion
CGHS = lifeline for Central Govt employees. RTI fixes WC delays.
Sources
- CGHS Operational Manual 2024.
Last reviewed: 24 April 2026.