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—rti-for-cghs-empanelment [2026/07/06 07:52] (current) – created - external edit 127.0.0.1
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 +{{htmlmetatags>metatag-title=(CGHS empanelment RTI guide | RTI Wiki)&metatag-description=(Use RTI to check CGHS hospital empanelment, revised rates, and your own claim. Step-by-step template, fee, PIO, and appeal ladder, 2025-26 verified.)&metatag-keywords=(CGHS RTI, CGHS empanelment, CGHS rates 2025, CGHS Additional Director, RTI CGHS, CGHS hospital list, HEM portal)&metatag-robots=(index,follow)&metatag-og:title=(CGHS empanelment RTI guide | RTI Wiki)&metatag-og:description=(Use RTI to check CGHS hospital empanelment, revised rates, and your own claim. Step-by-step template, fee, PIO, and appeal ladder, 2025-26 verified.)&metatag-og:type=(article)}}
  
 +====== CGHS empanelment — RTI to check hospitals, rates & your claim ======
 +
 +{{:social:auto:rti-for-cghs-empanelment.png?direct&1200 |CGHS empanelment RTI — RTI Wiki}}
 +
 +
 +<WRAP info>**Direct answer.** File your RTI to the **CPIO, CGHS (Additional Director of your city)** under **section 6(1) RTI Act 2005**. Pay **Rs.10** by IPO / bankers cheque / demand draft / court fee stamp (or cash against receipt at the PIO counter). The CPIO must reply in **30 days**. Ask for the empanelment status of a named hospital, the current CGHS rates, and the status of your own reimbursement claim.</WRAP>
 +
 +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.
 +
 +===== Why an RTI works for CGHS empanelment =====
 +
 +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.
 +
 +===== What changed in 2025-26 (and why the old page was wrong) =====
 +
 +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-by-step: file the RTI =====
 +
 +**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 [[pio-health-hospital-rti|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.
 +
 +===== Template =====
 +
 +<code>
 +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: ..
 +</code>
 +
 +===== What you can ask (and what you cannot) =====
 +
 +  - **Empanelment status** of a named hospital — disclosable (public interest).
 +  - **Applicable package rate** for a procedure — disclosable; the 2019 CIC order (above) confirms CGHS rate information belongs in the public domain.
 +  - **Your own claim file** — disclosable to you as the person concerned.
 +  - **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.
 +
 +===== Escalation ladder =====
 +
 +  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 [[claim-cghs-reimbursement-2026|how to claim CGHS medical reimbursement at non-empanelled hospitals]]. For the card itself (issue, renewal, dependent add-on), see the sister article [[rti-cghs-card-claim|CGHS card / claim RTI]] and the full application guide at [[apply-cghs-card-central-govt-employee-2026|the 2026 CGHS card application guide]].
 +
 +===== Related RTI patterns =====
 +
 +  * [[rti-for-vendor-empanelment|RTI for government vendor / agency empanelment]] — the same transparency pattern, applied to procurement empanelment.
 +  * [[rti-for-hospital-licence|RTI to verify a hospital's licence / registration]] — checks the state licence that sits underneath the CGHS empanelment.
 +
 +===== FAQ =====
 +
 +  * **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.
 +
 +===== Get the proof, then use it =====
 +
 +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.
 +
 +===== Sources =====
 +
 +  - 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.
 +  - 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).
 +  - MoHFW — RTI Act for Ministry: CPIO / FAA nominations, order dated 07-05-2024; Director (CGHS) as FAA for CGHS I/II/III/IV.
 +  - **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).
 +  - **Paschim Banga Khet Mazoor Samity v. State of West Bengal, (1996) 4 SCC 37** — right to emergency medical aid under Article 21.
 +  - CGHS empanelled hospital search: cghsnew.nic.in/reports/view_hospital.jsp.
 +  - HEM portal for empanelment applications: hem.nha.gov.in.
 +  - RTI Act fee and timelines: cic.gov.in (section 6(1), 7(1)).
 +
 +//Last reviewed: 3 July 2026.//
 +
 +{{tag>rti for cghs empanelment citizen-rti rti-template cghs-rates-2025 cghs-empanelment-2026}}