5 CGHS Scheme Hacks to Save Money on Healthcare

Navigating medical expenses can be overwhelming, especially with rising costs. Thankfully, the CGHS sheme—Central Government Health Scheme—offers a powerful safety net for central government employees, pensioners, and their families. But many beneficiaries don’t fully leverage its potential. In this guide, we’ll uncover 5 proven CGHS hacks to maximize benefits and save thousands on healthcare.

Understanding the CGHS Sheme

What is CGHS Scheme?

The Central Government Health Scheme (CGHS Scheme) is a government initiative aimed at providing comprehensive healthcare services to central government employees and pensioners. Established in 1954, it covers a wide range of medical services including OPD, inpatient treatments, diagnostics, and medicines.

Who is Eligible for CGHS Scheme?

Eligibility includes:

Central government employees and pensioners
Members of Parliament
Judges of the Supreme Court and High Courts
Freedom fighters
Certain autonomous organizations and PSU staff (optional)

How the CGHS Sheme Works

Beneficiaries are issued a CGHS card that grants them access to CGHS wellness centers, empanelled hospitals, diagnostic labs, and authorized dispensaries. Services are either cashless or reimbursed, depending on the situation.

Hack #1 – Choose the Right Empanelled Hospital

Benefits of Empanelled Hospitals

Empanelled hospitals are those recognized by CGHS Scheme to offer cashless treatment for specific procedures. Using them ensures:

No upfront payments
Standardized and subsidized charges
Easier processing of treatments and claims

How to Compare Hospital Facilities

Before choosing a hospital:

Check ratings and feedback from other CGHS users
Verify which specialties are covered
Ensure it offers seamless cashless services

Use the official CGHS website to access the latest empanelled hospital list by city and specialty.

Hack #2 – Utilize CGHS Wellness Centers for Free OPD Services

What Services are Covered in OPD?

CGHS wellness centers provide:

Free doctor consultations
Routine check-ups
Dispensing of prescribed medicines
Minor procedures and dressings

Avoiding Unnecessary Private Consultations

Instead of spending on private clinics, visit your nearest CGHS center. Most centers have experienced government doctors and specialists for basic and chronic ailments. This can save you anywhere from ₹500 to ₹2,000 per visit.

Hack #3 – Leverage Cashless Hospitalization Smartly

How Cashless Treatment Saves Money

In empanelled hospitals, cashless treatment is provided for:

Surgeries
Chronic illness care
Maternity care
Specialized diagnostics

This eliminates the need for upfront payments, making treatments financially stress-free.

Documentation and Pre-Authorization Tips

Ensure:

You carry your CGHS card and ID
Get a referral if required from the CGHS wellness center
Apply for pre-authorization for planned procedures

Delays in paperwork can cause unnecessary expenses.

Hack #4 – Maximize Reimbursement Claims

Timely Submission of Bills

If you receive treatment in a non-empanelled hospital (especially during emergencies), you can claim reimbursement. But remember:

Submit within 6 months
Include bills, prescriptions, and discharge summaries

Common Mistakes to Avoid in Reimbursement

Incomplete forms
Missing doctor registration numbers
Handwritten bills without stamps

Double-check everything before submission to avoid rejections.

Hack #5 – Use CGHS for Diagnostics and Medicines

Accessing Free Diagnostics

Many CGHS diagnostic centers offer tests such as:

Blood and urine tests
ECG, X-ray, MRI, and CT scans
Ultrasound and mammograms

Using these facilities instead of private labs can save significant amounts.

Getting Medicines from Authorized Dispensaries

Medicines prescribed at CGHS wellness centers are dispensed free of cost. Even chronic illness medicines like insulin, hypertension drugs, and cancer medications are covered.

Bonus Tips to Cut Healthcare Costs Using CGHS Scheme

Know the Latest CGHS Rates

CGHS rate lists ensure you are not overcharged by hospitals. Always check the rates before any planned procedure.

Use the CGHS Mobile App

Download the CGHS mobile app to:

Locate nearby wellness centers
Check medicine availability
Track claims and hospital lists

Common Misconceptions about CGHS Sheme

Is CGHS Only for Central Govt. Employees?

No. It also covers Members of Parliament, retired judges, and some autonomous body employees.

Does CGHS Cover All Hospitals?

No. Only hospitals empanelled with CGHS offer cashless services. Always verify before getting admitted.

How to Register and Get a CGHS Card

Online and Offline Application Process

Apply at cghs.nic.in or visit a CGHS office. Both individual and family cards are available.

Required Documents and Fees

ID proof
Address proof
Employment proof or PPO (for pensioners)

Fee: ₹250/year for self and dependents

When Not to Use CGHS

Emergency Situations in Non-Empanelled Hospitals

Go for immediate care; later file a reimbursement claim with valid documentation.

Situations Where Private Insurance Works Better

If your CGHS coverage is delayed or pending approval, private insurance can act as a backup.

Integrating CGHS with Private Health Insurance

CGHS as a Backup for Senior Citizens

Pairing CGHS with insurance means double protection—use CGHS first, and insurance as fallback.

How to Combine Reimbursement Systems

If CGHS only partially covers treatment, submit the balance claim to your insurance provider with a breakdown.

Frequently Asked Questions (FAQs)

Can I use CGHS after retirement?

Yes, by converting to a lifetime CGHS card with a one-time fee.

Are all medicines free under CGHS?

Only those prescribed at CGHS centers and available in their formulary are free.

How long does reimbursement take?

Usually 4–6 weeks if documentation is complete.

Can CGHS be transferred when I change cities?

Yes. Submit a request to your new city’s CGHS office.

Does CGHS cover maternity expenses?

Yes, including pre-natal and post-natal care in empanelled hospitals.

What happens if a hospital refuses cashless treatment?

Report it immediately to CGHS authorities with evidence.

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