Government Removes Geographical Restriction for CGHS Benefits for Central Government Employees
The Government of India has made an important change in the eligibility rules for the Central Government Health Scheme (CGHS). The Ministry of Health and Family Welfare has removed the existing geographical restriction for serving Central Government employees to avail CGHS facilities.
The new decision makes it easier for eligible Central Government employees posted or residing outside CGHS-covered areas to join CGHS, while employees already within CGHS-covered areas will have to remain under CGHS.
CGHS Eligibility Rules Changed
Earlier, CGHS coverage for serving Central Government employees was linked to their place of residence or posting and the geographical coverage of a CGHS Wellness Centre.
The Government has now decided to completely remove this geographical condition.
This means eligible Central Government employees who are living or posted outside the existing CGHS-covered area can also choose to become CGHS beneficiaries.
Employees Outside CGHS Area Can Opt for CGHS
Central Government employees who are currently using medical facilities under the CS(MA) Rules, 1944 only because they are living or posted outside the geographical coverage of CGHS can now exercise a one-time option to join CGHS.
However, they will have to fulfil the other applicable CGHS eligibility conditions and pay the prescribed CGHS contribution/subscription.
CGHS Will Be Mandatory in Covered Areas
The new rules also clarify that Central Government employees who are residing or posted within a CGHS-covered area will be mandatorily covered under CGHS.
Such employees will not be allowed to opt out of CGHS in favour of medical facilities under CS(MA) Rules, 1944.
Option Can Be Used Only Once
The option to join CGHS is a one-time option. Once an eligible employee exercises the option, it will be final and binding, subject to the applicable eligibility conditions.
Family Members Will Also Be Covered
The option exercised by the principal beneficiary will apply to all eligible dependants. The employee cannot divide the family’s medical coverage between CGHS and CS(MA).
For example, the employee cannot choose CGHS while keeping some eligible family members under CS(MA).
Benefits Under Both Systems Cannot Be Claimed
An employee or eligible family member covered under CGHS cannot simultaneously claim medical facilities under CS(MA) Rules.
The employee will have to provide an undertaking that neither the employee nor eligible family members will take benefits under both systems.
If any inadmissible benefit is taken under both systems, the amount may be recovered according to the applicable rules.
No TA/DA for CGHS Treatment
The Government has also clarified that TA/DA will not be applicable for availing treatment or purchasing medicines under CGHS Rules.
False Information Can Lead to Action
If an employee or beneficiary provides false, incorrect, suppressed or misleading information to obtain or continue CGHS benefits, disciplinary action may be taken under the applicable service rules.
Any inadmissible benefit received on the basis of such information may also be recovered.
New CGHS Rules Effective Immediately
The Ministry of Health and Family Welfare has stated that the provisions of the Office Memorandum will come into force with immediate effect.
