By Shyamu Maurya

Copyright informalnewz

CGHS: Big news for over 10 million central government employees and pensioners. The central government has announced the biggest changes to the Central Government Health Scheme (CGHS) in 15 years. New rates have been released for nearly 2,000 medical packages.

CGHS: Big news for over 10 million central government employees and pensioners. The central government has announced the biggest changes to the Central Government Health Scheme (CGHS) in 15 years. New rates have been released for approximately 2,000 medical packages. The new rates will be effective from October 13, 2025. This will make cashless treatment easier for CGHS cardholders in private hospitals.

Why Were These Changes Necessary?

For a long time, many hospitals under the CGHS have been reluctant to offer cashless treatment. The reasons cited were the old package rates and delays in payments. This forced employees and pensioners to bear out-of-pocket expenses and wait months for refunds. In August 2025, the Central Government Employees Union (GENC) demanded reforms from the government on this issue. In many cases, even emergency treatment was not available.

Rates for approximately 2,000 medical procedures will now be determined based on the city’s category and the hospital’s accreditation.

Rates in Tier-II cities will be 19 percent lower than the base rate.

Rates in Tier-III cities will be 20 percent lower.

The base rate will apply in NABH-accredited hospitals.

Rates in non-NABH hospitals will be 15 percent lower than the base rate.

Rates in super-specialty hospitals (200+ beds) will be 15 percent higher than the base rate.

Benefits for employees and hospitals

Cashless treatment will be easier. Hospitals will find it easier to provide cashless treatment due to the new rates. The burden on the pocket will be reduced. Employees will not have to bear large expenses upfront. Fast refunds will also be available, and employees will not have to wait long for refunds. CGHS cardholders will have increased confidence.

These changes were made

On September 16, 2025, the Ministry of Health updated the rules under the CS(MA) Rules, 1944. Now, transgender children and siblings can also receive CGHS benefits if they are financially dependent and certified under the Transgender Persons (Protection of Rights) Act, 2019.

Changes in the last year

The CGHS online portal and mobile app have been strengthened. Cashless treatment will now be available at more hospitals. New private hospitals have been added to the CGHS. An online referral system will make approvals quicker and easier. Real-time tracking of medications has been introduced. Special helpdesks have been created for senior citizens.

Who is eligible?

All central government employees, except those in the Railways and the Delhi Administration, and their families.

Central Pensioners (excluding Railways and Armed Forces).

Eligibility depends on residence in CGHS-covered cities. Currently, the scheme is available in 80 cities.

How to Get a CGHS Card

Employees should submit the prescribed form and family photo to their department. Pensioners should apply at the city’s Additional Director’s office or download the form from the CGHS website, cghs.gov.in. If the PPO is not ready, a provisional CGHS card can be issued based on the Last Pay Certificate.

How to View New Rates and Codes

Go to the CGHS website and open the Circulars or Notifications section. Here, you can download a PDF containing all procedure codes and new package rates. Rates for NABH and non-NABH hospitals differ. For example, in 2024, the rate for Laparoscopic Cholecystectomy was ₹33,000 at NABH hospitals and ₹8,050 at non-NABH hospitals.