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In a major relief for central government employees and pensioners, the Central Government Health Scheme (CGHS) has undergone its biggest update in 15 years, with new package rates coming into effect from October 13, 2025. This long-awaited revision covers nearly 2,000 medical procedures, making cashless treatment in private hospitals much smoother and more accessible.

Why Were These Changes Needed?

For years, several empanelled private hospitals had been hesitant to provide cashless treatment under CGHS. The primary reasons were outdated package rates and delays in payments from the government. As a result, many beneficiaries were forced to pay out of pocket and wait months for reimbursement.

In August 2025, the Central Government Employees National Confederation (GENC) urged the government to revise rates and payment systems, highlighting frequent issues such as denial of emergency care due to administrative bottlenecks.

What’s New in the CGHS Rate Revision?

The Ministry of Health has restructured rates across hospitals based on city category and accreditation standards. The new structure ensures fair pricing for both hospitals and patients, promoting wider acceptance of cashless treatment.

Here’s how the updated rates are categorized:

• Tier-II cities: 19% lower than the base rate

• Tier-III cities: 20% lower than the base rate

• NABH-accredited hospitals: Full base rate applicable

• Non-NABH hospitals: 15% lower than the base rate

• Super-specialty hospitals (200+ beds): 15% higher than the base rate

This structure incentivizes hospitals to maintain high standards while ensuring treatment affordability across regions.

Benefits for Employees, Pensioners, and Hospitals

The revised package rates aim to restore hospitals’ confidence in offering cashless facilities under CGHS. For beneficiaries, the impact will be immediate — no more heavy upfront payments, faster reimbursements, and improved service reliability.

Hospitals will also benefit from streamlined billing and faster settlements, creating a win-win situation for both healthcare providers and patients.

Expanded Coverage: Inclusion of Transgender Dependents

As per the Health Ministry’s September 16, 2025 update, the CGHS now extends coverage to transgender children and siblings who are financially dependent on the cardholder. This inclusion aligns with the Transgender Persons (Protection of Rights) Act, 2019, ensuring equal access to healthcare for all eligible family members.

Recent Improvements Under CGHS

Over the past year, CGHS has introduced multiple digital and operational upgrades:

• A revamped online portal and mobile app for easier access.

• Expansion of cashless treatment to more private hospitals.

• New hospital empanelments across multiple cities.

• Online referral system for faster and paperless approvals.

• Real-time tracking of medicines to prevent shortages.

• Dedicated helpdesks for senior citizens and pensioners.

These initiatives aim to make CGHS more transparent, efficient, and user-friendly.

Who Is Eligible for CGHS Benefits?

The CGHS primarily covers:

• All central government employees (excluding those under Railways and Delhi Administration).

• Central government pensioners, excluding the armed forces and railways.

• Family members who are financially dependent on the employee or pensioner.

Eligibility depends on residence within CGHS-covered cities, currently expanded to 80 urban centers across India.

How to Apply for a CGHS Card

• For employees: Submit the prescribed form along with family photographs through your department.

• For pensioners: Apply at the office of the Additional Director of CGHS or download the form from cghs.gov.in.

• If the Pension Payment Order (PPO) is not yet issued, a provisional card can be obtained using the Last Pay Certificate.

How to Check the New Rates and Procedure Codes

The complete list of revised package rates and procedure codes is available in PDF format on the CGHS website’s notification section. Beneficiaries can download the document to verify applicable rates for different treatments and hospitals.

The Bottom Line

With the new rate structure effective from today, the CGHS is set to become more transparent, inclusive, and efficient. The revision not only addresses long-standing issues of payment delays and outdated rates but also ensures that cashless medical care becomes smoother for thousands of central employees and pensioners across India.

This update marks a major milestone in India’s government-backed healthcare ecosystem—making quality treatment more accessible, timely, and dignified for those who serve the nation.

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