Enhancing CGHS Facilities: A Review of Recent Decisions and Future Directions
Introduction
The Central Government Health Scheme (CGHS) plays a vital role in providing healthcare access to central government employees and pensioners. This article delves into recent discussions and decisions concerning CGHS facilities, focusing on the expansion of wellness centres, improvements in claim settlements, and the availability of medicines. Understanding these developments is crucial for beneficiaries seeking to leverage the full benefits of the scheme.
Full Article
Expanding Access: New CGHS Wellness Centres
A significant step towards enhancing CGHS accessibility has been the approval for opening 29 new Wellness Centres across various cities in India. This initiative directly addresses the need for increased availability of CGHS facilities at the district level, aiming to bring services closer to beneficiaries. Cities like Bhilai, Udupi, Jamshedpur, Udaipur, and Bangalore are among those set to benefit from these new centres, improving the reach and convenience of outpatient services. This expansion is a direct response to the demand for better healthcare infrastructure within the CGHS network.
Addressing Specific Health Needs: Attendance Allowance for Pensioners
The scheme is reviewing a critical request for an Attendance Allowance for pensioners suffering from debilitating conditions such as Parkinson’s, Dementia, and other ailments requiring constant assistance. This proposal aims to ensure that individuals with chronic health issues can lead dignified lives with the necessary support. The Ministry of Health & Family Welfare and the CGHS administration are examining the feasibility and implementation of such an allowance, recognizing the unique challenges faced by these beneficiaries.
Strengthening In-Patient Care: Empanelment of Private Hospitals
While CGHS primarily operates through its network of Wellness Centres for outpatient care and empanelled private hospitals for inpatient services, the establishment of full-fledged CGHS hospitals is not its operational model. However, recent policy updates, particularly Office Memoranda (OM) dated 22.12.2025, are facilitating the empanelment of more private healthcare organizations (HCOs) in Tier II and Tier III cities. This measure is designed to ensure that CGHS beneficiaries have adequate access to quality inpatient care, even in areas where dedicated CGHS hospitals are not feasible.
Facilitating Diagnostic Services: Revised Referral Limits
Beneficiaries aged 70 and above now enjoy greater autonomy in accessing specialist consultations and diagnostic tests. They can directly consult specialists at empanelled hospitals without a prior referral from a CGHS Wellness Centre. Furthermore, for diagnostic tests costing less than ₹3,000 (excluding CT scans and MRIs), a valid prescription from a treating specialist is sufficient, eliminating the need for additional endorsements. Referrals issued by CGHS Wellness Centres remain valid for three months, covering up to six consultations, thereby streamlining the process for timely medical interventions.
Improving Medicine Availability and Procurement
Ensuring a consistent supply of quality medicines is a top priority. CGHS has recently notified a comprehensive ‘Drug Procurement Policy’ to address the continuous availability of essential medications. This policy aims to improve the procurement process and distribution channels. In cases where prescribed medicines are temporarily unavailable, including temperature-sensitive injections, CGHS ensures they are promptly arranged through Authorized Local Chemists (ALCs), adhering to proper storage and cold-chain norms. The policy also clarifies that while the manufacturer of a medicine may change, the salt, strength, and dosage will remain consistent.
Streamlining Medical Claims Settlement
The timely settlement of medical reimbursement claims (MRCs) is being prioritized through an enhanced online system designed for transparency and faster disposal. Clear timelines have been established for claims related to treatment at private non-empanelled hospitals for pensioner beneficiaries. Beneficiaries can now track their MRCs through the new MRC CGHS portal and the myCGHS 2.0 app. Furthermore, credit bills for pensioners are being processed on the revamped Transaction Management System (TMS) 2.0, ensuring quicker tracking and settlement of bills from private HCOs.
Enhancing Beneficiary Verification and Support
CGHS is exploring additional verification methods beyond OTP-based registration to alleviate inconvenience for beneficiaries, especially when family members accompany them. The current system where OTPs are sent to the primary beneficiary’s registered mobile number can pose challenges. The scheme is committed to finding solutions that ensure smooth and efficient point-of-care identification for cashless facilities.
Rationalizing Staffing and Empanelment Policies
Staffing across CGHS Wellness Centres is periodically reviewed and rationalized based on daily footfall to ensure optimal resource allocation. Simultaneously, CGHS has initiated processes to empanel healthcare organizations in Tier II and III cities, irrespective of existing CGHS coverage. This proactive approach aims to extend healthcare access to central government employees in a wider geographical area, particularly in regions where CGHS centres are not yet established.
Fixed Medical Allowance (FMA) Provisions
The provision of Fixed Medical Allowance (FMA) to beneficiaries residing in CGHS-covered areas is determined by the applicable Pension Rules. While FMA is a recognized benefit, its availability and terms are governed by these established pension regulations.
Developments in Jammu and Kashmir
In Jammu, an AYUSH dispensary is now operational within the premises of CGHS WC Jammu-2. Essential staff, including a doctor and pharmacist, have been posted, and the procurement of Ayurvedic medicines is underway. Additionally, the establishment of a polyclinic and laboratory services at Thanser Jammu South is currently under consideration, indicating ongoing efforts to bolster healthcare provisions in the region. Timely settlement of MRCs in Jammu is also being actively monitored.
Exploring Home Delivery of Medicines
The feasibility of extending home delivery of medicines under CGHS is being examined. This initiative aims to reduce the need for beneficiaries to visit Wellness Centres, thereby enhancing convenience and accessibility, particularly for those with mobility issues or residing at a distance.
Strengthening Existing Infrastructure and Policies
Beyond the establishment of new centres, CGHS is focusing on strengthening its existing infrastructure and implementing robust policies. The comprehensive ‘Drug Procurement Policy’ and the ongoing empanelment of private HCOs in non-CGHS covered areas are key components of this strategy. These efforts are geared towards ensuring uninterrupted access to quality healthcare services and medicines for all CGHS beneficiaries.
Addressing Capacity and Access in Kolkata
While there are no immediate plans for new CGHS Wellness Centres in Barasat, Baruipur, and Patuli in Kolkata, the scheme is actively expanding its network of private empanelled hospitals. This strategy aims to distribute the patient load from existing centres like Airport and Rajdanga and ensure smoother, more humane medical treatment for beneficiaries across the state. West Bengal currently has 18 CGHS Wellness Centres.
Important Information
| SI. No. | Agenda Item | Discussion/Decision |
|---|---|---|
| 1. | Availability of CGHS facilities at District level or reasonable rise in medical allowance | Approval for 29 new Wellness Centres granted. Item closed. |
| 2. | Request for an Attendance Allowance for pensioners with chronic ailments | CGHS requested to examine the request. [Action: M/o Health & Family Welfare/CGHS] |
| 3. | Establishment of a full-fledged CGHS-type hospital in Jharkhand | CGHS relies on Wellness Centres and empanelled hospitals. More private HCOs to be empanelled in Tier II/III cities. One new Wellness Centre in Jamshedpur is under process. Item closed. |
| 4. | Revision of current referral-free limit of Rs.3,000/- for diagnostic tests under CGHS | Beneficiaries aged 70+ can consult specialists directly. No additional endorsement for tests below ₹3,000 with valid prescription. Referral valid for 3 months/6 consultations. Item closed. |
| 5. | Establishment of CGHS Wellness centre at Puri, Odisha | No proposal for Puri WC. HCOs in Tier-2/3 cities eligible for empanelment. Beneficiaries can avail treatment at Govt. hospitals without referral. Private hospitals in Puri can seek direct empanelment. Item closed. |
| 6. | Timely settlement of medical claims | Claims processed through an online system. Clear timelines for private non-empanelled hospitals. Beneficiaries can track claims on MRC CGHS portal and myCGHS 2.0 app. Credit bills processed on TMS 2.0. Item closed. |
| 7. | OTP-based registration challenges and medicine availability | Considering other verification means for beneficiary identification. Prescribed medicine (salt) is not changed, only manufacturer may change if salt, strength, dosage remain the same. Medicines procured from Govt. sources; temporary unavailability handled by ALCs with proper storage. Item closed. |
| 8. | Expansion/Extension and staffing of CGHS WCs in specific cities; Policies for empanelment | Staff rationalization based on footfall. Process initiated to empanel HCOs in non-CGHS areas of Tier II/III cities. Item closed. |
| 9. | Providing option of FMA to those residing in CGHS covered areas | FMA granted as per applicable Pension Rules. Item closed. |
| 10. | Opening of Ayurvedic Dispensary at Jammu, Polyclinic at Jammu; Delay in settlement of MRCs and Shortage of Staff at WCs at Jammu | AYUSH dispensary operational in Jammu. Polyclinic & Lab services at Thanser Jammu South under consideration. MRCs processed timely and reviewed. [Action: M/o Health & Family Welfare/CGHS] |
| 11. | Extension of home delivery of medicines under CGHS | CGHS requested to examine feasibility. [Action: M/o Health & Family Welfare/CGHS] |
| 12. | Need to strengthen and expand CGHS services and improve medicine availability | 29 new CGHS wellness centres sanctioned. Comprehensive ‘Drug Procurement Policy’ notified. Item closed. |
| 13. | Opening a new CGHS Wellness Centre at Badlapur and ensuring regular supply of quality medicines | No proposal for Badlapur WC. More Pvt. HCOs to be onboarded in non-CGHS areas. Comprehensive ‘Drug Procurement Policy’ notified on 15th January 2026. Item closed. |
| 14. | Opening new Wellness Centres at Barasat, Baruipur, and Patuli in Kolkata | No proposal for new WCs in Kolkata. More Pvt. HCOs to be onboarded in non-CGHS areas. Total WCs in West Bengal: 18. Item closed. |
Conclusion
The recent decisions reflect a proactive approach by the Ministry of Health & Family Welfare and CGHS to enhance healthcare delivery. The expansion of wellness centres, policy adjustments for empanelment, and focus on efficient claim settlement and medicine availability are significant steps towards better serving beneficiaries. Continued monitoring and implementation will be key to realizing the full benefits of these initiatives.
Frequently Asked Questions
What is the recent development regarding the expansion of CGHS facilities?
Approval has been granted for opening 29 new CGHS Wellness Centres across various cities to improve accessibility.
Is CGHS planning to establish full-fledged hospitals in states like Jharkhand?
No, CGHS primarily operates through Wellness Centres and empanelled private hospitals, and does not establish standalone full-fledged hospitals.
What changes have been made regarding referral limits for diagnostic tests?
Beneficiaries aged 70 and above can directly consult specialists, and for diagnostic tests below ₹3,000, a valid prescription is sufficient without additional endorsement.
How is CGHS ensuring the availability of medicines, especially for critical patients?
A comprehensive ‘Drug Procurement Policy’ has been notified, and temporary unavailability of medicines, including temperature-sensitive injections, is managed through Authorized Local Chemists with proper storage.
What measures are being taken to improve the settlement of medical claims?
An online system, clear timelines, the MRC CGHS portal, and the myCGHS 2.0 app are being used to expedite and track medical reimbursement claims.
Are there any plans for extending home delivery of medicines under CGHS?
The feasibility of extending home delivery of medicines under CGHS is currently being examined.
What is being done about the OTP-based registration challenges for beneficiaries?
CGHS is considering the addition of other verification methods to simplify the registration process for beneficiaries and their accompanying family members.
How is CGHS addressing staffing needs in its Wellness Centres?
Staffing levels across Wellness Centres are periodically rationalized based on daily footfall to ensure optimal resource allocation.
Are there any new developments for CGHS beneficiaries in Jammu?
An AYUSH dispensary is operational in Jammu, and the establishment of a polyclinic and laboratory services is under consideration.
What is the general approach to increasing healthcare access in areas without CGHS centers?
CGHS is actively empanelling more private healthcare organizations (HCOs) in Tier II and Tier III cities to ensure adequate patient care access.
