CGHS Update: Cashless Treatment at Private Hospitals Made Easier with New Rules Effective October 13

Major Overhaul in CGHS After 15 Years

The Central Government has announced a major reform for its employees and pensioners under the Central Government Health Scheme (CGHS). After nearly 15 years, the government has revised around 2,000 medical package rates, which will come into effect from Monday, October 13, 2025. This move aims to simplify and expand access to cashless treatment in private hospitals for CGHS beneficiaries.

Why the Change Was Needed

For years, several private hospitals under the CGHS network hesitated to offer cashless treatments. The main reasons were outdated package rates and delays in payment settlements. As a result, employees and pensioners often had to pay medical bills upfront and wait months for reimbursement.

In August 2025, the Central Government Employees National Confederation (GENC) had urged the government to revise the outdated system. There were also instances where patients faced delays in emergency treatments due to unclear or inefficient payment procedures. The new reforms aim to fix these long-standing issues and rebuild trust between hospitals and beneficiaries.

How the New Package Rates Work

The revised CGHS structure introduces city-based and hospital category-based pricing, ensuring fairness and transparency. Here’s how it will work:

• Tier-II cities: Rates will be 19% lower than the base rate.

• Tier-III cities: Rates will be 20% lower than the base rate.

• NABH-accredited hospitals: Base rate will apply.

• Non-NABH hospitals: Rates will be 15% lower than the base rate.

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

This rationalized system will help hospitals recover costs appropriately while ensuring patients receive standardized treatment rates across different regions.

Benefits for Employees and Hospitals

With the implementation of the new rates, hospitals are expected to find cashless billing more viable and transparent. For employees and pensioners, this means no more paying large amounts upfront and waiting months for refunds. The simplified payment mechanism and revised rates will encourage hospitals to join or continue in the CGHS network, improving the overall healthcare experience for beneficiaries.

Additional Reforms Introduced

Alongside the rate revision, the Ministry of Health and Family Welfare introduced several digital and policy updates on September 16, 2025, to make the system more inclusive and efficient:

• Transgender children and siblings of government employees can now be covered under CGHS if they are financially dependent and certified under the Transgender Persons (Protection of Rights) Act, 2019.

• The CGHS online portal and mobile app have been upgraded for smoother navigation.

• More private hospitals have been added to the CGHS panel for cashless treatment.

• Online referral system introduced for quicker approvals.

• Real-time tracking of prescribed medicines has begun to ensure transparency.

• Dedicated help desks for senior citizens have been set up at major CGHS centers.

Eligibility Criteria

The scheme covers:

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

• All central government pensioners (excluding those from Railways and Armed Forces).

However, eligibility depends on residence in CGHS-covered cities. Currently, the scheme operates in around 80 cities across India.

How to Apply for a CGHS Card

For serving employees, the process involves submitting the prescribed application form with family photos through their respective departments.

For pensioners, applications can be submitted at the Additional Director’s Office of the concerned city or downloaded from the official CGHS website (cghs.gov.in).

If the Pension Payment Order (PPO) is not yet issued, a provisional CGHS card can be provided based on the Last Pay Certificate (LPC).

Checking New Rates and Codes

Beneficiaries can view or download the updated rate list and procedure codes from the official CGHS website. The PDF document includes separate pricing structures for NABH and Non-NABH hospitals.

Final Take

The new CGHS reforms mark a major modernization of India’s oldest health scheme for government employees. With streamlined digital processes, revised rates, and better inclusivity, the updated framework promises faster, fairer, and more accessible healthcare—especially in private hospitals.

Starting October 13, 2025, CGHS cardholders can expect a smoother experience with cashless treatments and improved medical support across India.