Central government employees and pensioners are set to experience significant relief in accessing healthcare, thanks to recent measures simplifying cashless treatment under the Central Government Health Scheme (CGHS). These changes, including revised package rates for medical procedures and more inclusive coverage, aim to make healthcare more accessible and reduce financial burdens for beneficiaries.
Revising Package Rates for Medical Procedures
The government has revised the package rates for approximately 2,000 medical procedures under CGHS, effective from October 13, 2025. This is the most significant revision in 15 years and is designed to make cashless healthcare easier and more accessible for over one crore central government employees and pensioners. The rates have been revised based on hospital accreditation, type, city classification, and ward entitlement. For example, rates in Tier-II cities are 19% lower than the base rate, while those in Tier-III cities are 20% lower. Hospitals with NABH accreditation will receive the base rate, and non-NABH hospitals will get 15% less than super-specialty hospitals (those with 200+ beds), which will receive 15% more than the base rate.
Addressing Past Issues
Previously, many hospitals empanelled under CGHS hesitated to offer cashless treatment, citing outdated package rates and payment delays. This forced employees and pensioners to pay out of pocket and wait months for reimbursements, causing financial strain and, in some cases, denial of emergency medical care. The Central Government Employees Union (GENC) had demanded reforms to address these issues. The revised rates are expected to be more viable for hospitals, encouraging them to provide cashless services.
Benefits for Employees and Hospitals
The reforms offer several key benefits:
- Easier cashless treatment: Hospitals will find the revised rates more acceptable.
- Reduced out-of-pocket payments: Employees can avoid large upfront costs.
- Faster reimbursements: Waiting times for refund claims will be reduced.
- Better healthcare access: Confidence among CGHS cardholders will be restored.
Inclusivity and Expanded Coverage
Inclusivity in healthcare has been boosted with the update of CGHS rules on September 16, 2025, to include dependent transgender children and siblings of central government employees and pensioners, regardless of age. To be eligible, they must be financially dependent and possess valid certification under the Transgender Persons (Protection of Rights) Act, 2019.
Streamlined Processes and Online Enhancements
The government has strengthened the CGHS online portal and mobile app to improve access to healthcare services. Cashless treatment will now be available in more hospitals, with new private hospitals being added to the CGHS panel. An online referral system has been introduced to expedite approvals, and real-time tracking of drug availability will be implemented. Special helpdesks have also been set up for senior citizens.
Directives and Implementation
The Union Health Ministry has instructed all healthcare organizations to accept the new rates by submitting an undertaking by October 13, 2025. Failure to do so will result in de-panelment. The Ministry has clarified that CGHS beneficiaries can undergo treatment at private hospitals empanelled under CGHS for specific procedures listed under the CGHS rate list, provided they are advised by a specialist in a government hospital or a CGHS Medical Officer, without needing any other referral letter.
Impact and Future Outlook
These changes are expected to positively impact approximately 4.6 million CGHS beneficiaries. By addressing the concerns of both patients and hospitals, the government aims to create a more sustainable and efficient healthcare ecosystem for its employees and pensioners. The expansion of cashless treatment, the inclusion of transgender dependents, and the streamlining of online processes mark significant steps towards a more accessible and inclusive healthcare system.
