CGHS Rules for KVS Employees
What is CGHS?
Think of CGHS as a special health card that helps government employees and their families get medical treatment at lower costs or even free in some hospitals. It's like having a discount card for healthcare.
Is CGHS Mandatory for KVS Employees?
No, it's optional! You can choose whether you want to join CGHS or not. But if you join, you get many benefits. The government decided in November 2024 that all KVS employees (teachers, principals, staff) can now use CGHS facilities.
CGHS Covered Cities - Complete List (71 Cities)
North India:
- Delhi and NCR: Delhi, Faridabad, Ghaziabad, Greater Noida, Gurgaon, Indirapuram, Sahibabad
- Uttar Pradesh: Agra, Aligarh, Allahabad (Prayagraj), Bareilly, Gorakhpur, Kanpur, Lucknow, Meerut, Moradabad, Saharanpur, Varanasi, Baghpat
- Punjab: Amritsar, Jalandhar, Chandigarh, Ambala
- Haryana: Sonepat
- Himachal Pradesh: Shimla
- Jammu & Kashmir: Jammu, Srinagar
- Uttarakhand: Dehradun
East India:
- West Bengal: Kolkata, Jalpaiguri
- Bihar: Patna, Chhapra, Darbhanga, Gaya, Muzzafarpur
- Jharkhand: Ranchi, Dhanbad
- Odisha: Bhubaneshwar, Cuttack, Berhampur
- Assam: Guwahati, Dibrugarh, Silchar
West India:
- Maharashtra: Mumbai, Pune, Nagpur
- Gujarat: Ahmedabad, Gandhinagar
- Goa: Panaji
- Rajasthan: Jaipur, Jodhpur, Ajmer, Kota
South India:
- Karnataka: Bengaluru
- Tamil Nadu: Chennai, Tiruchirapalli, Tirunelveli
- Telangana: Hyderabad
- Andhra Pradesh: Guntur, Nellore, Rajahmundry, Vijayawada, Tirupati, Vishakhapatnam
- Kerala: Thiruvananthapuram (and soon Kochi, Kannur, Kozhikode)
- Puducherry
North-East India:
- Meghalaya: Shillong
- Tripura: Agartala
- Manipur: Imphal
- Mizoram: Aizwal
- Nagaland: Kohima
- Sikkim: Gangtok
Central India:
- Madhya Pradesh: Bhopal, Indore, Gwalior, Jabalpur
- Chhattisgarh: Raipur
How Much Does CGHS Cost? (Monthly Subscription)
The amount you pay every month depends on your salary level:
- Level 1 to 5: ₹250 / month
- Level 6: ₹450 / month
- Level 7 to 11: ₹650 / month
- Level 12 and above: ₹1,000 / month
For working employees: This amount is automatically deducted from your salary every month.
For retired employees: You can pay yearly or pay for 10 years at once to get a lifetime card.
Situation 1: Employee & Family in CGHS City
This is the easiest situation! You and your family get a CGHS card and can use all facilities, get free medicines, and get treatment at CGHS centers and empanelled hospitals.
How to Register:
- Teachers/VPs: Give your application to your Principal.
- Principals & RO Staff: Submit to your Regional Office.
- Your office will check and send it to CGHS. You should get your card within a month.
Documents Needed:
- Application form, ID proof, Address proof
- Passport size photos of all family members
- Pay slip showing your salary
Situation 2: Employee in CGHS City, Family in Non-CGHS City
This is a bit tricky but manageable.
- For You (Employee): You get a CGHS card and can use all facilities in your city.
- For Your Family: They cannot get CGHS cards. However, they can still get treatment under CS(MA) Rules. This means they can go to government hospitals in their city, and you can get the money back (reimbursement) from your office.
- In emergencies, they can go to any private hospital, but you will only be reimbursed at CGHS-approved rates.
Situation 3: Employee in Non-CGHS City, Family in CGHS City
- For You (Employee): You cannot get a CGHS card. You are covered under CS(MA) Rules (go to government hospitals and get reimbursement).
- For Your Family: They can get CGHS cards! You need to pay their CGHS subscription in advance (for 6 months to 1 year) and provide proof of their residence in that CGHS city. They can then use all CGHS facilities there.
Situation 4: Employee & Family in Non-CGHS City
This is the simplest situation, but you don't get CGHS.
- Neither you nor your family can get CGHS cards.
- You are both covered under CS(MA) Rules.
- You go to government hospitals for treatment, keep all bills and prescriptions, and submit them to your office to get the money back.
Step-by-Step Registration (Working Employees)
- Fill the Application Form: Download from the KVS website, fill details, and paste photos of all family members.
- Collect Documents: You'll need ID proof, address proof, latest pay slip, and an NOC from your spouse if they are also a government employee.
- Submit Application: Give it to your Principal (if Teacher/VP) or Regional Office (if Principal/RO staff).
- Verification: Your office will check details from your service records and send them to CGHS.
- Get Your Card: CGHS will make your plastic cards in about one month.
Step-by-Step Registration (Retired Employees)
- Prepare Before Retirement: You can apply 6 months *before* you retire so the card is ready on day one.
- Fill Retirement Form: Use the special form for pensioners.
- Pay CGHS Subscription: You can pay yearly or pay for 10 years at once for a lifetime card. This is done via the Bharatkosh portal.
- Submit Documents: Submit the forms to the Regional Office that handled your retirement benefits. You must also submit a letter saying you don't want the Fixed Medical Allowance (FMA), as you can't have both.
- Receive Card: You'll get your card with 1-year or lifetime validity, depending on your payment.
What Treatment Can You Get Under CGHS?
- Outpatient (OPD): Regular doctor visits at CGHS wellness centers and free medicines.
- Inpatient (IPD): Hospital admission in government or empanelled private hospitals for surgeries and major treatments.
- Diagnostic Tests: Blood tests, X-rays, CT scans, MRI at empanelled centers.
- Emergency: You can go to any hospital in an emergency and get reimbursed at CGHS rates.
What if Your Spouse Also Works in Government?
Important Rule: Only one person can claim CGHS for the family.
The other person needs to give a NOC (No Objection Certificate) from their office stating they are not taking medical benefits, which you then submit with your application.
What if You Get Transferred?
- To another CGHS city: You must surrender your old card and apply for a new one in the new city within 21 days.
- To a non-CGHS city: You must surrender your card. You will then be covered under CS(MA) Rules.
Card Validity and Renewal
- For Working Employees: Your card is valid until you retire. No renewal is needed.
- For Retired Employees: Your card is valid for one year or lifetime, depending on your payment choice. Yearly cards must be renewed.
Important Things to Remember
- Keep your card safe. A duplicate costs ₹50 and requires an FIR.
- Update family details immediately (e.g., marriage, new child, or if a dependent starts earning).
- Medical bills must be submitted within 6 months for reimbursement.
- Dependents (parents, children) must have an income of less than ₹9,000 per month to be included.
Where to Apply and Get Help
- KVS Website: kvsangathan.nic.in
- CGHS Website: cghs.mohfw.gov.in
- CGHS Helpline: 1800-208-8900 (Toll-free)
Key KVS Circulars & Official Links
Here are some of the official documents and links for more details:
CGHS Payment & Reimbursement for KVS Employees
"Cashless" vs. "Reimbursement" - What's the difference?
Cashless Treatment: You show your card, get treatment, and walk out without paying. The hospital bills the government directly.
Reimbursement Treatment: You pay the full hospital bill from your own pocket, keep all receipts, and submit them to your office. The government gives you the money back later.
The Most Important Rule for KVS Employees (No Cashless)
This is the most important thing you need to know:
KVS employees (both serving and retired) DO NOT get cashless facility, even at CGHS-empanelled hospitals.
This means in almost all hospital cases, you must pay the bill yourself first and then submit the bills to your office to get the money back (reimbursement).
Payment Rules: Employee & Family in CGHS City
At CGHS Wellness Centers (Dispensary):
- You Pay: NOTHING.
- Show your card to get consultation and medicines completely FREE.
At Private Empanelled Hospitals (with permission):
- First, get a "referral letter" from a CGHS wellness center doctor.
- You Pay: 100% of the bill yourself.
- Keep all bills and receipts, then submit them to your office for reimbursement.
For Emergency Treatment (at ANY hospital):
- You can go to any hospital without permission.
- You Pay: 100% of the bill yourself.
- Get an "Emergency Certificate" from the hospital (this is very important!).
- Submit all bills and the certificate to your office for reimbursement.
What documents do I submit for reimbursement?
You will need to submit a file containing:
- Medical Reimbursement Claim (MRC) form.
- Emergency Certificate (if it was an emergency).
- All original bills and receipts.
- Discharge summary (copy).
- Copy of your CGHS card.
- Your bank account details for the money transfer.
Where do I submit my bills?
- Serving (Working) Employees: Submit to your school/office (e.g., Teachers submit to their Principal).
- Retired Employees: Submit to the CGHS wellness center where your card is registered.
How long does it take? Serving employees should get it back within 21 days. Retired employees within 45 days.
Payment Rules: Family in Non-CGHS City
Your family in a non-CGHS city cannot get CGHS cards. They are covered under CS(MA) Rules.
- For Regular Treatment: They should go to the nearest government hospital, pay the small fees, and send you the receipts. You submit these to your office for reimbursement.
- For Emergency: They can go to any private hospital, pay the full bill, get an emergency certificate, and send all papers to you. You submit these to your office for reimbursement at CGHS rates.
Payment Rules: Employee in Non-CGHS City
You are covered under CS(MA) Rules, not CGHS. Your family in a CGHS city *can* get CGHS cards.
- For You (Employee): You go to a government hospital, pay the fees, and get reimbursement from your office.
- For Your Family (in CGHS city): They follow the normal CGHS rules. They go to wellness centers for free. For hospital visits, they must pay first and then get reimbursement from their registered CGHS wellness center.
Payment Rules: Employee & Family in Non-CGHS City
Neither you nor your family can get CGHS cards. You are all covered under CS(MA) Rules.
- For All Treatment: Go to the nearest government hospital, pay the fees, and submit the bills to your office for reimbursement.
- For Emergency: Go to any hospital, pay the full bill, get an emergency certificate, and submit everything to your office for reimbursement at CGHS rates.
How long do I have to submit my bills?
You should submit bills within 3 months of the treatment ending. If you are late, you must explain why in writing. The maximum delay should not be more than 6 months.
What if I have other health insurance?
First, submit your bills to your private insurance company. Then, submit the duplicate bills (stamped by the insurance company) to your office/CGHS. You will get the balance amount, up to the approved CGHS rates.
Why don't I get the full amount back? (CGHS Rates)
The government has fixed rates for every single treatment (called "CGHS rates").
If a private hospital charges you ₹1,00,000 for a surgery, but the CGHS rate for that surgery is only ₹50,000, you will only get ₹50,000 back. This is why you may not get the full amount back, especially from emergency visits to non-empanelled hospitals.
Key Difference: KVS vs. Other Govt. Employees
This is the main point of confusion. Regular Central Government employees often get cashless treatment at empanelled hospitals.
However, KVS is an autonomous body. CGHS was extended to KVS on a "cost-to-cost" basis, and this does not include the cashless facility. For KVS, the rule is: pay first, get reimbursed later.