The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme, which was initially designed for economically weaker and vulnerable sections of society, continues to expand. The scheme was initially rolled out for around 10.74 crore poor and vulnerable families – representing about 50 crore beneficiaries from the bottom 40% of the Indian population – and now covers around 12 crore families, including 6 crore senior citizens above 70 years of age.
The eligibility criteria were further relaxed to include 37 lakh Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs), Anganwadi Helpers (AWHs), and their families. Fundamentally, the scheme still identifies beneficiaries based on specific deprivation and occupational criteria listed in the Socio-Economic Caste Census (SECC) 2011 data, and individuals/families who meet certain exclusion criteria are generally not covered.
Under the Ayushman Bharat scheme, CGHS (Central Government Health Scheme) and ECHS (ECHS (Ex-Servicemen Contributory Health Scheme) beneficiaries are also allowed to register, provided they surrender their existing CGHS and ECHS cards. They are basically allowed to avail a healthcare facility under either CGHS/ECHS or Ayushman Bharat but not both. This story talks about whether CGHS/ECHS beneficiaries should opt for Ayushman Bharat Scheme or not.
For CGHS beneficiaries — mainly central government employees, pensioners, and certain eligible family members — this shift can actually lead to a loss of benefits. CGHS already offers a comprehensive, cashless and deeply subsidised health-care system that is unmatched in many ways. Experts caution that CGHS members should avoid opting into Ayushman Bharat, because the benefits they enjoy today may not be available under the new scheme — and most importantly, once shifted, there is no option to return to CGHS.
Who gets a CGHS card?
CGHS is one of the oldest and most structured government-run health programmes in India. It is provided to – central government employees (serving and retired); central government pensioners and their dependents; certain categories of autonomous body employees; members of Parliament and ex-MPs; freedom fighters; and some constitutional post holders.
It is primarily meant for people settled in cities where CGHS facilities exist, ensuring easy access to dispensaries, diagnostic centres, and empanelled hospitals.
CGHS vs Ayushman Bharat: Understanding the benefits and limits
1. Coverage limits: CGHS offers far more for this category
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) provides Rs 5 lakh per family per year. This is excellent for low-income households and vulnerable groups — the population it was designed for.
CGHS, however, is structured differently:
-No fixed annual financial limit on treatment for CGHS beneficiaries.
-Both OPD and IPD are covered, including specialist consultations and regular medicines.
-Over 1,700 procedures are covered at CGHS rate packages, which are often cheaper and more comprehensive.
-Cashless treatment in empanelled hospitals for pensioners and certain categories.
-Extended diagnostic cover and access to government hospitals as well.
For a CGHS beneficiary already enjoying extensive access to medical services, shifting to Ayushman Bharat actually reduces the depth of benefits.
2. No going back once you switch
This is the most important and least-known fact: A CGHS beneficiary who opts into Ayushman Bharat cannot switch back to CGHS.
Once the transition is made your CGHS card becomes invalid and there is no “reverse migration” option under current policy. Restoring CGHS membership is not allowed even if you regret the decision later. This makes the decision permanent — and risky for those who rely on CGHS for regular medical services, medicines, and chronic treatment support.
3. Why CGHS is more suitable for existing beneficiaries
Broader scope of treatment
CGHS covers OPD consultations, lifelong chronic medicines, physiotherapy, dental treatment, diagnostic tests, and treatment in both govt and empanelled private hospitals.
Ayushman Bharat focuses mainly on hospitalisation, not day-to-day medical needs.
Regular medicines for chronic patients
Hypertension, diabetes, thyroid disorders, heart diseases — CGHS provides monthly medicine supply, something Ayushman Bharat does not cover.
Better continuity of care
CGHS beneficiaries already have a long-established treatment history with specific dispensaries and government centres. Switching breaks this continuity.
Suitable for the age group
A large section of CGHS users are pensioners and senior citizens, who typically need frequent OPD care and medicines — the very areas where CGHS is stronger than Ayushman Bharat.
4. What about ECHS? Health scheme for ex-servicemen
For comparison, ECHS (Ex-Servicemen Contributory Health Scheme) is given to retired Armed Forces personnel.
ECHS offers:
-Almost full cashless treatment in empanelled hospitals
-No financial ceiling on treatment
-Medicines supply through ECHS polyclinics
-Wide network of military and civil hospitals
Both CGHS and ECHS are structured, robust systems designed for specific groups.
Ayushman Bharat is not meant as a replacement for them — it is meant for households that lack any such formal health coverage.
5. How Ayushman Bharat evolved over the years
Since its launch in 2018, Ayushman Bharat has expanded rapidly:
-Coverage extended to over 12 crore families
-Inclusion of ASHA workers, Anganwadi workers, street vendors, labourers
-Integration with state schemes in many regions
-Expanded treatment packages
-New digital initiatives like Ayushman cards and hospital empanelment
-Targeted at economically vulnerable sections
It is a mass public health insurance scheme, not a replacement for specialised schemes like CGHS.
6. How CGHS expanded in recent years — major improvements
The government has made several reforms to strengthen CGHS:
1. Online appointment booking with specialists
Beneficiaries can now take online appointments in government hospitals, reducing long queues.
2. Paperless referrals and digital processing
Referrals to empanelled hospitals, approvals and reimbursements have become digital.
3. Cashless treatment extended to more pensioners
Government recently enabled cashless treatment in several new hospitals for pensioners.
4. Revision of CGHS rates for many procedures
Updated package rates made reimbursements faster and more realistic.
5. Expansion of CGHS cities
CGHS services have expanded into more cities, improving accessibility to retirees settling outside metros.
These improvements make CGHS more efficient and user-friendly — and further reduce the need for any CGHS beneficiary to move to Ayushman Bharat.
Conclusion: CGHS beneficiaries should not switch
While Ayushman Bharat is a strong and inclusive health scheme for millions of Indians, it is not the right choice for existing CGHS members. CGHS already offers wider and deeper benefits — from OPD care to medicines to lifelong treatment support — with no annual financial caps.
And the biggest risk is irreversible:
Once a CGHS beneficiary opts for Ayushman Bharat, they cannot return to CGHS under current rules.
For government employees, pensioners and their families who already enjoy a well-established medical support system, staying with CGHS remains the safest and most beneficial option.
