For decades, the Central Government Health Scheme (CGHS) has provided registered Central Government employees and pensioners with a comprehensive medical care solution.
To benefit Central Government employees, the Ministry of Health and Family Welfare has officially changed the eligibility conditions for availing CGHS facilities as per an announcement made on 17-09-2026.
The revised rules will benefit approximately 42 lakh beneficiaries who are covered by CGHS in 80 cities across the country.
CGHS new eligibility rules
The Ministry of Health and Family Welfare officially stated that it restricted CGHS coverage to serving beneficiaries who reside or work within a 5-kilometer radius of a CGHS Wellness Center in an Office Memorandum dated September 17, 2026, pertaining to the eligibility of serving Central Government employees to use CGHS facilities.
The Additional Director of CGHS in the respective city will inform the regions served by CGHS Wellness Centers if such boundaries are not stated. Employees who are otherwise CS(MA) beneficiaries and reside within the boundaries of the relevant Municipal Corporation but outside of a 5-kilometer radius of a CGHS Wellness Center may choose to use CGHS facilities.
“The matter has since been reviewed in view of the difficulties faced by serving Central Government employees residing/posted either outside the above prescribed geographical coverage of CGHS or in a city not covered by CGHS. It has been decided to totally dispense with the existing geographical criterion for determining eligibility of serving Central Government employees, for availing CGHS facilities,” said the Ministry of Health & Family Welfare.
Therefore, serving Central Government employees who live outside of the specified area and currently use the CS(MA) Rules, 1944 because they are employed or reside outside of the CGHS’s geographic coverage can take advantage of their one-time option to become a CGHS beneficiary, provided they meet all other relevant eligibility requirements and pay the required CGHS contribution or subscription.
According to the CS(MA) Rules, 1944, serving Central Government employees who live or work within the CGHS Covered Area—that is, the limits of the district headquarters where CGHS Wellness Centers are located—must be covered by CGHS and are not permitted to choose medical facilities over CGHS.
The Ministry of Health and Family Welfare has further clarified that any employee or beneficiary who provides false, incorrect, suppressed, or misleading information to obtain or continue CGHS benefits may face disciplinary action under the Central Civil Services (Conduct) Rules, 1964, and other applicable rules, as amended from time to time. The authorities may also recover any inadmissible benefits availed on the basis of such information.
What are the conditions?
The Ministry of Health and Family Welfare states that in order to be eligible for CGHS benefits, Central Government workers who live outside of the region must fulfill the following conditions.
Subject to the applicable eligibility requirements, the option is one-time and, once exercised, final and binding.
All dependents will be covered under the primary beneficiary’s selection. Within the family, the entitlement cannot be divided between the two systems.
Regardless of where they live or are posted, an employee who chooses to participate in CGHS must continue to pay the required CGHS contribution or subscription.
Medical facilities under CS (MA) cannot be used or claimed simultaneously by an employee or family covered by CGHS, and vice versa.
According to CGHS regulations, no TA or DA will be imposed for availing treatment and procurement of medicine.
The employee must provide an undertaking that neither they nor any eligible family members will get benefits under either scheme. Any inadmissible benefit received under either scheme will be subject to recovery under the applicable regulations.
If an employee chooses not to participate in CGHS under this official memorandum, they will still be subject to the CS(MA) Rules, 1944, as applicable.
CGHS provides health care through the following types of medicine:
Allopathic
Homoeopathic
Indian system of medicine
Ayurveda
Unani
Siddha and
Yoga
CGHS covered cities
| Agra |
| Agartala |
| Ahmedabad |
| Aizwal |
| Ajmer |
| Allahabad (Prayagraj) |
| Ambala |
| Amritsar |
| Baghpat |
| Bengaluru |
| Bareilly |
| Behrampur |
| Bhopal |
| Bhubaneshwar |
| Chandrapur |
| Chandigarh |
| Chhatrapati Sambhaji Nagar (Aurangabad) |
| Chennai |
| Chhapra |
| Coimbatore |
| Cuttack |
| Darbhanga |
| Dhanbad |
| Dehradun |
| Delhi & NCR: Delhi, Faridabad, Ghaziabad, Greater Noida, Noida, Gurgaon |
| Indirapuram, Sahibabad |
| Dibrugarh |
| Gandhinagar |
| Gangtok |
| Gaya |
| Gorakhpur |
| Guwahati |
| Guntur |
| Gwalior |
| Hyderabad |
| Imphal |
| Indore |
| Jabalpur |
| Jaipur |
| Jalandhar |
| Jammu |
| Jodhpur |
| Kannur |
| Kanpur |
| Kohima |
| Kolkata (including Ishapore) |
| Kochi |
| Kota |
| Kozhikode |
| Lucknow |
| Meerut |
| Moradabad |
| Mumbai |
| Muzaffarpur |
| Mysuru |
| Nagpur |
| Nashik |
| Nellore |
| Panaji |
| Panchkula |
| Patna |
| Puducherry |
| Pune |
| Raipur |
| Ranchi |
| Rajahmundry |
| Saharanpur |
| Shillong |
| Shimla |
| Silchar |
| Siliguri (including Jalpaiguri) |
| Sonipat |
| Srinagar |
| Thiruvananthapuram |
| Varanasi (Benaras) |
| Tiruchirapalli (Trichy) |
| Tirunelveli |
| Vadodara |
| Vijayawada |
| Vishakhapatnam |
Source: cghs.mohfw.gov.in
CGHS vs CS(MA): Key healthcare differences employees should know
The choice between CGHS and CS(MA) is essentially a choice between two different models of accessing government healthcare benefits. CGHS provides a structured healthcare ecosystem through Wellness Centres, government hospitals, laboratories and empanelled private hospitals, with services such as OPD consultations, medicines, diagnostics and hospitalisation available through the CGHS network.
CS(MA), by comparison, operates primarily through a medical attendance and reimbursement framework: employees pay for treatment and medicines upfront and then claim reimbursement, subject to the applicable rules and approved rate lists.
Cashless treatment is one of the more significant points of difference, and employees should not overlook it. Under CS(MA), there is no cashless facility; employees bear the cost first and recover it through the reimbursement process, which can involve prior sanctions, documentation, and delays. Under CGHS, eligible beneficiaries can access cashless treatment at empanelled private hospitals, subject to the prescribed procedures and authorisations. For employees who anticipate hospitalisation, specialist treatment or ongoing medical needs, this difference alone can be a major factor in the decision.
The more important question for an employee is therefore not simply which scheme offers more facilities on paper, but which system is more accessible and useful to their family, and how much value they place on cashless access versus the reimbursement route.
“Employees should look at where they and their dependents live, the hospitals and specialists they are likely to use, their regular requirement for medicines or diagnostics, the availability of CGHS facilities in those locations, and how comfortable they are managing CS(MA)’s reimbursement process,” said Rishi Agrawal, Ceo and Co founder of Teamlease Regtech.
“Because the choice is one-time and binding, it should be treated as a long-term healthcare decision rather than an administrative formality. The right comparison is between the actual healthcare needs of the family, the practical accessibility of each scheme, and the real difference cashless CGHS access makes versus CS(MA)’s pay-and-claim model,” Agrawal added.
Switching to CGHS? Key factors employees should consider
The most important consideration is that employees should not make this decision based solely on their current place of posting. The September 2026 change removes the earlier geographical restriction for eligible serving Central Government employees, but the employee’s choice is one-time and binding. That makes the decision inherently forward-looking.
Employees should consider the likelihood of future transfers, deputations or changes in residence, where their spouse and other dependents are likely to live, and whether those locations have access to the CGHS network.
They should also assess their family’s expected healthcare requirements, particularly recurring medicines, specialist consultations, diagnostics and hospitalisation and compare these with the services and reimbursement mechanisms available under CS(MA).
The financial aspect is equally important. Employees should consider not only the prescribed CGHS contribution but also the potential cost of travelling to access CGHS services if they are living outside a CGHS-covered area. These costs can include transportation, accommodation and the value of time spent travelling.
Ultimately, the undertaking should be viewed as a long-term family healthcare decision. The relevant question is not just, Is CGHS useful to me today? But will this model continue to work for me and my dependents as our postings, residences and healthcare requirements change.
No CGHS centre nearby? What costs could employees face?
The removal of the geographical restriction makes CGHS an option for employees even when they are posted or residing outside a CGHS-covered city. However, eligibility and accessibility are two different questions.
CGHS continues to operate through a defined network of Wellness Centres, dispensaries, government hospitals, laboratories and empanelled facilities.
Therefore, an employee living in a city without a Wellness Centre needs to assess how practically accessible the nearest CGHS facility is. If routine consultations or medicines require significant travel, the employee could incur transportation and, in some cases, accommodation costs, in addition to the time involved.
“This is particularly relevant because the new undertaking does not make travelling to obtain CGHS treatment or medicines a reimbursable entitlement in itself. Employees should therefore factor these expenses into their decision rather than looking only at the prescribed CGHS contribution,” commented Agrawal.
The financial calculation should essentially be: the annual CGHS contribution plus the likely cost of accessing the network, compared with the healthcare expenditure and reimbursement experience the employee would reasonably expect under CS(MA).
“For someone who is likely to move to a CGHS-covered city or regularly uses healthcare facilities within the CGHS network, the equation may be different from that of an employee who is likely to remain permanently in a location with limited CGHS access. The key issue is therefore practical accessibility, not merely eligibility,” Agrawal stated.
CGHS coverage: What if family members live in different cities or states?
This provision makes the decision significantly more important because the employee is effectively making a healthcare choice for the eligible family, not just for themselves. Where family members live in different cities or states, employees need to assess the accessibility of healthcare across all those locations before exercising the option.
For example, an employee may be posted in one city while their spouse works in another and dependent parents live elsewhere. If some of those locations have strong CGHS access while others do not, the practical value of CGHS can differ considerably between family members. The employee therefore needs to map where healthcare is actually being consumed by the family rather than assessing the scheme only from the perspective of the employee’s current posting.
This becomes particularly relevant for families with elderly dependents or members who require regular medication, specialist consultations or diagnostics. Travel requirements and the availability of empanelled facilities should be considered alongside the formal entitlement.
The inability to split the family between CGHS and CS(MA) means that this decision should be made at the household level. Employees should consider the healthcare geography of the entire family, their likely future locations and their expected medical requirements before submitting the undertaking.
Is CGHS contribution worth it for employees outside CGHS areas?
Employees should look at the CGHS contribution as the cost of retaining access to a broader government healthcare ecosystem, rather than evaluating it simply as a monthly deduction. But the value of that ecosystem will depend on how frequently an employee and their family can realistically use it.
A sensible assessment would consider four things:-
– the annual contribution
– the family’s expected healthcare utilisation
– the accessibility of CGHS facilities
– the cost of reaching those facilities.
Employees with regular requirements for OPD consultations, medicines, diagnostics or specialist care may derive greater value from the network, particularly if they or their dependents live in or frequently travel to CGHS-covered locations.
For employees who live permanently outside the CGHS network, however, the calculation needs to include the additional cost and time involved in accessing CGHS services. The fact that an employee remains eligible for CGHS does not by itself mean that the service is equally convenient in every location.
“This is why I would advise employees to evaluate the decision over their expected period of service rather than on the basis of a single year’s contribution. The real question is whether the combination of CGHS access, healthcare requirements and family circumstances justifies the recurring contribution and any additional access costs they may incur,” commented Agrawal.
Disclaimer: This article is for informational purposes only and should not be construed as investment, financial, tax, or legal advice. Any illustrations, examples, or return projections used in this article are for explanatory purposes only and do not guarantee actual investment outcomes. The views and opinions expressed by experts quoted in this article are their own and should not be considered investment recommendations. Readers should consult a qualified professional before making any financial decisions.
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