CGHS Eligibility 2026: New Rules for Central Govt Employees
CGHS Eligibility 2026: The Central Government has made an important change in the eligibility rules for serving Central Government employees to avail themselves of Central Government Health Scheme (CGHS) facilities.
The existing geographical restriction for serving Central Government employees has been removed. Employees who reside or are posted outside the prescribed geographical coverage of CGHS may now exercise a one-time option to become CGHS beneficiaries, subject to the applicable eligibility conditions and payment of the prescribed CGHS contribution/subscription.
CGHS Geographical Restriction Removed
Earlier, CGHS coverage for serving beneficiaries was linked to the geographical area around a CGHS Wellness Centre. Under the previous provisions, coverage was generally restricted to employees residing or working within a 5 km radius of a CGHS Wellness Centre, subject to the applicable rules.
The Government has now reviewed the matter in view of difficulties faced by Central Government employees residing or posted outside the prescribed CGHS geographical coverage or in cities where CGHS facilities are not available.
Accordingly, the existing geographical criterion for determining the eligibility of serving Central Government employees for CGHS facilities has been totally dispensed with.
Who Can Opt for CGHS?
Serving Central Government employees who:
- Are residing outside the prescribed CGHS geographical area; or
- Are posted outside the CGHS geographical coverage; and
- Are currently receiving medical facilities under the **CS(MA) Rules, 1944 solely because of their residence or posting outside the CGHS geographical coverage,
may exercise a one-time option to become a CGHS beneficiary.
The employee must fulfil all other applicable eligibility conditions and pay the prescribed CGHS contribution/subscription.
Mandatory CGHS Coverage Within Covered Areas
Serving Central Government employees residing or posted within the CGHS Covered Area, i.e. the limits of the district headquarters in which a CGHS Wellness Centre is situated, shall be mandatorily covered under CGHS.
Such employees will not be entitled to opt out of CGHS in favour of medical facilities under the CS(MA) Rules, 1944.
Important Conditions for Choosing CGHS
The one-time option to join CGHS will be subject to the following conditions:
1. One-Time and Final Option
The option can be exercised only once. Once exercised, it will be final and binding, subject to the applicable eligibility criteria.
2. Option Applies to Dependents
The option exercised by the principal beneficiary will apply to all eligible dependents.
The medical entitlement of family members cannot be divided between CGHS and CS(MA) systems.
3. CGHS Contribution Must Continue
An employee who opts for CGHS must continue to pay the prescribed CGHS contribution/subscription, irrespective of the place of residence or posting.
4. No Simultaneous Benefits
An employee or family covered under CGHS cannot simultaneously claim or avail medical facilities under the CS(MA) Rules, 1944, and vice versa.
5. No TA/DA for CGHS Treatment
No TA/DA will be applicable for treatment availed or medicines procured under CGHS Rules.
6. Undertaking Required
The employee must furnish an undertaking confirming that neither the employee nor any eligible family member will avail benefits under both CGHS and CS(MA) systems.
If any inadmissible benefit is availed under both systems, the amount may be recovered according to the applicable rules.
What If an Employee Does Not Opt for CGHS?
Employees for whom the one-time option is available but who do not exercise the option to come under CGHS will continue to be governed by the CS(MA) Rules, 1944, as applicable.
Action Against False Information
Employees or beneficiaries who provide false, incorrect, suppressed or misleading information to obtain or continue CGHS benefits may face appropriate disciplinary action under the Central Civil Services (Conduct) Rules, 1964, and other applicable rules.
Any inadmissible benefits obtained on the basis of such information may also be recovered.
CGHS Eligibility 2026: Key Changes at a Glance
Particular New Provision Geographical restriction Removed for serving Central Government employees Employees outside CGHS coverage May exercise one-time option for CGHS CGHS contribution Must be paid as prescribed Option One-time and final Dependents Same system as principal beneficiary Dual CGHS + CS(MA) benefits Not permitted Employees within CGHS Covered Area Mandatory CGHS coverage TA/DA for CGHS treatment Not applicable False/misleading information Disciplinary action and recovery may apply Effective date Immediate effect
Important Note
The removal of the geographical criterion does not mean that every serving Central Government employee automatically becomes eligible for CGHS. Employees must continue to satisfy the other applicable CGHS eligibility conditions and pay the prescribed contribution/subscription.
The Office Memorandum also makes it clear that the option is subject to the conditions specified by the Government and that CGHS and CS(MA) benefits cannot be availed simultaneously.
The Government’s decision to remove the geographical criterion is an important change for serving Central Government employees who were previously outside CGHS coverage because of their place of residence or posting.
Eligible employees currently covered under the CS(MA) Rules, 1944 solely due to geographical reasons can exercise the one-time option to become CGHS beneficiaries, subject to the applicable conditions.
The provisions of the Office Memorandum come into force with immediate effect.
Reference: Office Memorandum on Eligibility of serving Central Government employees for availing CGHS facilities, issued with the approval of the competent authority.
