UPSC clarifies CGHS medical reimbursement guidelines

The Union Public Service Commission (UPSC) has issued a clarification regarding Central Government Health Scheme (CGHS) medical reimbursement guidelines to streamline the claims process for staff and officials.

Key regulations include requirements for follow-up investigations, which should ideally be conducted at the same empanelled hospital where the primary consultation occurred. For diagnostic tests costing up to ₹3,000, beneficiaries must use the same facility or obtain prior endorsement from a CGHS Wellness Centre to use a different empanelled provider.

For major investigations exceeding ₹3,000, such as CT, MRI, and PET scans, a formal CGHS referral or endorsement is mandatory. Additionally, specialist consultations remain valid for seven days within the same specialty. For unlisted procedures or investigations, prior permission from the concerned department or office is required before undertaking the medical service.