India CGHS healthcare policy updates

The Indian Ministry of Health and Family Welfare has implemented several updates to the Central Government Health Scheme (CGHS) to expand coverage and streamline administrative processes.

Initially, the government introduced relaxations to the CGHS/CS(MA) Rules, 1944, regarding medical benefits for dependents. While age and marital status previously limited eligibility for dependent sons and brothers, the new regulations extend lifelong medical attendance to those suffering from critical or terminal illnesses, provided they meet dependency conditions and undergo assessment by a Medical Board.

Following this, the Ministry introduced a decentralized approval procedure to reduce reliance on the Standing Technical Committee (STC). This measure empowers Additional Directors of CGHS to grant approvals for specific categories, including certain transplant cases, listed medical devices, and robotic surgery for cancer patients. Additionally, the new guidelines remove the requirement for separate referrals when treatment is sought at specific government institutions, such as AIIMS or Tata Memorial Hospital, provided the cases undergo scrutiny by a Local Technical Committee.

Most recently, the Ministry issued an Office Memorandum removing geographical restrictions for Central Government employees accessing the scheme. Previously, eligibility was often subject to residing within a 5 km radius of a CGHS Wellness Centre. The new policy eliminates these criteria to assist employees posted in cities not covered by the scheme or outside prescribed coverage areas. Serving employees currently covered under the CS(MA) Rules, 1944, who reside outside CGHS areas, may exercise a one-time, binding option to become CGHS beneficiaries for themselves and all eligible dependents. However, employees already residing within CGHS-covered district headquarters cannot opt out of the scheme in favor of the CS(MA) Rules, 1944.