CGHS eligibility rules changed: Central govt employees outside covered areas can now opt for CGHS

Serving central government employees posted or living outside the geographical coverage of the Central Government Health Scheme (CGHS) can now decide, plan, and opt for CGHS benefits, subject to the applicable conditions.

This is a recent development announced by the Ministry of Health and Family Welfare in an Office Memorandum dated 17 September 2026. Let us discuss this development in detail, along with the history, inception and significance of CGHS.

To put it simply, the Central Government Health Scheme (CGHS) is a government healthcare programme for serving and retired Central government employees and their eligible family members. It was launched in Delhi on 1 July 1954, primarily to provide medical care and address difficulties employees faced in claiming reimbursement for outpatient medicines.

Over the past few decades, CGHS expanded beyond Delhi to several cities and now provides services through Wellness Centres, polyclinics, laboratories and empanelled hospitals.

Furthermore, its coverage has also widened to include eligible pensioners and certain other categories of beneficiaries. According to the Ministry of Health and Family Welfare's 2024-25 annual report, CGHS had spread to 81 cities, serving nearly 46.87 lakh beneficiaries

After much deliberation, the government has decided to do away with the geographical criteria that previously restricted CGHS eligibility for serving central government employees based on their place of residence or posting. The salient features of the same are as follows:

This is a welcome change, because the earlier geographical restrictions had created difficulties and complications for employees residing or posted outside the prescribed CGHS coverage. The revised rules permit eligible employees in such circumstances to opt for CGHS, provided they fulfil the other conditions and pay the prescribed contribution.

It is vital to keep in mind that the option is not reversible once exercised. Eligible employees opting for CGHS must also provide an undertaking that neither they nor eligible family members are going to claim medical benefits under both CGHS and the Central Services (Medical Attendance) Rules, 1944.

Employees already residing or posted in a CGHS-covered area will remain mandatorily covered under CGHS and cannot opt for CS(MA) benefits instead. The memorandum also elaborates on the point that incorrect or misleading information can result in serious consequences, disciplinary action, and the recovery of inadmissible benefits.

The revised and updated provisions take effect immediately. All eligible employees adversely affected by the earlier geographical restriction should check their eligibility and the prescribed procedure before proceeding to exercise the one-time option.

Shivam writes on personal finance, equity markets, and mutual funds. He has previously contributed to several leading publications, including Moneycontrol. He can be reached at [email protected]

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