CGHS Scheme Update: A welcome news for central government employees and pensioners. The Ministry of Health and Family Welfare has increased the maximum limit for medical reimbursement under the Central Government Health Scheme (CGHS). Heads of ministries and departments will now be able to settle medical claims up to ₹10 lakh without consulting the Integrated Finance Division. Previously, this limit was ₹5 lakh.
In addition, in cases where no exemptions are granted and payment is made strictly according to the prescribed CGHS rates, the settlement limit has been increased from ₹2 lakh to ₹5 lakh. The government believes this decision will speed up and simplify the process of settling medical bills.
What the Government Said
In an office memorandum issued on February 16, 2026, the Ministry of Health clarified that, after review, it has been decided to increase the maximum limit for medical reimbursement claims from ₹5 lakh to ₹10 lakh. However, this facility will be subject to prescribed conditions.
Conditions associated with the increased limit
Two key conditions will apply to the settlement of claims up to ₹10 lakh. First, there should be no relaxation in the CGHS or CS(MA) rules. Second, the amount to be paid must strictly comply with the prescribed CGHS and CS(MA) rates.
The Ministry also recalled that an earlier order issued on November 23, 2016, had increased the settlement limit for such cases from ₹2 lakh to ₹5 lakh, where no relaxation was allowed, and payments were made at the prescribed rates.
Medical Reimbursement Claim Process
Under CGHS, pensioners must apply within six months of completion of treatment or discharge from the hospital. This application is submitted to the CMO or Wellness Center where their CGHS card is registered.
The application must be accompanied by a completed medical reimbursement form, the required checklist, a copy of the discharge summary, a copy of the referral or permission slip, and an emergency certificate, if applicable. In addition, original hospital bills and receipts, a copy of a valid CGHS card, and a canceled check with bank details are also required. If the beneficiary’s name is not printed on the cheque, a mandate form with bank details must be submitted instead.
Ambulance Expenses Also Available
According to CGHS rules, ambulance expenses within the city can also be reimbursed, provided the treating doctor certifies that transporting the patient by other means would be life-threatening or could seriously worsen their condition. At the same time, it is expected that this decision of the government will provide relief to the employees and pensioners in case of big medical expenses, and the process of claim settlement will become smoother.
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