The Central Government Health Scheme (CGHS) has implemented significant revisions to its package rates, effective from October 13, 2025. This marks the most substantial overhaul in 15 years, aiming to enhance the accessibility and affordability of healthcare services for over 4.6 million central government employees, pensioners, and their dependents.
The revised rates encompass approximately 2,000 medical procedures, with adjustments based on factors such as hospital accreditation, city classification, and ward type. Key highlights include:
Hospital Accreditation: NABH-accredited hospitals will receive the base rate, while non-accredited hospitals will receive 15% less.
City Classification: Rates in Tier-II cities are set 19% lower than the base rate, and in Tier-III cities, 20% lower.
Super-Specialty Hospitals: Facilities with over 200 beds are eligible for a 15% higher rate than the base rate.
These adjustments aim to align reimbursement rates with the actual cost of medical procedures, addressing concerns raised by both healthcare providers and beneficiaries.
The rate revision is expected to significantly improve the healthcare experience for CGHS beneficiaries:
Enhanced Access to Cashless Treatment: With updated rates, more hospitals are likely to offer cashless services, reducing the financial burden on patients.
Faster Reimbursement: The revision aims to streamline the reimbursement process, ensuring quicker settlements for hospitals and reducing delays.
Improved Quality of Care: Hospitals are expected to maintain or enhance the quality of services provided, as the revised rates better reflect the actual costs involved.
Healthcare institutions, particularly those empanelled under CGHS, will experience several changes:
Financial Viability: The revised rates are designed to make CGHS services more financially sustainable for hospitals, encouraging more institutions to participate in the scheme.
Operational Adjustments: Hospitals may need to update their billing systems and staff training to accommodate the new rate structure and ensure compliance with CGHS guidelines.
Increased Patient Volume: With improved reimbursement rates and cashless facilities, hospitals may see an increase in the number of CGHS beneficiaries seeking treatment.
The CGHS rate revision is a significant step towards modernizing and improving the healthcare services available to central government employees and pensioners.
By addressing long-standing issues related to reimbursement rates and hospital participation, the government aims to create a more efficient and accessible healthcare system. Both beneficiaries and healthcare providers stand to benefit from these changes, leading to a more robust and responsive healthcare infrastructure.
References:
1. Directorate General of Health Services, Government of NCT of Delhi. Approved Rates for Treatment and Investigative Procedures. September 30, 2025. Accessed October 15, 2025. https://dgehs.delhi.gov.in/dghs/approved-rates-treatment-and-investigative-procedures.
(Rh/Eth/ARC/MSM)
