CGHS rates revised after 15 years: How it affects you

**CGHS Rates Revised After 15 Years: How It Affects You**
*By Mudit Dube | Oct 06, 2025, 05:28 PM*

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**What’s the Story?**

The Union Health Ministry has announced a significant overhaul of the Central Government Health Services (CGHS) scheme for the first time since 2014. The revised rates for nearly 2,000 medical procedures will come into effect from October 13, 2025.

This new rate structure takes into account several important factors, including accreditation status, hospital type, city classification, and ward entitlement, aiming to better reflect current healthcare realities.

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**Scheme Revamp: Addressing Complaints from Beneficiaries and Hospitals**

The revision comes amid growing complaints from CGHS beneficiaries about the denial of cashless treatment by empanelled hospitals. Many patients reported having to pay out of pocket and then wait months for reimbursement.

Hospitals, meanwhile, argued that the government-set package rates had become outdated and failed to keep pace with medical inflation over the past 11 years.

The newly introduced multi-dimensional rate structure seeks to address these issues, ensuring fair compensation for hospitals and smoother access to cashless treatment for patients.

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**New Rate Structure: Based on Ward Entitlement**

The revised framework applies to all categories of CGHS cardholders, with rates anchored to the cost of a semi-private room, which serves as the base package rate.

– **General Ward Entitlement**: A 5% reduction in rates applies.
– **Private Ward Entitlement**: Rates increase by 5% compared to the base.

Additionally, consultations at hospitals and healthcare organizations accredited by NABH or NABL will be charged at the standard base rate. Non-accredited healthcare organizations will have rates 15% lower than those for accredited hospitals.

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**City-Wise Rate Variations Introduced**

To accommodate geographical cost differences, the scheme now includes tier-wise rate variations for CGHS-empanelled hospitals located in Tier I, II, and III cities:

– Rates in **Tier II cities** will be 10% lower than in Tier I.
– Rates in **Tier III cities** will be 20% lower than in Tier I.

However, rates for radiotherapy, investigations, day-care procedures, and minor procedures that do not require hospital admission will remain consistent across all ward entitlements and city classifications.

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**Beneficiary Coverage and Implementation**

CGHS primarily serves central government employees, pensioners, and their dependent family members. As of October 5, 2025, the scheme covers approximately 4.26 million beneficiaries across 80 cities in India.

The Union Health Ministry has instructed all healthcare organizations under the CGHS network to submit an undertaking confirming their acceptance of the new rates’ terms and conditions by October 13. Failure to comply will result in de-paneling from the scheme.

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**What This Means for You**

If you are a CGHS beneficiary, the revised rates could affect the costs associated with your medical procedures depending on your ward entitlement, your city, and the accreditation status of the hospital you visit.

For hospitals and healthcare providers, accepting the new terms is mandatory to continue serving CGHS patients and to receive government reimbursements under the updated framework.

Stay informed and check with your CGHS-appointed healthcare provider about how these changes may impact your access to services and reimbursements going forward.
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