CGHS Scheme Rule Change: A big change in the Central Government Health Scheme (CGHS) started on October 13, 2025. The new rates will cover nearly 2,000 medical procedures at hospitals registered under the scheme. CGHS provides cashless treatment to central government employees, pensioners, and their families. For many years, the old rates were a problem.
CNBC TV18 reported that many hospitals delayed or refused to treat CGHS patients because the rates were too low. With the new pricing system, experts expect the scheme to work much better for both patients and hospitals.
Diwali Car Loans: Check Cheapest EMI Options Across Banks
What Changed in the CGHS Scheme?
The CGHS has started a multi-level pricing system. The new rates now depend on several things like the hospital’s accreditation, the type of hospital, the city it is in, and which ward the patient is eligible for. Accredited hospitals will get standard rates.
Non-accredited hospitals will get 15% lower reimbursements. Super-speciality hospitals will get 15% higher rates. Hospitals in tier-2 and tier-3 cities will get 10-20% lower rates compared to hospitals in metro cities.
This change means hospitals willnow accept more CGHS patients. With higher payments for procedures, hospitals could be more willing to treat beneficiaries. Hospitals will also get special incentives for super-speciality treatments, making it easier for patients to access these services. But cashless treatment still depends on the government paying hospitals on time, which has been a problem in the past.
Impact on Hospitals and Patients
Analysts say that the new framework could increase high-priced treatments by 25-30%, especially in super-speciality areas. Big private hospitals like Max Healthcare, Narayana Health, Fortis, and Yatharth Hospitals are expected to benefit most because they treat many CGHS patients. While hospitals may see better cash flow, delays in payments could still affect their profits.
EPFO 3.0 Explained: Here’s how new PF withdrawal norms affect millions
In the coming days, a hospital-wise list of new rates and rules for ward eligibility will be released. CGHS beneficiaries should check that their hospital follows the new rate structure. Some non-accredited hospitals may not be included in the scheme because of lower rates. The long-term success of this change will depend on the government settling claims quickly, which has been a major issue in the past.
