CGHS New Referral Rules 2024: Big Relief for Central Government Employees & Pensioners
CGHS Issues Revised Referral Guidelines for Consultation, Investigations & Treatment
The Ministry of Health & Family Welfare, Government of India, has issued revised guidelines for the referral process under the Central Government Health Scheme (CGHS). The Office Memorandum dated 28 June 2024 introduces major relaxations and simplified procedures for CGHS beneficiaries seeking consultation, investigations, and treatment in government as well as empanelled private hospitals.
Download Relief for Central Government Employees & Pensioners
These revised instructions modify earlier OMs issued in 2018 and aim to make healthcare access easier and faster for beneficiaries.
Government Hospitals Covered Without Referral
Under the revised guidelines, the term “Government Hospital” will now include:
All AIIMS institutions
Institutes of National Importance (INIs)
North East Institutions
Tata Memorial Hospital
Other Central Government medical institutions
CGHS beneficiaries can directly undergo consultation, investigations, and treatment procedures — including unlisted procedures — in these hospitals without any referral, endorsement, or permission from CGHS.
Major Changes for Treatment in Private Empanelled Hospitals
1. Single Referral Valid for 3 Months
A referral issued by any CGHS Wellness Centre Medical Officer for specialist consultation will now remain valid for three months.
During this period:
Beneficiaries may consult up to three specialists
A maximum of six consultations will be allowed
Additional specialists can be consulted if recommended by the primary specialist
This is expected to reduce repeated visits for fresh referrals.
2. No Fresh Endorsement for Routine Tests & Minor Procedures
If a specialist in a CGHS empanelled private hospital advises routine investigations or minor procedures not requiring hospital admission, no additional CGHS endorsement will be needed within the 3-month validity period.
However, CGHS endorsement/referral will still be necessary for:
CT Scan
MRI Scan
PET Scan
Any investigation costing more than ₹3,000
These approvals will also remain valid for three months.
3. Referral Needed for Hospital Admission
Any treatment procedure requiring hospital admission will still need referral/endorsement from the CGHS Medical Officer. The validity of such approval will be three months.
4. Approval for Unlisted Procedures
For unlisted investigations and treatment procedures advised by specialists of empanelled hospitals:
Pensioners will require approval from the CGHS Additional Director/Director
Serving employees will require approval from the concerned Head of Department/Office
5. Age Limit Relaxed for Senior Citizens
The special provision earlier available for beneficiaries aged 75 years and above has now been extended to those aged 70 years and above.
The memorandum also mentions that beneficiaries can avail tele-consultation services through the e-Sanjeevani 2.0 platform.
6. Emergency & Post-Operative Treatment
The existing rules regarding emergency treatment and post-operative follow-up treatment will continue without any change.
Objective of the New Guidelines
The revised referral policy is aimed at:
Reducing paperwork and repeated referrals
Improving access to specialist healthcare
Simplifying approval procedures
Providing faster treatment to CGHS beneficiaries
Enhancing convenience for senior citizens
These revised guidelines are expected to significantly benefit lakhs of CGHS beneficiaries across the country by streamlining the referral and treatment process.