CGHS Medical Reimbursement Rules Updated: Key Changes Effective 25 June 2026
CGHS Enhances Financial Powers for Faster Medical Reimbursement and Approvals
The Ministry of Health & Family Welfare has issued a significant Office Memorandum dated 25 June 2026, revising the financial powers delegated to CGHS authorities for settling medical reimbursement claims and granting permissions/ex-post facto approvals. The move aims to reduce delays, simplify procedures, and ensure quicker disposal of cases for CGHS beneficiaries, including pensioners and serving CGHS employees.
Key Highlights
1. Higher Financial Limits for Medical Reimbursement Claims
The revised delegation substantially increases the financial powers of CGHS authorities:
| Competent Authority | Previous Limit | Revised Limit |
|---|---|---|
| Additional Director, CGHS City/Zone | ₹7 lakh | ₹15 lakh |
| Director, CGHS | ₹15 lakh | ₹25 lakh |
| Additional Secretary & DG, CGHS | ₹25 lakh | ₹50 lakh |
Claims exceeding ₹50 lakh will continue to require approval from the Ministry of Health & Family Welfare with the concurrence of the Integrated Finance Division (IFD).
2. Enhanced Powers for Unlisted Investigations, Procedures and Implants
Financial limits for cases where CGHS package rates are unavailable have also been increased:
- Additional Director: Up to ₹2 lakh (earlier ₹1 lakh)
- Director, CGHS: Up to ₹5 lakh (earlier ₹3 lakh)
- Additional Secretary & DG, CGHS: Up to ₹10 lakh (earlier ₹5 lakh)
Cases exceeding ₹10 lakh will continue to require approval from the Ministry with IFD concurrence.
3. Simplified Permission and Ex-Post Facto Approval Process
The memorandum authorizes Additional Directors of CGHS Cities/Zones to consider requests for:
- Treatment in non-empanelled hospitals and diagnostic centres.
- Ex-post facto approvals in cases involving procedural lapses.
In such cases, reimbursement will generally be limited to CGHS package rates or the actual expenditure, whichever is lower.
Important Conditions
The revised powers are subject to the following conditions:
- They do not apply to cases requiring relaxation of CGHS rules.
- Reimbursement remains restricted to admissible CGHS rates wherever applicable.
- Cases without CGHS package rates may be considered based on actual expenditure, subject to admissibility and financial limits.
- Every case must comply with CGHS rules, supported by valid medical records, bills, and audit requirements.
- The delegated powers must be exercised on a case-by-case basis and should not be treated as a precedent for future claims.
Conclusion
The revised delegation of financial powers marks a major step toward speedier processing of medical reimbursement claims and approvals under CGHS. By empowering CGHS authorities with higher financial limits, the Government expects to reduce administrative delays and improve service delivery for pensioners, serving employees, and other eligible CGHS beneficiaries. The revised guidelines came into effect with the Office Memorandum issued on 25 June 2026.