Check current empanelment first
Hospital empanelment and approved specialties can change. Verify the hospital and required treatment/specialty on the current official CGHS list before admission or investigation.
Referral rules
MoHFW's 2025–26 Annual Report says beneficiaries are referred through CGHS/Government pathways for specialist and indoor treatment, while specialist OPD consultation at empanelled private hospitals is permitted on CGHS referral, subject to current rules.
70 years and above
The same 2025–26 report states that CGHS beneficiaries aged 70 years and above are entitled to direct specialist consultation at empanelled hospitals. Confirm any documentation required under the current operational instructions.
Cashless treatment
A long-standing MoHFW simplification order provides cashless treatment at empanelled private hospitals for specified entitled categories including pensioners for covered procedures, subject to applicable CGHS rules and referral/prescription requirements.
Serving employees
Serving employees may have reimbursement/document requirements that differ from pensioners. Do not assume the pensioner cashless pathway applies identically.
At admission
Show the current CGHS card and applicable referral/prescription. Ask the hospital to confirm that the specialty/procedure is covered under its current CGHS empanelment.
If the hospital demands payment unexpectedly
Ask for the reason in writing and whether the treatment/procedure falls outside cashless entitlement, package, referral or empanelment conditions. Preserve estimates, bills, denial notes and referral documents for complaint or reimbursement review.
Emergency care
Emergency treatment can follow different rules from planned treatment. Do not delay urgent medical care merely to obtain a routine referral; use the current CGHS emergency/reimbursement rules for the case.
Related CGHS guides
CGHS Hub · CGHS Card · Wellness Centre · Empanelled Hospitals
Official sources
- MoHFW Annual Report 2025–26
- MoHFW simplification order for empanelled hospitals
- CGHS / MoHFW official portal
Source review: 10 September 2026.