The Central Government Health Scheme (CGHS) has issued a public notice confirming its migration to new National Health Authority (NHA) IT platforms (TMS 2.0/UMP/HEM 2.0) and the immediate implementation of Revised CGHS Rates, both effective from 00:00 hrs (midnight) on October 13, 2025.
The advisory provides mandatory instructions for all CGHS Pensioner beneficiaries eligible for credit to ensure smooth access to care, transparent billing, and compliance.
Key Operational Changes
A. Access and Identification
- Referral Validity: Care will not be denied, even if the referral was issued before October 13, 2025. Empanelled Health-Care Organisations (HCOs) must provide treatment against all valid prior referrals.
- Digital Card Use: The use of a Digital CGHS Card is valid. A soft copy downloaded from the CGHS website, the My CGHS 2.0 mobile app, or DigiLocker is acceptable for identification at HCOs.
B. Billing and Payment Rules
- Revised Rates Applicability: Services rendered on or after 00:00 hrs, October 13, 2025, will be charged at the Revised CGHS Rates. Services rendered prior to this cutoff time will be subject to the Old CGHS Rates.
- Inadmissible Items: HCOs must issue a separate bill/receipt for inadmissible items (those not payable by CGHS, such as personal toiletries, attendant food, or non-medical services). These charges must not be included in the final bill submitted to CGHS.
- Package Inclusions: The notice strictly clarifies items included in package rates and ward charges that cannot be billed separately. This includes:
- Administrative Charges: Registration fees, administrative discharge processing.
- Ward Consumables: Special beds (Alpha bed, Water bed), routine air conditioning/heating, basic monitors, pulse oximeters, and laundry.
- Test Consumables: Glucometer strips (covered under RBS test cost), ECG leads/electrodes (included in ECG cost), and Vacutainers/syringes used for lab tests (included in lab test cost).
- Medical Records: Issuance of discharge summary, lab reports, and X-ray/CT/MRI films/CD copies.
C. Verification and Transparency
- Mandatory OTP Verification: OTP verification on the beneficiary’s registered mobile number is mandatory for claim submission on the TMS 2.0 portal. Beneficiaries must ensure their mobile number is updated via their nearest CGHS Wellness Centre.
- Geotagged Photo: Beneficiaries must co-operate with HCOs in capturing a geotagged photograph at the point of care for verification purposes.
- Mandatory Feedback: Beneficiaries or their attendants must clearly fill out the CGHS feedback form at the time of discharge. This form requires the patient to explicitly state if any amount was collected during admission.
Grievance and Misuse Prevention
Every empanelled HCO is now required to maintain a grievance redressal desk (with Nodal officer details displayed).
Beneficiaries are advised to report any suspicious intimation (e.g., SMS for an unavailed service) to the office of the respective Additional Director immediately. The advisory warns that any misuse of the CGHS card by a beneficiary or an HCO constitutes an offence and will attract action under applicable rules and law.