CGHS enhances financial powers of officials to expedite cashless treatment, medical claims

In a move aimed at reducing delays in medical treatment and reimbursement under the Central Government Health Scheme (CGHS), the Union Health Ministry has now substantially enhanced the financial powers of senior CGHS officials to approve cashless treatment, settle medical reimbursement claims and sanction unlisted investigations and procedures.

The revised delegation of powers enables additional directors heading CGHS cities and zones, as well as senior officials at the CGHS headquarters, to approve significantly higher-value cases than before. The changes are expected to reduce the number of proposals that require referral to higher authorities, speeding up decisions on treatment approvals and claim settlements.

Revised limits

Under the revised delegation, additional directors heading CGHS cities and zones can now sanction medical reimbursement claims and hospital bills at approved rates — of up to ₹15 lakh, compared with the earlier limit of ₹7 lakh, for directors the revised power stands at ₹25 lakh from ₹15 lakh and Additional Secretary and DG, CGHS has revised financial approval power of ₹50 lakh up from ₹25 lakh.

Cases exceeding ₹50 lakh shall continue to be referred to the Union Health Ministry for approval with the concurrence of the Integrated Finance Division.

For unlisted investigations/procedures and implants additional directors heading CGHS cities and zones, director and additional secretary and DG have revised approval powers up to ₹2 lakh, ₹5 lakh and ₹10 lakh respectively.

The order, dated June 25, now raises the financial limits for settling medical reimbursement claims submitted by beneficiaries after treatment. Such claims, particularly those involving high-cost procedures or emergency care, have often required multiple levels of scrutiny before reimbursement could be sanctioned. By increasing the approval limits at the city and zonal levels, the Ministry expects a larger proportion of cases to be disposed of locally.

Benefits pensioners, elderly

Speaking about the revision, a senior health official said the changes are expected to particularly benefit pensioners and elderly beneficiaries, who account for a substantial share of CGHS users and often require costly tertiary care. Delays in administrative approvals and reimbursement of medical expenses have remained among the most common grievances raised by beneficiaries.

“Revised financial powers are intended to decentralise decision-making and improve the efficiency of the scheme by allowing routine cases to be disposed of at the level closest to the beneficiary. This is also expected to reduce the workload on the CGHS headquarters and enable quicker disposal of complex or exceptional cases requiring policy-level decisions. The latest revision is part of a series of administrative changes introduced in recent years to modernise the CGHS,” said the official.