The implementation of the new rates will increase the likelihood of hospitals participating more frequently under the CGHS.
A historic change in the pricing structure of the Central Government Health Scheme (CGHS) was officially implemented on October 13, 2025. This change introduces new rates for nearly 2,000 medical procedures at CGHS-registered hospitals. While the scheme provides cashless treatment to central government employees, pensioners, and their dependents, the old rates have been a point of contention between hospitals and the government for many years. According to a CNBC TV18 report, many hospitals have either delayed or refused to treat CGHS patients due to these unreasonable rates. Now, the implementation of the new pricing structure is expected to improve the system significantly. This will not only impact CGHS beneficiaries but also hospitals.
What has changed in the CGHS Scheme?
- A multi-tiered pricing system has been implemented under the new framework. Rates for medical procedures will now be determined based on various factors:
- Hospital accreditation (NABH/NABL-accredited hospital vs. non-accredited)
- Facility type (general vs. super-speciality)
- City classification (metropolitan vs. tier-2/tier-3 city)
- Patient ward eligibility
Some key amendments include:
- Accredited hospitals will be paid standard rates.
- Non-accredited hospitals will receive 15% lower reimbursements.
- Super-speciality hospitals will receive 15% higher rates.
- Hospitals in tier-2 and tier-3 cities will receive 10-20% lower rates compared to those in metro cities.
What does this mean for patients?
The implementation of the new rates will increase the likelihood of hospitals participating more frequently under the CGHS. With higher procedure payments, hospitals may now be more willing to accept CGHS beneficiaries. Additionally, hospitals will receive special incentives for super-speciality treatments, improving access to these treatments. However, the availability of cashless treatment for CGHS beneficiaries will still depend on timely reimbursement by the government, which has long been a concern.
Impact on Hospitals
According to analysts, the implementation of the new framework could lead to a 25-30 per cent increase in high-priced treatments, especially super-speciality treatments. Private healthcare companies such as Max Healthcare, Narayana Health, Fortis, and Yatharth Hospitals are likely to benefit the most, as these hospitals have a large number of CGHS patients. While this change may increase hospitals’ cash flow visibility, delays in settlements could lead to a loss of profitability.
What could be the future impact?
In the coming days, a hospital-wise list of revised rates and ward eligibility rules will be released. CGHS beneficiaries should ensure that their chosen hospital has adopted the new rate structure, as some non-accredited centres may be excluded from the scheme due to lower rates. The success of this change will ultimately depend on the speedy settlement of claims, a major issue in previous attempts that needs to be addressed.
