CGHS New Rule: Central Government Employees Outside CGHS Areas Can Now Opt for CGHS

CGHS Geographical Restriction Removed for Serving Employees

The Central government has changed the eligibility rules for the Central Government Health Scheme (CGHS), allowing eligible serving Central government employees located outside CGHS-covered areas to opt for the scheme.

The Ministry of Health and Family Welfare issued an Office Memorandum on September 17, 2026, removing the existing geographical criterion for determining whether serving Central government employees can avail themselves of CGHS facilities. The revised provisions came into effect immediately.

The change addresses difficulties faced by employees who were posted or residing in locations outside the geographical coverage of CGHS and were consequently governed by the Central Services (Medical Attendance) Rules, 1944, commonly known as the CS(MA) Rules.

Under the new arrangement, eligible employees in this category can make a one-time choice to join CGHS, provided they meet the other applicable eligibility conditions and pay the prescribed CGHS contribution or subscription.

What Was the Earlier CGHS Rule?

Previously, CGHS eligibility for serving beneficiaries was linked to geographical coverage.

The earlier framework generally restricted CGHS coverage to serving beneficiaries residing or working within a 5-kilometre radius of a CGHS Wellness Centre. Where specific geographical demarcations were not available, the Additional Director of CGHS in the concerned city could notify the areas covered by a Wellness Centre.

An employee living within the relevant municipal limits but beyond the 5-kilometre radius could, in certain circumstances, opt for CGHS if otherwise covered under the CS(MA) Rules.

However, employees posted or residing in locations outside the prescribed CGHS coverage generally remained under the CS(MA) framework.

The government has now decided to dispense with this geographical criterion for determining CGHS eligibility for serving Central government employees.

Who Can Now Opt for CGHS?

The new provision primarily benefits serving Central government employees who are outside the prescribed geographical coverage of CGHS and are currently using CS(MA) Rules solely because their residence or posting is outside CGHS coverage.

Such employees can exercise a one-time option to become CGHS beneficiaries.

However, the option is not unconditional. Employees must:

• Meet all other applicable CGHS eligibility conditions.

• Pay the prescribed CGHS contribution or subscription.

• Exercise the option only once.

• Comply with the undertaking and other administrative requirements prescribed under the revised rules.

The employee's location outside a CGHS-covered area is therefore no longer, by itself, a reason to prevent the employee from choosing CGHS.

What Is the Difference Between CGHS and CS(MA) Rules?

The change is particularly relevant because employees outside CGHS areas were previously governed by the Central Services (Medical Attendance) Rules, 1944 in situations where CGHS was not geographically available.

The two systems operate differently.

Under CS(MA) Rules, eligible employees can receive medical treatment and claim reimbursement according to the applicable provisions. The Economic Times report notes that such employees do not have the same cashless treatment arrangement available through CGHS.

CGHS, on the other hand, provides access to its network of Wellness Centres, polyclinics, laboratories and empanelled healthcare facilities, subject to the applicable rules.

The new option therefore gives eligible employees outside CGHS areas greater flexibility in choosing the medical-benefit framework applicable to them.

CGHS Option Will Be Available Only Once

One of the most important conditions under the revised rule is that the choice is one-time.

An eligible employee who chooses to become a CGHS beneficiary cannot repeatedly switch between CGHS and CS(MA) based on changes in posting or residence.

Once exercised, the option becomes final and binding, subject to the applicable eligibility conditions.

This means employees should consider their long-term circumstances before making the choice.

For example, an employee who is currently posted in a location without a CGHS Wellness Centre may find the new option relevant. But the employee should also consider future postings, family requirements and the practical availability of CGHS services before making a permanent choice.

Family Members Will Also Be Covered Under the Same Choice

The revised provisions also address the treatment of eligible dependants.

The choice made by the principal beneficiary will apply to the employee's eligible dependants. The medical entitlement cannot be divided between CGHS and CS(MA) within the same family.

Therefore, an employee cannot choose CGHS for themselves while simultaneously keeping eligible family members under CS(MA) merely to access benefits under both systems.

This makes the one-time option an important family-level decision rather than simply an individual employee choice.

CGHS and CS(MA) Benefits Cannot Be Claimed Together

The government has specifically clarified that an employee or family covered under CGHS cannot simultaneously claim medical facilities under the CS(MA) Rules, 1944.

Similarly, a person covered under CS(MA) cannot simultaneously claim CGHS benefits.

Employees opting for CGHS must therefore furnish an undertaking confirming that neither they nor their eligible family members will claim benefits under both systems.

If an inadmissible benefit is claimed or received under both systems, the amount can be recovered under the applicable rules.

What If an Employee Does Not Choose CGHS?

Employees who are eligible to exercise the new option but decide not to opt for CGHS will continue to be governed by the CS(MA) Rules, 1944, as applicable.

This means the new rule does not automatically transfer every employee outside a CGHS area into the scheme.

Instead, it creates a one-time choice for the eligible category.

The employee therefore has to decide whether to remain under the existing CS(MA) framework or exercise the option to become a CGHS beneficiary.

Employees Within CGHS Areas Remain Under CGHS

The removal of the geographical restriction does not mean that employees inside CGHS-covered areas can freely choose between CGHS and CS(MA).

According to the revised provisions, serving Central government employees residing or posted within a CGHS-covered area remain mandatorily covered by CGHS. They cannot opt out of CGHS in favour of medical facilities under the CS(MA) Rules.

The memorandum identifies the covered area in terms of the limits of the district headquarters where a CGHS Wellness Centre is situated.

The important distinction is therefore:

Employee's situationPosition under new ruleOutside CGHS-covered area and currently under CS(MA) solely because of locationCan exercise one-time option for CGHSWithin CGHS-covered areaCGHS coverage is mandatoryEligible employee outside area who does not opt for CGHSContinues under CS(MA), as applicableEmployee opting for CGHSCannot simultaneously claim CS(MA) benefitsFamily of employee opting for CGHSEligible dependants follow the principal beneficiary's choice

CGHS Contribution Still Has to Be Paid

Employees who choose CGHS cannot receive the scheme without paying the applicable contribution or subscription.

The revised order makes payment of the prescribed CGHS contribution a condition for employees outside the geographical coverage who exercise the option.

The contribution is linked to the applicable pay-level structure under CGHS rules.

Earlier CGHS contribution rates reported by the Economic Times included:

Pay levelMonthly CGHS contributionLevel 1–5Rs 250Level 6Rs 450Level 7–11Rs 650Level 12 and aboveRs 1,000

Employees should confirm the applicable contribution at the time of opting because government rules and contribution structures can be revised.

No TA/DA for Treatment Under CGHS

Another clarification in the new order concerns travelling and daily allowances.

Employees will not be entitled to TA/DA for treatment or procurement of medicines under CGHS rules.

This is relevant for employees posted far from a CGHS facility. Although the geographical restriction on eligibility has been removed, the government has not created a separate TA/DA entitlement for travelling to obtain CGHS treatment or medicines.

Employees should therefore consider the practical distance and availability of healthcare facilities when evaluating the option.

Why the New CGHS Rule Matters

The change is significant because government employees can be transferred across the country during their careers.

Under the earlier geographical system, an employee could move from a CGHS-covered location to an area outside CGHS coverage and consequently become dependent on the CS(MA) framework.

The revised rule separates eligibility for CGHS from the employee's geographical location for the affected category.

This can be particularly relevant for employees posted in smaller cities, remote locations or districts without CGHS Wellness Centres.

The government said the decision followed a review of difficulties faced by serving Central government employees residing or posted outside prescribed CGHS coverage or in cities not covered by CGHS.

What Employees Should Consider Before Opting

The new option may provide greater flexibility, but eligible employees should not make the decision solely because CGHS is now available as an option.

Before exercising the one-time choice, employees should consider:

1. Family healthcare requirements

The choice will apply to eligible dependants, so employees should consider the healthcare requirements of the entire family.

2. Location of CGHS facilities

Removing the geographical eligibility restriction does not mean that a CGHS Wellness Centre or empanelled hospital will necessarily be located close to the employee's residence.

3. Future postings

Government employees may be transferred to different locations during their careers. The one-time nature of the option makes future postings relevant.

4. Contribution

Employees should calculate the applicable monthly CGHS contribution and understand the long-term cost.

5. CS(MA) reimbursement

Those considering remaining under CS(MA) should understand the reimbursement provisions applicable to their circumstances and compare them with the CGHS facilities available to them.

6. No dual benefits

Employees should remember that CGHS and CS(MA) benefits cannot be claimed simultaneously.

What Happens to Employees Who Move Between Locations?

The new rule is particularly relevant for employees whose postings change.

An employee outside a CGHS-covered area who exercises the one-time option can become a CGHS beneficiary subject to the applicable conditions.

The employee's eligibility is therefore no longer automatically blocked simply because the current residence or posting is outside the geographical coverage of a CGHS Wellness Centre.

At the same time, employees should not interpret the rule as creating unrestricted freedom to switch between CGHS and CS(MA) every time they are transferred. The one-time option is intended to be a final choice.

What About Central Government Pensioners?

The September 17 order specifically concerns serving Central government employees.

Pensioners have separate CGHS provisions. In February 2026, the government had already extended certain CGHS options to Central government pensioners residing in non-CGHS-covered areas, including the ability in specified circumstances to register in a nearby CGHS-covered city after paying the required subscription.

Therefore, the September 2026 change concerning serving employees should not automatically be interpreted as a new pensioner rule.

Pensioners should continue to follow the specific provisions applicable to their category.

What If False Information Is Provided?

The revised framework also contains compliance requirements.

Employees opting for CGHS must provide the required undertaking and cannot claim benefits under both CGHS and CS(MA).

The memorandum states that furnishing false, incorrect, suppressed or misleading information to obtain or continue CGHS benefits can result in appropriate disciplinary action under the Central Civil Services (Conduct) Rules, 1964, along with recovery of any inadmissible benefit obtained on the basis of such information.

Employees should therefore ensure that their CGHS records and declarations are accurate.

CGHS New Rule: Key Changes at a Glance

The main changes can be summarised as follows:

• The geographical criterion for serving Central government employees has been removed.

• Eligible employees outside CGHS-covered areas can exercise a one-time option to join CGHS.

• The employee must satisfy other applicable eligibility conditions.

• Prescribed CGHS contribution or subscription must be paid.

• The choice is final and binding once exercised.

• The principal beneficiary's choice applies to eligible dependants.

• CGHS and CS(MA) benefits cannot be claimed simultaneously.

• Employees who do not opt for CGHS continue under CS(MA), where applicable.

• Employees within CGHS-covered areas remain mandatorily covered by CGHS.

• No TA/DA is payable for treatment or procurement of medicines under CGHS rules.

Bottom Line

The Central government has removed the geographical restriction for serving Central government employees' CGHS eligibility, allowing eligible employees who live or work outside CGHS-covered areas to make a one-time choice to join CGHS. The change was notified by the Ministry of Health and Family Welfare through an Office Memorandum dated September 17, 2026, and took effect immediately.

The change is particularly relevant to employees who were previously required to rely on the CS(MA) Rules, 1944 solely because their residence or posting fell outside the CGHS geographical area.

However, the decision comes with important conditions. The employee must pay the prescribed CGHS contribution, meet other eligibility requirements and cannot claim CGHS and CS(MA) benefits simultaneously. The option is available only once and the employee's choice applies to eligible dependants as well.

Employees already residing or posted within a CGHS-covered area remain mandatorily covered under CGHS and cannot opt out in favour of CS(MA).

For eligible employees outside CGHS areas, the new rule therefore provides a new choice—but because that choice is one-time and binding, employees should consider their family healthcare needs, likely future postings, CGHS facility availability and the applicable contribution before exercising it.