Big Relief For Govt Employees, Pensioners: CGHS Medical Claim Approval Limit Hiked, Know Rules And Process

Central government employees and pensioners will now find it easier to recover large hospital expenses, after the Union Ministry of Health and Family Welfare (MoHFW) significantly increased the financial powers of departments.

The government has raised the ceiling for settling medical reimbursement claims from ₹5 lakh to ₹10 lakh, reducing delays and cutting down procedural hurdles. Department heads can now clear eligible claims without referring them to the Integrated Finance Division (IFD), a step expected to speed up payments.

What the new MoHFW order says

In an office memorandum dated February 16, 2026, the ministry clarified the revised limits and decision-making authority. It stated, "In this regard, the matter has been re-examined and decided to enhance the present ceiling limit from Rs 5 lakh to Rs 10 lakh for settling medical reimbursement cases by the heads of departments of ministries/departments without the consultation of IFD provided conditions are fulfilled."

The memorandum also revised another category of cases. For reimbursement matters where rules remain unchanged and entitlement is calculated strictly at prescribed Central Government Health Scheme (CGHS) rates, the settlement limit has been increased from ₹2 lakh to ₹5 lakh.

"The undersigned is directed to refer to the MoHFW vide OM No. 11011/20/2014-CGHS(P)/EHS, dated November 23, 2016, whereby the ceiling limit for the settlement of medical reimbursement cases (where no relaxation of rules is involved and entitlement is worked out strictly as per prescribed CGHS rates) was enhanced from Rs 2 lakh to Rs 5 lakh," the MoHFW OM further states.

Conditions linked to reimbursement ceiling

The higher approval limit comes with strict compliance requirements. Authorities can clear claims only when the following conditions are met:

• No relaxation of CGHS or CS(MA) rules is allowed in the reimbursement case
• The reimbursable amount must strictly follow the rates notified under CGHS and CS(MA) guidelines

This means departments gain faster approval authority but not additional discretion over entitlement.

Documents and application procedure

Pensioners must submit their claims within six months from discharge or completion of treatment to the Chief Medical Officer (CMO). Along with the application, they need to provide:

• Properly filled MRC forms and checklist
• Copies of discharge summary
• Valid CGHS card
• Referral or permission slip and emergency certificate, if applicable
• Original receipts and hospital bills
• Cancelled cheque with bank details for ECS payment, or mandate form if the beneficiary's name is not printed on the cheque

The revised policy is expected to reduce waiting time for reimbursements, especially in high-value treatments, and bring quicker financial relief to employees and retirees who depend on government healthcare coverage.