Who is eligible for CGHS and can they file RTI about their benefits?

CGHS (Central Government Health Scheme) covers serving and retired Central Government employees and their dependants, MPs, freedom fighters, and certain other categories as notified by the Ministry of Health and Family Welfare. All CGHS wellness centres and the CGHS Directorate are public authorities under Section 2(h) of the RTI Act, 2005. Beneficiaries can file RTI to get written information about their card status, claim decisions, and applicable CGHS rules.

CGHS rejected or reduced my reimbursement claim. Can RTI help me understand why?

Yes. File an RTI asking for the specific reason for rejection or reduction with reference to the applicable CGHS schedule rate or rule. Reimbursement is typically governed by CGHS rate lists published by the Ministry of Health and Family Welfare. Common reasons for reduction include treatment at non-empanelled hospitals, rates exceeding CGHS approved rates, or absence of a referral. The RTI response gives you the documented basis to file a reconsideration request or an appeal.

How do I find out which hospitals are empanelled under CGHS in my city?

CGHS publishes empanelled hospital lists on its website (cghs.gov.in). However, if you need to confirm whether a specific hospital is empanelled, or want the empanelment validity dates and treatment categories, you can file an RTI with the CGHS Additional Director's office for your city. Also ask for the procedure to get a referral to an empanelled hospital for a specific specialty.

A medicine prescribed to me is not available at my CGHS wellness centre. Can RTI help?

Yes. File an RTI asking whether the medicine is in the CGHS-approved drug formulary, the approved rate under the CGHS formulary, and the wellness centres in your city where it should be available. If it is in the formulary but not stocked, this creates a documented basis to escalate through CGHS's grievance mechanism.

What if CGHS does not respond to my RTI within 30 days?

File a First Appeal under Section 19(1) of the RTI Act with the First Appellate Authority (FAA) at CGHS within 30 days of the date of the decision or the expiry of the 30-day response period, whichever is applicable. If the FAA's response is absent or unsatisfactory, file a Second Appeal with the Central Information Commission (CIC) under Section 19(3) within 90 days. CGHS is a Central Government scheme under the Ministry of Health and Family Welfare, so second appeals go to the CIC.

Home/Guides/How to File RTI with CGHS (Central Government Health Scheme) — Card, Empanelment, Reimbursement

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How to File RTI with CGHS (Central Government Health Scheme) — Card, Empanelment, Reimbursement

Step-by-step guide to file an RTI application with CGHS for CGHS card delays, empanelled hospital list, medical reimbursement claim status, and medicine availability. Includes a ready-to-use sample RTI draft.

Updated 24 May 2026

Quick Facts

MinistryMinistry of Health and Family Welfare

Address RTI ToCPIO, CGHS Wellness Centre / CGHS Additional Director's Office

Application Fee₹10 under RTI (Regulation of Fee and Cost) Rules, 2005. Free for BPL cardholders.

Response Time30 days from receipt (Section 7(1), RTI Act 2005). 48 hours if the matter involves life or liberty.

File Online Athttps://rtionline.gov.in

All information on this page is based on the Right to Information Act, 2005 (Act No. 22 of 2005) and the RTI (Regulation of Fee and Cost) Rules, 2005. First Appeal: Section 19(1). Second Appeal to CIC/SIC: Section 19(3).

The Central Government Health Scheme (CGHS) is a health service provided by the Ministry of Health and Family Welfare, Government of India, to serving and retired Central Government employees, their families, and other eligible beneficiaries. CGHS operates through wellness centres (formerly polyclinics) and empanelled hospitals across major cities in India.

CGHS is a public authority under Section 2(h) of the RTI Act, 2005. Beneficiaries use RTI to resolve card issuance delays, understand the basis of reimbursement claim rejections, verify empanelled hospital information, and check medicine availability under the CGHS formulary.

What Can You Achieve with an RTI to CGHS?

Know the reason for delay or rejection of a CGHS card application or renewal
Get the specific basis for reduction or rejection of a medical reimbursement claim with the applicable CGHS rate or rule
Obtain the current list of empanelled hospitals in your city with treatment categories and validity dates
Check whether a specific medicine is in the CGHS formulary and its approved rate
Know the procedure for referral to an empanelled hospital for a specialist or procedure
Get information about CGHS wellness centre facilities and service availability in your area

Where to File: The Right Authority

CGHS is administered city-wise. Each city has an Additional Director's Office (for major cities) or a Joint Director's Office that oversees wellness centres and empanelled hospitals in that city.

File your RTI at rtionline.gov.in under: Ministry of Health and Family Welfare → Central Government Health Scheme.

For matters specific to a wellness centre, you may also file directly with the Medical Officer In-charge of that wellness centre.

How to File: Step by Step

Step 1: Gather Your Details

Your CGHS beneficiary ID or card number
Your wellness centre name and city
Your claim reference number for reimbursement matters
The hospital name and treatment dates for reimbursement claims
The application reference number for card-related matters

Step 2: Draft Your Application

Be specific about the type of query — card, claim, empanelment, or medicine. Ask for the applicable CGHS rule or schedule rate in reimbursement queries. The sample draft covers all four scenarios.

Step 3: File Online

File at rtionline.gov.in under Ministry of Health and Family Welfare → CGHS, and pay ₹10 online.

Step 4: Appeals

If there is no response within 30 days, or the response is unsatisfactory, file a First Appeal under Section 19(1) of the RTI Act with the First Appellate Authority at CGHS within 30 days of the date of the decision or the expiry of the 30-day response period, whichever is applicable. For a Second Appeal, approach the Central Information Commission (CIC) under Section 19(3) within 90 days. CGHS is a Central Government scheme — second appeals go to the CIC, not a State Information Commission.

What Specific Information Can You Ask For?

CGHS card:

Current status of card application / renewal Ref. No. — stage at which it is pending and reason for delay
Documents or formalities outstanding, if any, before the card can be issued

Reimbursement claim:

Status of claim Ref. No. — approved, partially approved, or rejected
If rejected or reduced: specific reason with reference to the applicable CGHS schedule rate, rule, or circular
Whether a referral was required for the treatment and, if so, whether it was in the beneficiary's file

Empanelled hospitals:

List of currently empanelled hospitals under CGHS City/Zone with treatment categories and empanelment validity dates
Procedure for referral to an empanelled hospital for Specialty/Procedure

Medicine formulary:

Whether Medicine Name, Composition, Dosage is in the CGHS-approved drug list / formulary
Approved rate under the CGHS formulary and wellness centres where it is available in City

Sample RTI Application Draft

To,
The Central Public Information Officer (CPIO),
Central Government Health Scheme (CGHS),
Additional Director's Office, CGHS,
[City / Zone Address]

Subject: Application under the Right to Information Act, 2005 — CGHS Card / Reimbursement Claim / Empanelled Hospital

Sir/Madam,

I, [Your Full Name], residing at [Your Full Address], submit this application under Section 6 of the Right to Information Act, 2005, to seek the following information:

Beneficiary details:
  CGHS Beneficiary ID / Card No. (if available): [Beneficiary ID]
  CGHS Wellness Centre / City: [Wellness Centre Name and City]
  Reference / File No. for application or claim (if any): [Reference Number]
  Subject: [CGHS Card Issue / Reimbursement Claim / Empanelled Hospital / Medicine Availability]

Information sought:

1. [For CGHS card delay] The current status of my application for CGHS card / renewal bearing reference number [XXX] submitted on [DD/MM/YYYY], including the stage at which it is pending and the reason for delay.

2. [For reimbursement claim] The current status of my medical reimbursement claim for treatment at [Hospital Name] for the period [Date], bearing claim reference number [XXX]. Whether the claim has been approved, partially approved, or rejected — and if rejected or reduced, the specific reason and the applicable CGHS rule or schedule rate.

3. [For empanelled hospital list] The list of currently empanelled hospitals under CGHS in [City/Zone] along with the categories of treatment available at each hospital and their empanelment validity dates.

4. [For medicine availability] Whether [Medicine Name] is included in the CGHS formulary / approved drug list. If yes, the approved rate and the wellness centre(s) in [City] where it is available. If not, the reason for non-inclusion.

5. The name and designation of the officer responsible for the above matter.

I am enclosing the application fee of Rs. 10 [via online payment; Reference No.: [Payment Ref]].

I request the above information within 30 days as required under Section 7(1) of the RTI Act, 2005.

Yours sincerely,

[Your Full Name]
[Your Complete Address]
Phone: [Your 10-digit Mobile Number]
Email: [[email protected]]
Date: [DD/MM/YYYY]

Replace all text in [square brackets] with your actual details before filing. Do not include the brackets in your submission.

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