CGHS Doctor Consultation Charges Explained: How Much Fee Do Central Employees and Pensioners Have to Pay?

The Central Government Health Scheme (CGHS) has long been a crucial healthcare support system for central government employees and pensioners. While the scheme makes quality medical treatment more accessible, recent confusion around OPD consultation charges left many beneficiaries uncertain about how much they need to pay when visiting a doctor.

According to an update reported by Moneycontrol, the Ministry of Health has now clearly explained the consultation fee structure under CGHS, putting an end to speculation around the ₹350 and ₹700 charges.

Why Was There Confusion About CGHS Fees?

Over the past few weeks, several CGHS beneficiaries were unsure about when the ₹350 consultation fee applies and in which cases the ₹700 fee is charged. Many believed these fees were applicable for every doctor visit, which is not the case.

The Health Ministry clarified that not all OPD or IPD consultations attract higher fees, and the charges depend largely on the type of doctor and treatment involved.

When Does the ₹350 or ₹700 OPD Fee Apply?

As per the official clarification, the ₹350 and ₹700 consultation charges apply only in specific cases. These fees are valid only when treatment is provided by a super-specialist doctor.

A super-specialist, under CGHS rules, refers to a doctor who holds a DM (Doctor of Medicine) or MCh (Master of Chirurgiae) degree. Additionally, the treatment must be taken in a CGHS-empanelled hospital and should fall under the same super-specialty category.

If any one of these conditions is not fulfilled, the higher consultation fee—especially the ₹700 charge—will not be admissible under CGHS.

OPD and IPD Consultation Rules Explained

The Ministry has also reiterated the consultation fee structure for general treatment under CGHS:

• ₹350 consultation fee is applicable for OPD (Outpatient Department) visits

• The same ₹350 fee is applicable for IPD (Inpatient Department) consultations

• These charges are reimbursable only if CGHS rules and empanelment conditions are met

For patients admitted under IPD, there is also a daily consultation limit. A CGHS beneficiary is allowed a maximum of two consultations per day with the same specialist. Any consultation beyond this limit will not be eligible for payment under CGHS guidelines.

Who Can Avail CGHS Benefits?

CGHS is one of India’s largest government-run healthcare schemes, covering over one crore central government employees and pensioners. The scheme offers access to OPD services, hospitalization, diagnostics, and medicines through government and empanelled private hospitals.

How to Apply for a CGHS Card?

• Pensioners can apply for a CGHS card through the Additional Director CGHS office in their city

• Serving employees need to submit the application form through their respective departments

• The application form can be downloaded from the official CGHS website

Having a valid CGHS card is mandatory to avail consultation, treatment, and reimbursement benefits.

Monthly CGHS Contribution (As per 7th Pay Commission)

The monthly CGHS subscription depends on the pay level:

• Level 1–5: ₹250 per month

• Level 6: ₹450 per month

• Level 7–11: ₹650 per month

• Level 12 and above: ₹1,000 per month

Pensioners also have the option to make annual payments or a one-time lump-sum payment for 10 years, offering greater convenience.

Ward Entitlement in CGHS Hospitals

Ward entitlement under CGHS is determined by basic salary or pension amount:

• Up to ₹36,500: General Ward

• ₹36,501–₹50,500: Semi-Private Ward

• Above ₹50,500: Private Ward

Patients opting for a higher ward category than their entitlement may need to bear additional expenses.

Important Takeaway for CGHS Beneficiaries

Experts advise CGHS beneficiaries to remain vigilant while seeking treatment. Always verify:

• The doctor’s qualification (especially for super-specialist consultations)

• Whether the hospital is CGHS-empanelled

• Applicable OPD/IPD consultation limits

Understanding these rules can help avoid claim rejections and unnecessary out-of-pocket expenses. With the latest clarification from the Health Ministry, CGHS beneficiaries can now plan their medical visits with greater confidence and clarity.