The Ministry of Health and Family Welfare has changed an important eligibility rule under the Central Government Health Scheme (CGHS). Under an Office Memorandum dated 17 September 2026, the Government has decided to completely dispense with the existing geographical criterion used for determining CGHS eligibility of serving Central Government employees.
The change is particularly relevant to serving employees who were covered under the Central Services (Medical Attendance) Rules, 1944 — CS(MA) Rules only because their residence or place of posting was outside the prescribed CGHS geographical area.
Such eligible employees can now exercise a one-time option to become CGHS beneficiaries, subject to the prescribed conditions and payment of the applicable CGHS contribution.
What was the earlier CGHS 5-km rule?
The new Office Memorandum refers to an earlier Ministry of Health and Family Welfare OM dated 6 April 2018.
Under that framework, CGHS coverage for serving beneficiaries was linked to whether they were residing or working within a 5-km radius of a CGHS Wellness Centre. Where a specific area had not been demarcated, the Additional Director of CGHS for the concerned city could notify the area covered by the Wellness Centre.
There was already a limited exception for employees who lived within the concerned Municipal Corporation limits but beyond the 5-km radius and were otherwise covered under CS(MA) Rules.
The September 2026 OM goes significantly further by removing the geographical criterion itself for determining eligibility of serving Central Government employees.
Who can now opt for CGHS?
The new provision is aimed at serving Central Government employees who are presently under CS(MA) Rules, 1944 solely because they reside or are posted outside the geographical coverage of CGHS.
Such employees may exercise a one-time option to become CGHS beneficiaries, provided they satisfy the other applicable eligibility conditions and pay the prescribed CGHS contribution or subscription.
This is important because the Government has effectively separated CGHS eligibility from physical proximity to a Wellness Centre for this category of serving employees.
However, removal of the geographical condition should not be interpreted as automatic CGHS enrolment for every employee.
The employee has to exercise the option where the option is available.
Who will continue to be mandatorily covered under CGHS?
The OM also creates a clear distinction for employees who already live or work within a CGHS-covered area.
Serving Central Government employees residing or posted within the limits of a district headquarters where a CGHS Wellness Centre is situated will continue to be mandatorily covered under CGHS.
They cannot opt out of CGHS in favour of medical facilities under the CS(MA) Rules, 1944.
Serving employee outside prescribed CGHS geographical coverage and currently under CS(MA) because of that location
Mandatory CGHS
Serving employee residing or posted within the CGHS-covered district headquarters
Is the CGHS option temporary or reversible?
No.
The OM specifically states that the option will be one-time, final and binding, subject to the applicable eligibility conditions.
This means an employee should carefully consider the practical implications before switching from CS(MA) Rules to CGHS.
The decision is also not limited to the employee individually.
The choice made by the principal beneficiary will apply to all eligible dependants, and medical entitlement cannot be split between CGHS and CS(MA) within the same family.
For example, an employee cannot choose CGHS personally while keeping eligible family members under CS(MA).
What conditions apply after switching to CGHS?
The Office Memorandum places several important conditions on employees exercising the option:
- the option can be exercised only once and is final and binding;
- the principal beneficiary’s option applies to all eligible dependants;
- the employee must continue paying the prescribed CGHS contribution irrespective of residence or posting;
- CGHS and CS(MA) benefits cannot be claimed simultaneously;
- no TA/DA will be admissible for travelling to obtain treatment or medicines under CGHS;
- an undertaking must be submitted confirming that neither the employee nor eligible family members will claim benefits under both systems.
These conditions are important because the order expands eligibility, but it does not eliminate the financial or procedural responsibilities associated with CGHS membership.
Will employees receive TA/DA if the nearest CGHS facility is far away?
No.
This is one of the most important practical limitations in the new policy.
The OM expressly states that no TA/DA will be admissible for availing treatment or procuring medicines under CGHS Rules.
Therefore, removing the geographical restriction does not mean that a new Wellness Centre will automatically become available close to every employee.
An employee posted in a non-CGHS city may now become eligible to opt for CGHS, but any travel required to access CGHS treatment or medicines will not automatically generate a TA/DA entitlement under this OM.
In simple terms:
The Government has removed the eligibility barrier, not the physical distance to the healthcare facility.
Can an employee use CGHS and CS(MA) together?
No.
Once an employee and eligible family members are covered under CGHS, they cannot simultaneously claim medical facilities or reimbursement under CS(MA), and the reverse also applies.
The attached undertaking requires the employee to specifically confirm that neither the employee nor any eligible family member will claim benefits under both systems.
Any inadmissible dual benefit can be recovered under the applicable rules.
What if an employee does not exercise the CGHS option?
Where the option is available under the new OM and an employee chooses not to exercise it, the employee will continue to be governed by the CS(MA) Rules, 1944, as applicable.
So this order does not automatically transfer every employee outside a CGHS-covered area into CGHS.
It creates a choice for the specified category.
What happens if incorrect information is submitted?
The OM contains a specific warning against false or misleading declarations.
An employee or beneficiary providing false, incorrect, suppressed or misleading information for obtaining or continuing CGHS benefits may face disciplinary action under the Central Civil Services (Conduct) Rules, 1964, along with recovery of any inadmissible benefit.
This makes the undertaking attached to the OM more than a routine formality.
What does the Option and Undertaking Form require?
The Office Memorandum includes an annexure titled “Option and Undertaking Form for Serving Central Government Employees.”
The employee has to provide details including name, designation and pay level, Ministry or Department, present residential address, district and State.
The form specifically records the employee’s one-time decision to switch from CS(MA) Rules, 1944 to CGHS without geographical limitation.
It also authorises the Head of Office or DDO to deduct the prescribed monthly CGHS subscription continuously from the employee’s pay and allowances.
The form has to be signed by the employee and countersigned by the Head of Office/DDO with seal and stamp.
Does this order apply to Central Government pensioners too?
The 17 September 2026 OM specifically deals with serving Central Government employees.
It should therefore not be presented as a blanket change in CGHS eligibility rules for all pensioners.
CGHS itself serves both serving and retired Central Government employees and their eligible family members, but the one-time geographical-limit option introduced through this particular OM is framed for serving employees. Official Ministry records describe CGHS as a scheme covering serving and retired Central Government employees and eligible dependants.
What has not changed under the new CGHS order?
The new order does not mean that CGHS Wellness Centres have been opened in every city.
It does not provide free CGHS membership.
It does not permit an employee to use CGHS and CS(MA) simultaneously.
It does not provide TA/DA for travelling to a CGHS facility.
And it does not automatically convert every CS(MA)-covered serving employee into a CGHS beneficiary.
The major change is narrower but significant:
Geographical distance from a CGHS Wellness Centre will no longer, by itself, prevent an otherwise eligible serving Central Government employee from exercising the one-time option available under the new policy.
Leave a Reply