The Central Government Health Scheme (CGHS) is a well-known plan that covers most Central government staff’s medical needs. This scheme has more than 42 lakh beneficiaries all over India and covers employees and their dependents.

The CGHS operates in 80 cities and offers in-house and outpatient treatment with a network of empanelled hospitals, over 300 allopathic centres and more than 100 AYUSH (Ayurveda, Unani, Siddha and Homeopathy) units.

Typically, subscribers are charged a fee (up to ₹1,000 a month depending on the employee’s level) for lifelong coverage. They are also charged for outpatient and specialist consultations at subsidised rates.

Though the coverage of the CGHS is extensive, there are some shortfalls. Room rents are capped at modest levels, ICU charges also have an upper ceiling among a few other challenges. And with ever-changing healthcare landscape with newer ailments and modern treatments, the existing network may not suffice to cater to such a large scale of subscribers.

The Department of Financial Services has launched a new health policy in January this year – Paripoorna Mediclaim Ayush Bima – exclusively for CGHS beneficiaries to cover some of these gaps and to broaden coverage.

Taking greater cover

The new mediclaim policy is administered by New India Assurance and offers access to cashless service in as many as 1,500 network hospitals. The Paripoorna Mediclaim Ayush Bima is like most other regular health covers.

This mediclaim policy offers floater coverage of ₹10 lakh and ₹20 lakh. There is flexibility to add as many as six family members including spouse, children, parents and parents-in-law.

Coverage is extended to room rent, ICU, doctor’s fees, medicines, diagnostics, surgeries, dialysis, chemotherapy and so on.

Room rent is capped at 1 per cent of sum insured per day amounting to ₹10,000 for ₹10-lakh policy and ₹20,000 for a ₹20-lakh policy, much higher than the regular CGHS cover. The coverage for ICU rents can go up to 2 per cent of the sum insured per day.

AYUSH coverage is allowed up to 100 per cent of the sum insured.

Pre-hospitalisation (30 days) and post-hospitalisation (60 days) are covered. Cataract cover of up to ₹1 lakh per eye is available for ₹10 lakh sum insured and up to ₹1.5 lakh for ₹20 lakh sum assured.

Modern treatments are covered up to 25 per cent of sum assured. Ambulance expenses are allowed subject to limits.

There is no age bar for renewing the policy. A cumulative bonus of 10 per cent of sum assured is allowed for every claim-free year, subject to a maximum of 100 per cent of sum insured.

Then there are factors that CGHS subscribers must note before opting for the insurance policy.

Claims in the new mediclaim policy are allowed only for in-patient treatments involving hospitalisations of more than 24 hours. There are, of course, exemptions in the case of specific day care procedures (dialysis, chemotherapy etc).

Cashless treatment is available only in network hospitals.

 There is a waiting period for the first 30 days for everyone. For diabetes and hypertension, there is a 90-day waiting period. In the case of specified illness or pre-existing ailments, the waiting period goes up to 24 months.

Waiver for pre-existing diseases may be considered if a good health certificate is produced with no hospitalisation in the past 24 months.

Medical check-ups are compulsory for the first time when you wish to add anyone aged more than 60 in the policy.

Copay clauses and premiums

The Paripoorna Mediclaim Ayush Bima does not pay the hospitalisation bill for the treatments taken.

There are co-payment clauses. Two choices are offered to subscribers – 70:30 and 50:50. So, subscribers have to bear 30 per cent or 50 per cent of the hospitalisation claim amount from their own pockets depending on the co-pay option they take.

The premiums are not inexpensive either. From the example, calculation for a 70:30 co-payment policy of ₹10-lakh floater, this becomes clear.

The premium for the primary beneficiary (aged 45) is around ₹13,476; for the second person (aged 38), the premium is ₹10,012 and the amounts are ₹7,184 and ₹7,256 for children aged 11 and 15, respectively. The total premium comes to ₹37,828 for a family of four. This goes up steeply if senior citizens are added in the policy.

For those wanting to augment their CGHS coverage, going with regular private or other public sector players offering health covers may be better than taking this mediclaim policy, as they are available without co-payment clauses and at similar/lower premiums. More so, if the applicants are relatively young.

The new insurance scheme may be useful in one specific scenario. If you have senior citizens who are dependents, have no other medical cover and are finding it challenging to find policies elsewhere, this new scheme may be worthwhile, although the premiums are a tad high.

Published on March 21, 2026