Quicker Medical Claims For Govt Staff, Pensioners As Centre Raises CGHS Approval Limits

Last Updated:June 27, 2026, 09:38 IST

Claims of up to Rs 50 lakh can now be cleared at senior departmental levels, reducing the need for ministry approval.

In a move to cut the time taken to settle medical reimbursement claims, the central government has decided to significantly raise the financial delegation limits under the Central Government Health Scheme (CGHS).

According to an office memorandum dated June 25, the revision is intended “to streamline procedures, reduce avoidable references and facilitate timely disposal of cases". With greater approval authority now vested at the additional director and director levels, central government employees and pensioners can expect faster settlement of claims for hospital bills and treatment expenses at non-empanelled facilities.

According to the document, “the matter has been reviewed by the Ministry in view of the need to enhance and rationalize the financial delegations for expeditious settlement of claims and related approvals under CGHS."

Cases involving unlisted investigations and procedures — those not covered under standard CGHS rates — will also be processed and approved at the departmental level without escalation.

What Does The New Order Say?

The Department of Health and Family Welfare has increased the delegated financial powers across multiple administrative tiers.

For medical reimbursement claims and hospital bills at approved rates, the additional director of CGHS for a city or zone can now approve claims of up to Rs 15 lakh, more than double the earlier limit of Rs 7 lakh.

The director of CGHS has been empowered to approve claims of up to Rs 25 lakh, compared with the previous limit of Rs 15 lakh. The additional secretary and director general can now approve claims of up to Rs 50 lakh, against the earlier ceiling of Rs 25 lakh.

For unlisted investigations, procedures and implants not covered under standard CGHS package rates, the increases are even steeper.

According to the document, additional directors can now approve expenditure of up to Rs 2 lakh, up from Rs 1 lakh, while directors can sanction up to Rs 5 lakh, up from Rs 3 lakh. Additional secretaries have been granted a ceiling of Rs 10 lakh, double the earlier limit of Rs 5 lakh.

The document specifies that “cases exceeding Rs 50 lakhs shall continue to be referred to the Ministry of Health & Family Welfare for approval with the concurrence of the Integrated Finance Division (IFD)."

For unlisted investigations, “cases exceeding Rs 10 lakhs shall continue to require approval of the Ministry with the concurrence of IFD."

Govt Expands Base Of Beneficiaries

The revision expands permissions and ex-post facto approvals for treatments and investigations at non-empanelled hospitals and diagnostic centres.

The additional director of the concerned CGHS city or zone will now consider requests for permission or ex-post facto approval “in respect of pensioners/ex-MPs/freedom fighters, serving CGHS employees etc." for elective treatment or investigations at non-empanelled facilities, provided reimbursement is restricted to CGHS package rates or actual expenditure, whichever is lower.

Additionally, in cases involving procedural lapses, the additional director can grant approvals “without recommendation of government specialist or chief medical officer and without prior permission", significantly reducing processing delays.

The memorandum specifies that reimbursement across all categories “shall be restricted to CGHS package rate / CGHS ceiling rate, wherever applicable, or actual expenditure, whichever is less."

All approvals remain subject to admissibility under CGHS rules, the availability of supporting medical records and bills, the reasonableness of charges, budgetary provisions and audit requirements.

The revised delegations “shall supersede earlier instructions on the subject to the extent of the financial delegations being conveyed." The powers delegated “shall be exercised on a case-to-case basis and shall not be treated as creating any general entitlement or precedent for future cases."

About the Author

Himani ChandnaSenior Associate Editor

Himani Chandna, Senior Associate Editor at CNN-News18, tracks healthcare, pharma and medical research, bringing clarity to complex science and policy.

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