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Question on Central Govt Health Scheme

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07 Sep, 2020 by Baz

Hello!


Glad to be part of this forum.


I have a query - My father is an ex-army man and my mother is a retired central govt employee. I have purchased health insurance coverage for both of them (3 lakhs base + 12 lakhs super top up - individual) and have been renewing for more than 4 years now.


Recently, with insurance cost increasing , my mother mentioned that there is no need to renew health insurance policy as they are already covered by CGHS. I have no idea how CGHS works. Is there any reason to continue renewing health insurance if CGHS coverage is there? What are the pros and cons of CGHS (limits, claims etc)? Please advise.


Thank you!

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Parents-Health-Insurance

1 Answer

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08 Sep, 2020
Mahavir Chopra

Hello @Baz

Thank you for reaching out.


CGHS provides a wide bouquet of healthcare covers to Central Government employees, pensioners, defense personnel etc. This includes not only hospitalization cover, but also outpatient treatment like cost of medicines, doctor consultations, investigations. So its a good cover, no doubt.


There are a few things that you should investigate in detail.

  1. Limits, Copays: when you opt for treatment at non-government empaneled hospitals.
  2. Cashless Network: Find out the cashless network of private hospitals in areas/locations where you are likely to visit, in case of an exigency.
  3. Quality of service: What I know from people working in central government is that the budget for CGHS and ECHS is inadequate, while more and more retirees get added to the overall pool. Find out the experience of making claims from people who have made claims in the past (specially in private hospitals)


In case all of the above are fine - there are no limits, there is adequate cashless coverage, and the quality of service is excellent - then you may consider taking a reduced cover that suits your budget. In case even one of the three above is a problem, then you may like to continue the cover, in fact gradually upgrade it to at least 25L floater asap.


Hope this helped.


Cheers!

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14 Sep, 2020
Baz
Thank you so much!
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