Revised CGHS Financial Delegation – Medical Claims & Approvals (OM Z.15025/14/2/DIR/CGHS)

Government of India

Ministry of Health and Family Welfare

Department of Health & Family Welfare

New Delhi

No: Z.15025/14/2/DIR/CGHS

Date: 25.06.2026

OFFICE MEMORANDUM

Subject: Revision of delegation of financial powers for settlement of medical reimbursement claims and grant of permissions/ex-post facto approvals in respect of pensioner CGHS beneficiaries and other eligible beneficiaries, including serving CGHS employees - regarding.

With reference to this Ministry's Office Memorandum of even number Z.15025/79/2/DIR/CGHS dated 5th October, 2016 on the subject cited above and subsequent instructions issued from time to time, 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.

Accordingly, with a view to streamline procedures, reduce avoidable references and facilitate timely disposal of cases, it has been decided to revise the delegation of financial powers to the competent authorities as under:

A. MEDICAL REIMBURSEMENT CLAIMS / HOSPITAL BILLS AT APPROVED RATES

• Additional Director, CGHS City/Zone: Existing Power – Rs. 7 lakhs; Revised Power – Rs. 15 lakhs
• Director, CGHS: Existing Power – Rs. 15 lakhs; Revised Power – Rs. 25 lakhs
• Additional Secretary & DG, CGHS: Existing Power – Rs. 25 lakhs; Revised Power – Rs. 50 lakhs

Note: 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).

B. UNLISTED INVESTIGATIONS / PROCEDURES / IMPLANTS

• Additional Director, CGHS City/Zone: Existing Power – Up to Rs. 1 lakh; Revised Power – Up to Rs. 2 lakhs
• Director, CGHS: Existing Power – Up to Rs. 3 lakhs; Revised Power – Up to Rs. 5 lakhs
• Additional Secretary & DG, CGHS: Existing Power – Up to Rs. 5 lakhs; Revised Power – Up to Rs. 10 lakhs

Note: Cases exceeding Rs. 10 lakhs shall continue to require approval of the Ministry with the concurrence of IFD. The above delegation shall apply to cases where CGHS package rate / CGHS ceiling rate is not available for the investigation, procedure or implant.

C. PERMISSIONS / EX-POST FACTO APPROVALS

i) Permission / ex-post facto approval in non-empanelled hospitals / Diagnostic Labs / Imaging Centres:

Requests for permission / ex-post facto approval for elective treatment / investigations in non-empanelled hospitals / diagnostic centres in respect of Pensioners/ex-MPs/Freedom Fighters, serving CGHS employees etc., shall be considered by Addl. Director of concerned CGHS city / Zone subject to the reimbursement being restricted to CGHS package rates or actual expenditure, whichever is less.

ii) Permission / ex-post facto approval in cases involving procedural lapse:

Addl. Director of concerned CGHS city / Zone shall consider requests for approval of elective treatment / investigations in empanelled hospitals / diagnostic centres without recommendation of Govt. Specialist or CMO and without prior permission in respect of Pensioners/ex-MPs/Freedom Fighters, serving CGHS employees etc., subject to the reimbursement being restricted to CGHS rates or actual expenditure whichever is less.

The revised delegations mentioned above shall be subject to the following conditions:

i. The revised delegations shall not include cases involving relaxation of rules, irrespective of the amount involved.

ii. Cases exceeding the monetary limits prescribed above shall be referred to the Ministry of Health & Family Welfare for approval with the concurrence of the Integrated Finance Division.

iii. Reimbursement shall be restricted to CGHS package rate / CGHS ceiling rate, wherever applicable, or actual expenditure, whichever is less.

iv. In cases covered under para 2(B), where no CGHS package rate / CGHS ceiling rate is available, reimbursement may be considered on actual expenditure, subject to admissibility, reasonableness and the financial limits prescribed above.

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

vi. The powers delegated herein shall be exercised on a case-to-case basis and shall not be treated as creating any general entitlement or precedent for future cases.

vii. These revised delegations shall supersede earlier instructions on the subject to the extent of the financial delegations now being conveyed.

This issues with the concurrence of the Integrated Finance Division, Ministry of Health & Family Welfare, vide their reference Dy. No.1029, dated 18.06.2026.

Director, CGHS

Copy to:

1. C.C.A., MoHFW, Nirman Bhawan, New Delhi
2. Addl. DDG (HQ), CGHS, MoHFW, Nirman Bhawan, New Delhi
3. AD (HQ), CGHS, R.K. Puram, Sector-12, New Delhi
4. All Additional Directors of CGHS cities outside Delhi
5. Additional Director (SZ)/(CZ)/(EZ)/(NZ)/(MSD), MCTC CGHS, New Delhi
6. JD (HQ), JD (Grievance)/JD (R&H), CGHS, Delhi
7. Director (Policy), MoHFW, Nirman Bhawan, New Delhi
8. Hospital Empanelment Cell, CGHS, MoHFW, Nirman Bhawan, New Delhi
9. CGHS-I/II/III/IV, Directorate General of CGHS, MoHFW, Nirman Bhawan, New Delhi
10. Integrated Finance Division, MoHFW, Nirman Bhawan, New Delhi
11. All Pay & Accounts Offices, Ministry of Health & Family Welfare
12. O/O CEO NHA
13. Guard file

Copy for information to:

1. PS to Secretary (HFW)
2. PS to DGHS
3. PS to JS CGHS