In a significant relief for Central Government employees, pensioners, CGHS beneficiaries, Ex-MPs and Freedom Fighters, the Ministry of Health & Family Welfare has issued a new Office Memorandum (O.M.) dated 25 June 2026 revising the delegation of financial powers for settlement of medical reimbursement claims and grant of permissions under the Central Government Health Scheme (CGHS).
The revised delegation substantially increases the financial authority of CGHS officers for approving reimbursement claims, unlisted medical procedures and ex-post facto permissions. The primary objective is to reduce delays, minimize unnecessary referrals to the Ministry and ensure quicker disposal of medical reimbursement cases.
The revised powers are applicable not only to CGHS pensioners but also to serving CGHS employees and other eligible CGHS beneficiaries.
Why Was the Revision Necessary?
The earlier delegation of financial powers was issued through an Office Memorandum dated 5 October 2016. Over the last decade, healthcare expenses have increased considerably due to inflation, technological advancements in medical treatment and rising hospitalization costs.
Many reimbursement cases that exceeded the earlier financial limits had to be referred to the Ministry of Health & Family Welfare for approval. This often resulted in lengthy processing times, causing hardship to pensioners and serving employees awaiting reimbursement of expensive medical treatments.
After reviewing the existing system, the Ministry decided to substantially enhance the financial powers of CGHS authorities to make the reimbursement process faster and more efficient.
Key Highlights of the CGHS Office Memorandum Dated 25 June 2026
The revised Office Memorandum introduces higher financial limits for medical reimbursement claims, expands approval powers for unlisted procedures and simplifies permission procedures for treatment in non-empanelled hospitals under specified conditions.
The revised delegation also ensures that only exceptionally high-value cases continue to require approval from the Ministry along with concurrence of the Integrated Finance Division (IFD).
Revised Financial Powers for Medical Reimbursement Claims
One of the most important changes relates to reimbursement of hospital bills at approved CGHS package rates.
Competent Authority Earlier Limit Revised Limit
Additional Director, CGHS City/Zone ₹7 lakh ₹15 lakh
Director, CGHS ₹15 lakh ₹25 lakh
Additional Secretary & DG, CGHS ₹25 lakh ₹50 lakh
Under the revised order, reimbursement claims exceeding ₹50 lakh will continue to require approval of the Ministry of Health & Family Welfare with concurrence of the Integrated Finance Division.
This enhancement is expected to significantly reduce the number of cases referred to the Ministry, thereby speeding up reimbursement.
Higher Approval Limits for Unlisted Procedures, Investigations and Implants
Medical technology is evolving rapidly, and several advanced procedures or implants are not covered under existing CGHS package rates. The revised Office Memorandum substantially increases approval limits for such cases.
Competent Authority Earlier Limit Revised Limit
Additional Director ₹1 lakh ₹2 lakh
Director, CGHS ₹3 lakh ₹5 lakh
Additional Secretary & DG ₹5 lakh ₹10 lakh
If expenditure exceeds ₹10 lakh, approval of the Ministry with concurrence of the Integrated Finance Division will still be necessary.
These revised powers apply only in situations where CGHS package rates or ceiling rates are not available for the particular investigation, implant or medical procedure.
Major Relief for Pensioners Seeking Treatment in Non-Empanelled Hospitals
One of the most practical changes introduced through the Office Memorandum concerns treatment in non-empanelled hospitals, diagnostic laboratories and imaging centres.
The Additional Director of the concerned CGHS City or Zone has now been empowered to grant permission or ex-post facto approval for elective treatment or investigations carried out in such institutions.
However, reimbursement in these cases will remain restricted to CGHS package rates or the actual expenditure incurred, whichever is lower.
This provision benefits pensioners who often undergo treatment in nearby hospitals that may not be included in the CGHS empanelled list.
Relaxation in Cases Involving Procedural Lapses
The revised Office Memorandum also addresses situations where beneficiaries may have inadvertently failed to complete certain procedural formalities.
The Additional Director of the concerned CGHS City or Zone may now consider requests for approval where treatment was taken in an empanelled hospital without obtaining:
- recommendation of a Government Specialist,
- recommendation of the Chief Medical Officer (CMO), or
- prior permission from CGHS.
Even in such cases, reimbursement will be restricted to the applicable CGHS package rates or actual expenditure, whichever is lower.
This provision is expected to reduce hardship faced by beneficiaries whose reimbursement claims were earlier delayed merely because of procedural deficiencies.
Important Conditions Attached to the Revised Delegation
Although financial powers have been increased substantially, the Office Memorandum clearly specifies several safeguards.
The revised delegation does not apply to cases involving relaxation of CGHS rules. Any case requiring relaxation of existing rules will continue to be referred to the Ministry irrespective of the financial amount involved.
Similarly, reimbursement shall normally remain limited to CGHS package rates or ceiling rates. Wherever no package rate exists, reimbursement may be considered on actual expenditure after assessing admissibility, reasonableness of charges and the applicable financial limits.
Every approval will continue to depend upon submission of valid medical records, original bills, compliance with CGHS rules, availability of budget and audit requirements.
The Ministry has also clarified that delegated powers are to be exercised on a case-to-case basis and should not be treated as creating any automatic entitlement or precedent.
How Will Pensioners Benefit?
For lakhs of Central Government pensioners enrolled under CGHS, the revised delegation is likely to bring several practical benefits.
Higher financial limits mean that many reimbursement claims can now be settled directly at the city or zonal level without waiting for Ministry approval. This should reduce processing time considerably.
Similarly, pensioners requiring advanced implants or specialized investigations that are not covered under existing CGHS package rates may receive faster decisions because higher approval powers have now been delegated.
The simplified provisions relating to non-empanelled hospitals and procedural lapses are also expected to reduce unnecessary rejection or prolonged correspondence in genuine cases.
Impact on Serving Government Employees
Serving Central Government employees covered under CGHS also stand to benefit from the revised delegation.
Expensive hospitalization claims involving major surgeries, cancer treatment, cardiac procedures, organ-related interventions or advanced diagnostic investigations may now be processed more quickly within CGHS itself.
The reduced dependence on Ministry-level approvals is expected to improve administrative efficiency across the CGHS system.
Expert Analysis
The revised Office Memorandum represents one of the most important administrative reforms in CGHS reimbursement procedures since the 2016 delegation.
While the Government has not changed reimbursement eligibility or CGHS package rates, it has significantly strengthened the decision-making authority of field-level officers. This administrative decentralization should reduce delays, especially in high-value reimbursement cases involving pensioners.
The increase from ₹25 lakh to ₹50 lakh for the Additional Secretary & Director General, CGHS is particularly noteworthy because a large number of costly medical claims will now be disposed of without requiring Ministry approval.
At the same time, the Government has retained adequate financial safeguards by requiring Ministry approval for exceptionally high-value cases and maintaining strict adherence to CGHS rules, audit requirements and package rates.
Conclusion
The Office Memorandum dated 25 June 2026 marks a significant step towards making the CGHS reimbursement system more efficient, transparent and beneficiary-friendly.
By substantially increasing financial powers, simplifying approval procedures and reducing unnecessary referrals, the Ministry of Health & Family Welfare has attempted to ensure that eligible beneficiaries—particularly pensioners—receive faster reimbursement for genuine medical expenses.
CGHS beneficiaries should nevertheless continue to preserve all medical records, original bills, prescriptions and discharge summaries, as reimbursement will remain subject to CGHS rules, admissibility and verification by the competent authority.
Frequently Asked Questions (FAQs)
What is the effective date of the revised CGHS financial powers?
The revised delegation comes into effect through the Office Memorandum issued on 25 June 2026.
What is the new reimbursement approval limit for the Additional Director, CGHS?
The financial power has been increased from ₹7 lakh to ₹15 lakh.
What is the highest reimbursement amount that can now be approved within CGHS?
The Additional Secretary & Director General, CGHS can now approve reimbursement claims up to ₹50 lakh.
Are pensioners eligible under the revised delegation?
Yes. The revised Office Memorandum specifically covers CGHS pensioners, serving CGHS employees and other eligible CGHS beneficiaries.
Will treatment in non-empanelled hospitals now be reimbursed?
Yes, subject to permission or ex-post facto approval by the competent authority. Reimbursement will remain restricted to CGHS package rates or actual expenditure, whichever is lower.
Does this order change CGHS package rates?
No. The Office Memorandum only revises the delegation of financial powers. Existing CGHS package rates and reimbursement rules continue to apply.