The Central Government Health Scheme (CGHS) has introduced a major revision of its healthcare package rates for empanelled private hospitals, effective October 13, 2025. These new rates supersede all previous memoranda and are designed to bring greater uniformity and rationalization to the cost structure after years of complaints from both hospitals—citing outdated rates—and beneficiaries who faced denied cashless treatment. The updated rates will apply to all CGHS-empanelled healthcare organizations (HCOs) and cover medical reimbursement claims for all eligible beneficiaries, including serving employees and pensioners, who will continue to receive cashless treatment.
The revised structure introduces a multi-dimensional pricing framework based on four key factors. Accreditation is now crucial, as hospitals without NABH/NABL accreditation will receive 15% lower rates than accredited facilities, while super specialty hospitals will be entitled to 15% higher rates than NABH-accredited hospitals in the same city. Rates also vary significantly by city classification: Tier II (Y) cities will have rates 10% lower than Tier I (X) cities, and Tier III (Z) cities will be 20% lower.Changes have also been made to ward entitlement costs. The base package rates are set for the semi-private ward. General ward rates will see a 5% drop, while the admissible claim amount for the private ward entitlement will rise by 5%. Importantly, rates for consultations, investigations, radiotherapy, and daycare procedures will remain uniform regardless of the ward entitlement. Due to the complete overhaul, all existing Memoranda of Agreement (MoAs) with empanelled private hospitals ceased to be valid on October 13, 2025, with all HCOs required to submit an undertaking accepting the new terms or face automatic de-empanelment.
