HERO
Calculate CGHS contribution, Fixed Medical Allowance (FMA), OPD reimbursement, ward entitlement, and annual medical benefit — for Central Govt employees and pensioners. Updated CGHS 2026 rates.
₹1,000/moFMA (Non-CGHS)
₹250–₹1,000CGHS Contribution
25 CitiesCGHS Coverage
100%OPD Tax-Free
CALCULATOR
Medical Allowance & CGHS Benefits Calculator
Your CGHS contribution, ward entitlement, FMA, reimbursement limits and net medical benefit
Determines CGHS contribution rate and ward entitlement
Monthly basic pay (for annual benefit calculation)
Spouse + children + dependent parents (if any)
Current DA — for OPD medicine value estimation
Actual bill submitted for CGHS reimbursement (limited to CGHS package rates)
Total OPD bills reimbursed under CS(MA) Rules this year
📊 Medical Benefits Statement
🏥 Ward Entitlement: —
CGHS Contribution—Per month
Annual Contribution—Yearly cost
Est. Annual Benefit—OPD + coverage value
Net Medical Benefit—Benefit minus contribution
Medical Benefit BreakdownAmount
Pay Level—
Coverage Type—
Ward Entitlement—
Monthly CGHS / FMA Contribution—
Annual CGHS / FMA Amount—
Number of Beneficiaries Covered—
Estimated OPD Medicines Value / Year—
Hospitalisation Reimbursement (This Year)—
Insurance Premium Equivalent (Market Rate)—
💚 Estimated Net Medical Benefit / Year—
🏥 Your CGHS Entitlements at a Glance
📋 Step-by-Step Benefit Calculation
INFO SECTIONS
CGHS & Medical Allowance Rules 2026 — Complete Guide
Contribution rates, ward entitlement, OPD rules, FMA, CS(MA) Rules, reimbursement process
💳 CGHS Contribution Rates & Ward Entitlement — 7th CPC
ℹ️
CGHS contribution is deducted monthly from salary. The ward entitlement determines the category of hospital room you are entitled to during inpatient treatment. All CGHS beneficiaries — serving employees and pensioners — are covered for OPD, IPD, specialist care, diagnostics, and medicines from empanelled hospitals.
| Pay Level (7th CPC) | Monthly Contribution | Annual Contribution | Pensioner Lifetime Card | Ward Entitlement |
|---|---|---|---|---|
| Level 1–5 (GP ₹1,800–₹2,800) | ₹250 | ₹3,000 | ₹30,000 | General Ward |
| Level 6 (GP ₹4,200) | ₹450 | ₹5,400 | ₹54,000 | Semi-Private Ward |
| Level 7–11 (GP ₹4,600–₹6,600) | ₹650 | ₹7,800 | ₹78,000 | Private Ward |
| Level 12+ (GP ₹7,600+) | ₹1,000 | ₹12,000 | ₹1,20,000 | Private Ward / Single Suite |
Pensioner Lifetime Card: Pensioners can pay a one-time lifetime contribution (10 years’ worth) for a lifetime CGHS card. This is mandatory within 6 months of retirement for those who wish to continue CGHS coverage. The lifetime card rate equals the monthly contribution × 120 months.
🗺️ CGHS vs CS(MA) Rules vs FMA — Which Applies to You?
| Scheme | Who It Covers | Cities / Areas | OPD Treatment | IPD Reimbursement | Monthly Amount |
|---|---|---|---|---|---|
| CGHS Central Govt Health Scheme |
Serving employees + pensioners in CGHS cities | 25 cities (Delhi, Mumbai, Chennai, Kolkata, Hyderabad, Bengaluru, Pune, Jaipur etc.) | Free OPD at Wellness Centres + empanelled hospitals | Cashless at empanelled hospitals (CGHS package rates) | ₹250–₹1,000 contribution |
| CS(MA) Rules Central Services Medical Attendance |
Serving employees only — NOT pensioners | Non-CGHS areas (all India except 25 CGHS cities) | Govt hospital OPD — bill reimbursed as per rules | Reimbursement from Govt/approved hospitals | No contribution deducted |
| FMA Fixed Medical Allowance |
Pensioners in non-CGHS areas ONLY | Areas not covered by CGHS | No free OPD — fixed ₹1,000/month paid as allowance | No reimbursement (use FMA for all expenses) | ₹1,000 received (not deducted) |
⚠️ FMA Enhancement Pending: The Parliamentary Standing Committee on Personnel (DRPSC) has recommended enhancing FMA from ₹1,000 to ₹3,000/month. DoP&PW has sought information on this — as of March 2026, the revision has NOT yet been officially notified. Current FMA remains ₹1,000/month.
💊 OPD Reimbursement — Key Rules
CGHS OPD
Free at Wellness Centres
OPD consultation, prescribed medicines, diagnostic tests are provided free of cost at CGHS Wellness Centres for all enrolled beneficiaries. No co-payment for OPD. Medicines are dispensed from the wellness centre’s pharmacy.
Private OPD
Limited Reimbursement
OPD treatment from private clinics/hospitals is generally not reimbursable under CGHS for routine cases. Only specialist consultations at empanelled hospitals with a referral from CGHS Medical Officer are reimbursable at CGHS rates.
Emergency
Any Hospital — Claim Later
In a genuine medical emergency, treatment can be obtained from any hospital (empanelled or not). Submit Medical Reimbursement Claim (MRC) within 6 months. Reimbursement limited to CGHS package rates — not actual private hospital bill.
Medicines
Generic Preferred
CGHS dispenses generic medicines from the NLEM (National List of Essential Medicines). Branded medicines may be dispensed if generic is unavailable. Pensioners can collect medicines for 3 months at a time from Wellness Centres.
Specialist
Referral Required
For specialist consultation at empanelled hospitals, a referral from the CGHS Medical Officer at the Wellness Centre is required (except emergencies). Without referral, private specialist charges are not reimbursed.
NABH Rates
Non-NABH = Lower Reimbursement
Reimbursement from non-NABH hospitals is at a lower rate — typically 10–15% less than the CGHS package rate for NABH-accredited hospitals. Always prefer empanelled NABH hospitals for maximum reimbursement.
📋 Medical Reimbursement Claim — Step by Step
1
Get Treated — Keep All Bills
Obtain treatment at a CGHS-empanelled or Govt hospital. In emergencies, any hospital is allowed. Collect all original bills, prescriptions, discharge summary, diagnostic reports, and payment receipts.
2
Fill Medical Reimbursement Claim (MRC) Form
Download the MRC form from the official CGHS portal. Fill details: patient name, CGHS card number, hospital name, diagnosis, treatment dates, and total bill amount. Attach all original documents.
3
Submit to DDO / CGHS Office Within 6 Months
Serving employees submit to their DDO (Drawing & Disbursing Officer) who forwards to PAO. Pensioners submit directly to the CMO/Additional Director of their registered CGHS Wellness Centre. Deadline: 6 months from discharge date.
4
Reimbursement Limited to CGHS Package Rates
The government reimburses as per the CGHS Package Rate — not the actual private hospital bill. If the hospital charges ₹1.5 lakh for a procedure but CGHS rate is ₹1.0 lakh, you receive only ₹1.0 lakh. NABH rates are higher than non-NABH.
Reimbursement = min(Actual Bill, CGHS Package Rate for the procedure)
5
Credit to Bank Account
After approval by CGHS office, the reimbursement is transferred directly to the employee/pensioner’s bank account (linked to CGHS card). Processing time: typically 30–60 working days for approved claims.
👴 Special Rules for Pensioners — CGHS & FMA
| Scenario | Medical Benefit | Amount / Limit | Tax Treatment |
|---|---|---|---|
| Pensioner in CGHS city (CGHS card) | Full CGHS benefits — OPD, IPD, medicines, diagnostics | Lifetime card or yearly contribution | Benefit is tax-free |
| Pensioner in non-CGHS area (FMA) | Fixed Medical Allowance — ₹1,000/month | ₹12,000/year — fully tax-free | 100% Tax-Free — Section 10(14) |
| Pensioner with CGHS card in non-CGHS area | IPD reimbursement from Govt/approved hospitals | Limited to CGHS rates of nearest CGHS city | Reimbursement tax-free |
| Family pensioner (spouse) | Same CGHS benefits as pensioner | Under same CGHS card | Tax-free |
| Pensioner in CGHS city — opts for FMA instead | NOT allowed — must take CGHS if in CGHS city | Not applicable | — |
🧭 How to Use the Medical Allowance Calculator Correctly
Start by selecting whether you are a serving employee or pensioner, because the contribution and benefit route can differ. Then choose CGHS or non-CGHS coverage based on the arrangement that actually applies to you. The calculator is designed to organise the inputs and estimate the value of medical support; it is not a substitute for a sanction order, CGHS package rate, reimbursement approval, or the medical rules applied by your department.
Your pay level matters because contribution and ward entitlement are linked to the applicable pay category. If you are unsure about your current level or cell, confirm it with the Pay Matrix Calculator. If your pay recently changed after promotion or MACP, first verify the revised basic pay through the Promotion Pay Fixation Calculator or MACP Increment Calculator. This prevents a medical-benefit estimate from being based on an outdated pay level.
✅Best practice: Use the calculator to prepare an estimate, then match your category, contribution and ward entitlement against the latest department/CGHS order before relying on the result for a claim or retirement decision.
👔 Serving Employees: Salary and Medical Deduction Check
For a serving employee, medical coverage is only one line in the monthly salary structure. When checking the real cost of CGHS contribution, compare it with your gross and in-hand salary rather than with basic pay alone. The Salary Break-up Calculator can help separate basic pay, DA, HRA and other earnings, while the Gross vs Net Salary Calculator helps show the effect of deductions on take-home pay.
Dearness Allowance can materially change salary even though the medical contribution itself may be a fixed slab. Use the DA Calculator to keep your pay assumptions consistent. If your HRA changes because of transfer or accommodation status, the HRA X/Y/Z Cities Calculator can help you recalculate monthly cash flow. This is useful when you are comparing the effective cost of medical coverage with other recurring payroll deductions.
Employees covered by NPS should also remember that retirement deductions affect in-hand salary. The NPS Calculator and NPS Impact Calculator can be used alongside this page so that medical contribution, pension deduction and salary are evaluated together.
👴 Pensioners and Family Pensioners: What to Verify Before Choosing FMA or CGHS
For pensioners, the key question is not simply which option produces the larger number in an estimate. The practical choice depends on residence, access to a covered city or wellness centre, the medical facility available under the applicable rules, and whether Fixed Medical Allowance is permitted in the situation. Confirm your pension category, place of residence and the option recorded with the pension-disbursing authority before treating FMA or CGHS as interchangeable.
If you are planning retirement, use the Pension Calculator 7th CPC to estimate pension first and the Retirement Benefits Calculator to review the broader settlement. The Gratuity Calculator and Leave Encashment Calculator can then complete the picture. Medical contribution or FMA should be assessed as part of this retirement cash-flow plan rather than as a stand-alone benefit.
Family pensioners should also verify whose entitlement is being continued, whether a new card or contribution arrangement is required, and whether dependants listed in the calculator remain eligible under the applicable rules. The calculator can count beneficiaries for planning, but eligibility of a particular family member depends on the governing conditions and supporting records.
📋 Reimbursement Claim Verification Checklist
Before submitting a reimbursement claim, collect the prescription, consultation record, diagnostic reports, original bills, payment receipts, discharge summary for hospitalisation, and any referral or emergency documentation required by your office. Check that names, dates, hospital details and amounts are consistent across documents. A technically valid expense can still be delayed if the claim form and supporting documents do not match.
Next, distinguish the amount billed by the hospital from the amount that may be admissible under the applicable package or reimbursement rules. The calculator can record the claim amount you enter, but it does not determine whether every item is sanctionable. Non-admissible consumables, room-category differences, non-empanelled treatment conditions, referral requirements and emergency exceptions can change the final reimbursement.
Keep a copy of the complete claim set and note the submission date. If the office asks for clarification, respond against the same claim reference instead of submitting a second independent claim. For annual financial planning, compare any unreimbursed medical cost with your estimated taxable income through the Income Tax Calculator for Government Employees. This keeps medical out-of-pocket expenses, salary deductions and taxes in one practical budget.
🏥 CGHS, FMA and CS(MA): A Practical Decision Framework
CGHS
Use when CGHS coverage applies
Confirm your city/coverage, contribution slab, beneficiary list and ward entitlement. Use CGHS facilities and reimbursement procedures applicable to your category.
FMA
Use only when FMA conditions are met
FMA is a fixed allowance route for eligible pensioners in the relevant circumstances. Do not assume it can always be drawn together with full CGHS OPD benefits.
CS(MA)
Serving employee medical reimbursement
Where CS(MA) Rules apply, keep referrals, prescriptions and original bills. Reimbursement depends on admissibility rules, not on the amount entered in the calculator alone.
Retirement
Plan medical costs with pension
Review recurring medical contribution, expected pension and retirement corpus together. Use the Retirement Corpus Calculator for long-term planning.
🔗 Related PayBandCalc Tools
For current employees, the most useful companion tools are the Pay Matrix Calculator, Annual Increment Calculator, DA Calculator and Salary Break-up Calculator. They help keep the pay inputs on this medical calculator consistent with your actual salary.
For pension and retirement planning, use the Pension Calculator, Revised Pension Calculator, Family Pension Calculator, Gratuity Calculator, Leave Encashment Calculator and Retirement Benefits Calculator. These provide a clearer view of how medical costs fit into overall post-retirement income.
👨👩👧 Dependant Coverage: What to Check Before Counting Family Members
The dependants field is useful for estimating the scale of family medical coverage, but the number entered should reflect people who are actually eligible under the applicable medical rules. Do not automatically include every person living in the household. Check the relationship category, dependency conditions, age or marital-status conditions where relevant, and whether the person is already covered through another government medical arrangement.
When a family situation changes—marriage, birth of a child, a dependant becoming financially independent, death of a beneficiary, or a change in residence—update the official record as well as your planning estimate. A calculator cannot update the beneficiary database or validate documentary eligibility. Keep identity, relationship and dependency documents current so that a medical claim is not delayed because the beneficiary was missing or incorrectly recorded.
🚚 Transfer, Change of City and Change of Medical Coverage
A transfer can alter the practical way you access medical benefits even when your service remains continuous. If you move from one city to another, verify whether your new place of posting is covered by CGHS, whether your existing card remains usable without modification, and whether your department requires any transfer or mapping action. Do not rely on the city count shown in a general guide to determine your personal entitlement.
If your transfer changes HRA or salary structure at the same time, update those pay assumptions separately using the HRA City Class Calculator and Salary Break-up Calculator. This is useful because medical contribution, housing allowance and transport-related salary changes can occur together after relocation, and the combined effect determines your actual in-hand pay.
🏁 Moving from Service to Retirement: Medical Benefit Transition
Employees approaching retirement should verify their medical option before the final month of service instead of assuming the serving-employee arrangement will automatically continue unchanged. Review the pension papers, medical-card procedure, contribution option, place of settlement, dependant records and any lifetime-card payment requirement that applies to your case. Keep copies of the retirement order, pension payment documents and medical contribution receipt with the medical records.
At the same time, estimate your retirement income with the Pension Calculator and your total settlement with the Retirement Benefits Calculator. If you expect a large one-time settlement, the Gratuity Calculator and Leave Encashment Calculator help separate recurring monthly income from one-time retirement receipts. Medical contribution should be budgeted against the recurring pension, not against temporary retirement cash.
⚠️ Common Reasons a Medical Estimate Differs from the Final Reimbursement
The most common difference is that the hospital bill and the admissible reimbursement are not always identical. Package limits, room entitlement, referral requirements, emergency certification, empanelment status and exclusions can reduce the payable amount. Another common problem is incomplete documentation: missing prescriptions, unsigned bills, unclear payment proof, inconsistent patient names or dates, and absence of a discharge summary can all slow processing.
A second source of mismatch is using the wrong category in the calculator. For example, selecting a pay level that does not match the employee’s current record can produce the wrong contribution or ward estimate. Verify the current cell using the Pay Matrix Browser when needed. If a promotion or MACP took effect recently, check whether the revised pay has actually been entered in the service record and salary bill before changing the medical category used for planning.
Finally, avoid treating the calculator’s estimated insurance-equivalent or OPD value as an amount you are automatically entitled to receive in cash. Those figures are planning values used to illustrate the economic value of coverage. Actual cash reimbursement depends on admissible expenditure and the rules governing the claim.
📅 Build an Annual Medical Budget Around Your Government Benefits
A practical medical budget has three layers: regular contribution or FMA, predictable out-of-pocket spending, and a contingency reserve for expenses that may not be fully reimbursed. Start with the fixed monthly amount shown by the calculator, multiply it for the year, then add expected dental, optical, medicine, travel-to-hospital and non-admissible costs that your family commonly incurs. Keep the contingency amount separate from ordinary monthly spending.
For working employees, compare this reserve with your annual increment and DA changes using the Annual Increment Calculator and DA Rate History & Calculator. For pensioners, compare medical outgo with pension and retirement corpus using the Revised Pension Calculator and Retirement Corpus Calculator. This approach makes the medical calculator part of a broader cash-flow plan instead of a one-time benefit estimate.
Keep estimates conservative: Do not count uncertain reimbursement as guaranteed income. Budget first for the amount you may need to pay, then treat approved reimbursement as recovery of that expense.
FAQ
Frequently Asked Questions
CGHS card, FMA, reimbursement limits, pensioner rules and dependent eligibility
Who is eligible for CGHS and in which cities is it available?▾
CGHS is available to Central Government employees drawing salary from central civil estimates (not Railways/Armed Forces who have separate schemes), and Central Government pensioners (except Railways and Armed Forces pensioners). The scheme is currently operational in 25 cities: Delhi (including NCR), Mumbai, Chennai, Kolkata, Hyderabad, Bengaluru, Pune, Ahmedabad, Jaipur, Lucknow, Kanpur, Patna, Bhopal, Nagpur, Allahabad, Bhubaneswar, Chandigarh, Jabalpur, Ranchi, Guwahati, Agartala, Jammu, Shillong, Shimla, and Dehradun. Eligibility is based on residence, not office location.
What is Fixed Medical Allowance (FMA) and who gets it?▾
Fixed Medical Allowance (FMA) is a monthly allowance of ₹1,000 per month (₹12,000/year) paid to Central Government pensioners who reside in areas not covered by CGHS. It is intended to partially meet their OPD medical expenses since they cannot access CGHS Wellness Centres. FMA is completely tax-free under Section 10(14). Important: FMA is ONLY for pensioners in non-CGHS areas — serving employees in non-CGHS areas are covered under CS(MA) Rules, not FMA. A pensioner who moves to a CGHS city and gets a CGHS card must stop claiming FMA. The DRPSC has recommended increasing FMA to ₹3,000/month but as of March 2026, this has not been officially notified.
Can I get reimbursement from a private hospital that is not empanelled with CGHS?▾
Yes, but only in genuine medical emergencies. For emergency hospitalisation at a non-empanelled private hospital, you can submit a Medical Reimbursement Claim (MRC) afterwards. However, the reimbursement will be restricted to the CGHS package rate for that procedure — not the actual private hospital bill, which is typically much higher. In non-emergency cases, treatment at non-empanelled hospitals without prior approval from the CMO is not reimbursable. For elective (non-emergency) treatment, always obtain a referral from your CGHS Medical Officer and go to an empanelled hospital to ensure full reimbursement at applicable rates.
Who counts as a dependent for CGHS coverage?▾
For CGHS coverage, the following family members are considered dependents: Spouse (always), unmarried sons up to age 25, dependent unmarried/widowed/divorced daughters (no age limit), disabled sons (any age, irrespective of income), minor brothers, dependent widowed/divorced sisters, and parents or parents-in-law (for female employees). For parents and others (except spouse and disabled son), the dependency condition applies: their income from all sources must be less than ₹9,000 + DA per month and they must normally reside with the government employee. All dependents must be listed on the CGHS card.
How do I get a CGHS card after retirement (pensioner lifetime card)?▾
After retirement, a Central Government pensioner residing in a CGHS city can obtain a CGHS pensioner card within 6 months of retirement to continue coverage. You must pay a one-time lifetime contribution (10 years × monthly contribution rate): ₹30,000 for Level 1–5, ₹54,000 for Level 6, ₹78,000 for Level 7–11, and ₹1,20,000 for Level 12+. Alternatively, yearly contributions can be paid. Apply at the CGHS Additional Director’s office in your city with pension payment order (PPO), last pay slip, service book extract, Aadhaar, and passport photos. The lifetime card is valid until the pensioner’s death (and then used by spouse under family pension).
Is CGHS contribution taxable? What about medical reimbursements?▾
The CGHS contribution deducted from salary is not a tax-exempt deduction by itself — it is simply a payroll deduction like any other. However, the benefits received (OPD medicines, hospitalisation reimbursements) are fully tax-free as they are perquisites in the nature of medical facilities. Fixed Medical Allowance (FMA) of ₹1,000/month is 100% tax-exempt under Section 10(14). Medical reimbursements received under CGHS or CS(MA) Rules are also tax-free — they are not treated as income. Under the new tax regime (2026), the standard deduction includes ₹50,000, which partially compensates for medical-related expenses.
What are the CGHS rates revised in 2026?▾
The Ministry of Health & Family Welfare issued revised CGHS package rates in early 2026 (OM notification dated January/February 2026). The revised rates are for semi-private ward entitlement and are available at the official CGHS portal. Key changes in 2026 rates: (a) package rates for cardiology, orthopaedics, oncology procedures revised upward; (b) cashless treatment extended to more empanelled hospitals for pensioners; (c) NABH-accredited hospitals get higher package rates than non-NABH. Actual reimbursement at your ward entitlement level may differ — private ward beneficiaries (Level 7+) get the full private room rate, while General Ward beneficiaries are limited to general ward package rates.
Official Resources:
the official CGHS portal (CGHS portal, wellness centre list, package rates, empanelled hospitals) |
the official pensioners portal (FMA, pensioner CGHS rules) |
the Ministry of Health portal (MoHFW circulars and revised rate notifications).