Timely treatment and reimbursement of claims under CGHS

 Timely treatment and reimbursement of claims under CGHS 

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
DEPARTMENT OF HEALTH AND FAMILY WELFARE
LOK SABHA

UNSTARRED QUESTION NO. 1081
TO BE ANSWERED ON 24TH JULY, 2026

1081. SHRI DAGGUMALLA PRASADA RAO:
      Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) the number of hospitals empanelled under the Central Government Health Scheme, State-wise and district-wise for Andhra Pradesh;

(b) the number of treatment requests received and approved in the country since its inception, year-wise, State-wise and district-wise for Andhra Pradesh;

(c) the number of claims submitted and compensation released, State-wise and district-wise for Andhra Pradesh;

(d) the number of hospitals submitting reimbursement claims, State-wise and district-wise for Andhra Pradesh, along with the number of claims reimbursed;

(e) whether delays have been observed in claim processing, approval or reimbursement;

(f) if so, the average time taken, the number of delayed claims, reasons for delay and corrective measures undertaken by the Government in this regard, State-wise; and

(g) whether there is a monitoring and grievance redressal mechanism established by the Government to ensure timely treatment and reimbursement, if so, the details thereof?

ANSWER

THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

(SHRI PRATAP RAO JADHAV)

(a) to (g)

The number of Health Care Organizations (HCOs) empaneled under various Offices of Additional Director, Central Government Health Scheme (CGHS) across the country is attached at Annexure-1.

Further, the District wise details of empaneled HCOs in Andhra-Pradesh are at Annexure-2.

Reimbursement of medical claims in case of serving beneficiaries are done through respective administrative departments/Ministries. The reimbursement of medical claims in case of pensioner beneficiaries are done by CGHS. Details of expenditure made under Pensioner and Other Retirement Benefits (PORB) head in last five years by CGHS is at Annexure-3.

Beneficiaries can track the status of their Medical Reimbursement Claims online through the CGHS web portal as well as the MyCGHS 2.0 Mobile App using the Claim ID generated at the time of submission of the claim.

CGHS has created dedicated digital dashboards within the CGHS HMIS module to track Medical Reimbursement Claim (MRC) cases and grievances among others. Access to these dashboards is given to all Additional Directors, CMO I/c at Wellness Centers, and other stakeholders to monitor overall progress, total claims, and average processing days, etc.

Further, CGHS has the following mechanism to lodge a grievance:

• CGHS Grievance Portal
• CPGRAMS
• Toll-Free Helpline & Email: For direct assistance, beneficiaries can call the toll-free number or write to the helpdesk at cghs-helpdesk@lsmgr.nic.in
• Local Committees and Complaint Boxes: Physical Complaint boxes are available at Wellness Centers, and issues can also be raised during regular meetings of Local Advisory Committees (LAC) and Zonal Advisory Committees (ZAC).

ANNEXURE-1

NUMBER OF HOSPITALS EMPANELLED UNDER OFFICES OF ADDITIONAL DIRECTORS, CGHS ACROSS THE COUNTRY

S. No.	Office of Additional Director, CGHS	No. of empaneled HCOs
1.	Ahmedabad	47
2.	Bangalore	60
3.	Bhopal	84
4.	Bhubaneswar	12
5.	Chandigarh	171
6.	Chennai	65
7.	Dehradun	43
8.	Delhi NCR	924
9.	Guwahati	18
10.	Hyderabad	128
11.	Jabalpur	57
12.	Jaipur	151
13.	Kanpur	72
14.	Kolkata	57
15.	Lucknow	86
16.	Meerut	60
17.	Mumbai	102
18.	Nagpur	101
19.	Patna	51
20.	Prayagraj	92
21.	Pune	49
22.	Ranchi	31
23.	Shillong	08
24.	Trivandrum	37

ANNEXURE-2

District wise details of empaneled HCOs in Andhra-Pradesh

Districts in Andhra Pradesh	No. of empaneled HCOS
East Godavari	03
Guntur	03
Krishna	02
NTR	11
Sri Potti Sriramulu Nellore	05
Tirupati	02
Vishakhapatnam	20
Total	46

ANNEXURE-3

DETAILS OF EXPENDITURE MADE UNDER PENSIONER AND OTHER RETIREMENT BENEFITS (PORB) HEAD IN LAST FIVE YEARS BY CGHS

Year	PORB Expenditure (In Crore)
2021-22	2741.17
2022-23	4630.68
2023-24	4282.72
2024-25	5645.97
2025-26	6144.17

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