Welfare scheme cannot hide behind circulars — CGHS reimbursement upheld
Issue -
May - 2026, Posted On: 01 May 2026
Two retired government employees, both senior citizens and lifelong subscribers to the Central Government Health Scheme (CGHS), sought reimbursement of medical expenses incurred for serious cardiac and related ailments. Having paid the requisite subscription and foregone fixed medical allowance at retirement, they were entitled to OPD and IPD benefits under the scheme.
Their reimbursement claims for medicines and diagnostic tests were rejected on the ground that OPD medicines purchased from the open market were not reimbursable under various Office Memoranda and circulars governing CGHS procedures.