Big Relief for Employees and Pensioners, Govt Announces Major Benefit Update

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Great news has arrived for central government employees and pensioners! The Ministry of Health and Family Welfare (MoHFW) has raised the maximum limit for medical reimbursements. Department heads can now approve medical claims up to Rs 10 lakh without needing to consult the Integrated Finance Division (IFD). This is an increase from the previous limit of Rs 5 lakh. This announcement was made via an Office Memorandum (OM) dated February 16, 2026.

What are the specifics?

The ministry has introduced another significant change. In situations where no relaxations are provided and the full payment adheres to the prescribed CGHS rates, the settlement limit has been raised from Rs 2 lakh to Rs 5 lakh. This means that if the claim fully complies with the Ministry of Health and Family Welfare (CGHS) rates, it will now be simpler to process larger payments. This change is anticipated to ease the burden on employees by reducing long wait times and delays in filing claims.

However, two specific conditions have been established for the new Rs 10 lakh limit. Firstly, there will be no relaxations in CGHS or CS(MA) rules for claims. Secondly, the reimbursement amount will strictly follow the CGHS/CS(MA) prescribed rates. The implication is clear: if the hospital bill exceeds the prescribed rate and a relaxation of the rules is necessary, the issue will still need to be escalated. The Ministry has also referenced its previous order from November 23, 2016, which raised the limit for cases without rule relaxations from Rs 2 lakh to Rs 5 lakh.

Where is the application made?

The CGHS medical claim process has also been simplified. Pensioners must apply to the CMO of their wellness center within six months of treatment or discharge. They must also submit the medical reimbursement claim form, a checklist, a copy of the discharge summary, a referral/permission slip, an emergency certificate (if applicable), original hospital bills and receipts, a copy of a valid CGHS card, and a canceled check or mandate form for bank details. Complete and accurate documentation expedites the process.

Ambulance expenses are also reimbursable, but with one condition. Ambulance expenses within the city will only be covered if the treating doctor provides a certificate stating that transporting the patient by any other means would have endangered their life or worsened their condition. Overall, this government decision will expedite the approval of medical claims and provide relief to employees and pensioners even in cases involving large sums of money.

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