PMJAY vs CGHS — Understanding the Differences
India has two major government health schemes that people often confuse — PM-JAY (Ayushman Bharat) and CGHS (Central Government Health Scheme). While both provide healthcare benefits, they serve completely different populations, have different eligibility criteria, and work very differently.
This guide explains the key differences so you can understand which scheme covers you and what benefits you are entitled to.
What Is PMJAY?
The Pradhan Mantri Jan Arogya Yojana (PM-JAY), popularly known as Ayushman Bharat, is a health insurance scheme for economically weaker families identified through the SECC 2011 database. It covers approximately 55 crore Indians across 12 crore families with up to ₹5 lakh per family per year for hospitalisation at empanelled hospitals.
What Is CGHS?
The Central Government Health Scheme (CGHS) provides comprehensive healthcare to current and retired central government employees and their dependents. It covers OPD consultations, medicines, diagnostics, and hospitalisation at CGHS dispensaries, government hospitals, and empanelled private hospitals.
Key Differences
Eligibility: PM-JAY covers BPL and economically weaker families based on SECC criteria. CGHS covers central government employees (serving and retired) and pensioners — regardless of income level.
Coverage Amount: PM-JAY provides ₹5 lakh per family per year. CGHS has no upper cap on coverage — it covers the full cost of treatment as per approved rates, with no maximum limit.
OPD Coverage: PM-JAY does NOT cover OPD (outpatient) consultations — it only covers hospitalisation. CGHS covers both OPD and IPD (inpatient) treatment, including regular doctor visits, medicines, and diagnostic tests without hospitalisation.
Hospital Network: PM-JAY empanelled hospitals and CGHS empanelled hospitals are different networks. Some hospitals are empanelled under both schemes. On PMJAYHospitals.com, you will see hospitals marked as “PMJAY”, “Only CGHS”, or “PMJAY and CGHS” indicating their empanelment status.
Card and Access: PM-JAY uses an ABHA-based e-card with biometric authentication. CGHS uses a CGHS card issued by the Ministry of Health with a unique beneficiary ID.
Referral System: CGHS requires referral from a CGHS dispensary or government doctor for most specialist consultations and hospitalisations. PM-JAY does not require any referral — you can go directly to any empanelled hospital.
Geographical Coverage: PM-JAY is portable across India — you can use it at any empanelled hospital in any state. CGHS is city-based — coverage is available only in cities where CGHS has dispensaries and empanelled hospitals (currently about 72 cities).
Can You Have Both?
Typically, no. If any family member is a central government employee, the family is excluded from PM-JAY eligibility. However, in some cases where a retired government employee’s pension is very low, the family may still appear in the SECC database and could technically be eligible for PM-JAY. In practice, such families are better served by CGHS which has no coverage cap.
Which Hospitals Accept Which Scheme?
When searching for hospitals on PMJAYHospitals.com, each hospital’s empanelment badge tells you which scheme it accepts. Always verify with the hospital directly before visiting.
Disclaimer: PMJAYHospitals.com is an independent directory and is not affiliated with the National Health Authority or any government body. For official information, visit pmjay.gov.in or call 14555.