Question 1

What is GHICO TPA? What does GHICO mean?

Accepted Answer

GHICO stands for Government Health Insurance Company. It is a TPA (Third Party Administrator) that primarily manages health insurance claims for government employees, pensioners, and their dependents under CGHS (Central Government Health Scheme) and state government health schemes. Some PSU (Public Sector Undertaking) employees may also be covered if their employer has empanelled GHICO as TPA for their group health insurance policy.

Question 2

What is the GHICO TPA helpline number?

Accepted Answer

GHICO / CGHS helpline: 1800-180-1111 (toll free). Email: cghs@gov.in. The helpline handles pre-authorisation queries, claim status checks, and general CGHS-related queries. For urgent hospitalisation, call the helpline before or immediately after admission. Your CGHS Wellness Centre can also assist with pre-auth for planned procedures.

Question 3

How do I download my GHICO eCard?

Accepted Answer

To download your GHICO / CGHS eCard: (1) Log in to the CGHS member portal using credentials issued by your ministry or department; (2) Go to 'My Card' or 'Health Card' section and download the PDF; (3) Alternatively, visit your nearest CGHS Wellness Centre with your employee ID to get a physical card issued or updated. The CGHS card shows your beneficiary ID, covered family members, and the Wellness Centre you are registered with.

Question 4

How do I check my GHICO claim status?

Accepted Answer

Check GHICO claim status by: (1) logging into the CGHS portal with your beneficiary credentials; (2) calling the CGHS helpline 1800-180-1111 with your claim reference number; (3) contacting your DDO (Drawing & Disbursing Officer) at your office - they track reimbursement claims submitted through official channels. For PSU employees on GHICO, check with your HR team who can query the GHICO portal directly.

Question 5

What documents are needed for GHICO reimbursement? Where do I get the claim form?

Accepted Answer

For GHICO / CGHS reimbursement, you need: (1) CGHS Reimbursement Claim Form - available from your DDO or the CGHS portal; (2) Discharge certificate (original); (3) Itemised hospital bills with receipt and hospital seal; (4) Investigation reports (lab, radiology); (5) Pharmacy bills with doctor's prescription; (6) Referral letter from CGHS Wellness Centre (if treatment was at a private hospital). Submit through your DDO within 3 months of discharge. Settlement typically takes 30-45 working days.

Question 6

How do I get pre-authorisation for planned surgery through GHICO?

Accepted Answer

Pre-authorisation for planned surgery under GHICO / CGHS: (1) First get a referral from your registered CGHS Wellness Centre doctor; (2) The Wellness Centre doctor refers you to a specialist at a CGHS empanelled hospital; (3) Submit the specialist's treatment advice and estimated cost to GHICO at least 5-7 working days before planned admission; (4) GHICO reviews and issues pre-authorisation within 48 hours of receiving complete documents. For emergencies, the hospital contacts GHICO directly for immediate authorisation.

Question 7

Is GHICO only for government employees?

Accepted Answer

GHICO primarily serves central and state government employees, pensioners, and their dependents under CGHS and state government health schemes. However, some PSU (Public Sector Undertaking) employees may also be covered if their employer has empanelled GHICO as TPA for their group health insurance policy. Private sector companies generally use other TPAs like Medi Assist, FHPL, or Vidal Health.

Question 8

How does the CGHS tie-in work with GHICO?

Accepted Answer

GHICO operates as the claims processing and administration arm for CGHS-empanelled hospitals. When a government employee presents their CGHS card at a GHICO-managed hospital, GHICO verifies eligibility, authorises treatment, and settles bills directly with the hospital - eliminating out-of-pocket payment for the employee. The insurer reimburses GHICO, and GHICO settles with the hospital.

Question 9

How are reimbursements processed for non-CGHS empanelled hospitals?

Accepted Answer

If treatment is taken at a non-empanelled hospital (in emergencies or where CGHS hospitals are unavailable), submit all original documents to your office's DDO (Drawing & Disbursing Officer) within 3 months of discharge. The DDO forwards the claim to GHICO, which processes it at CGHS package rates. Settlement typically takes 30-45 working days. Non-emergency treatment at non-empanelled hospitals without prior CGHS referral may result in reduced reimbursement.

Question 10

What is the CGHS package rate and how does it affect my reimbursement?

Accepted Answer

CGHS package rates are fixed rates defined by the Ministry of Health for specific procedures and treatments at empanelled hospitals. If you seek treatment at a non-empanelled hospital, reimbursement is limited to CGHS rates even if the actual hospital bill is higher. For example, if a procedure costs Rs.50,000 at a private hospital but the CGHS rate is Rs.35,000, you will only be reimbursed Rs.35,000. Always verify CGHS empanelment status before choosing a hospital for planned treatment.

Question 11

What happens in a medical emergency at a non-empanelled hospital?

Accepted Answer

In genuine medical emergencies where a CGHS empanelled hospital was not accessible, reimbursement can be claimed at a non-empanelled hospital. You must submit documentary proof that it was an emergency and that no CGHS hospital was available within a reasonable distance. Reimbursement will still be at CGHS package rates. Inform your DDO as soon as possible after the emergency admission.

Question 12

Can family members use the CGHS / GHICO facility?

Accepted Answer

Yes. CGHS coverage extends to dependent family members including spouse, dependent children, and dependent parents. Each family member is listed on the CGHS card. For treatment, dependent family members must present the primary beneficiary's CGHS card along with a valid relationship document (Aadhaar, marriage certificate). Coverage terms for dependents are the same as for the primary government employee beneficiary.

Hospital Name	Location	Type	Services Available
AIIMS Delhi	Ansari Nagar, Delhi	Government	24x7
Safdarjung Hospital	Safdarjung, Delhi	Government	24x7
Ram Manohar Lohia Hospital	Connaught Place, Delhi	Government	Business Hours
Lady Hardinge Medical College	Shaheed Bhagat Singh Marg, Delhi	Government	Business Hours
Lok Nayak Hospital	Delhi Gate, Delhi	Government	24x7
Guru Teg Bahadur Hospital	Dilshad Garden, Delhi	Government	24x7
Dr. Baba Saheb Ambedkar Hospital	Rohini, Delhi	Government	24x7
Bhagwan Mahavir Hospital	Pitampura, Delhi	Government	Business Hours
Deen Dayal Upadhyay Hospital	Hari Nagar, Delhi	Government	24x7
Chacha Nehru Bal Chikitsalaya	Geeta Colony, Delhi	Pediatric Government	24x7
Sanjay Gandhi Memorial Hospital	Mangolpuri, Delhi	Government	Business Hours
Maharishi Valmiki Hospital	Pooth Khurd, Delhi	Government	24x7
ESIC Hospital	Okhla, Delhi	Government	Business Hours
Railway Hospital	New Delhi Railway Station	Government	24x7
Hindu Rao Hospital	Civil Lines, Delhi	Government	24x7
Rajiv Gandhi Super Speciality Hospital	Tahirpur, Delhi	Government	24x7
LNJP Hospital	Delhi Gate, Delhi	Government	24x7
Northern Railway Central Hospital	Basant Lane, Delhi	Government	Business Hours
Central Government Health Scheme	Various Wellness Centres, Delhi	Government	Business Hours
Rajiv Gandhi Cancer Institute	Rohini, Delhi	Cancer Specialty	24x7

Region	Empanelled Hospitals	Pre-Auth	Hospital Type
Delhi NCR	200+	Yes	Govt + CGHS empanelled
Mumbai	120+	Yes	Govt + CGHS empanelled
Bengaluru	90+	Yes	Govt + CGHS empanelled
Chennai	85+	Yes	Govt + CGHS empanelled
Hyderabad	80+	Yes	Govt + CGHS empanelled
Kolkata	70+	Yes	Govt + CGHS empanelled
Pune	55+	Yes	Govt + CGHS empanelled
Other CGHS Cities	Varies	Wellness Centre referral	CGHS Wellness Centres

GHICO TPA - CGHS Claims, eCard, Hospital List & Helpline Guide

About GHICO TPA

Key Services

CGHS Claim Process - Cashless & Reimbursement

Cashless (Empanelled Hospital)

Get CGHS Referral

Pre-Auth from GHICO

Present CGHS Card

Direct Settlement

Reimbursement (Non-Empanelled Hospital)

Emergency Treatment

Collect All Originals

Submit via DDO

GHICO Processes

Contact Information

Turnaround Times

CGHS Empanelled Hospitals - Delhi NCR

CGHS Empanelled Hospitals by City

Mumbai

Bengaluru

Hyderabad

Chennai

Kolkata

Pune

CGHS Network Coverage Summary

Document Checklist

Cashless Claim Documents

Reimbursement Claim Documents

GHICO TPA & CGHS - Frequently Asked Questions

Need Group Health Insurance for Your Organisation?