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CGHS Option & Undertaking Form | Ministry of Health & Family Welfare

CGHS Option & Undertaking Form – Download PDF | Ministry of Health & Family Welfare

CGHS OPTION & UNDERTAKING FORM

One-Time Option to Switch from CS(MA) Rules, 1944 to CGHS | Ministry of Health & Family Welfare, OM dated 17.09.2026

Reference OM Z.16025/227/2026/CGHS-III/EHS

OM Date 17th September 2026

Purpose One-Time Option for CGHS

Applicable To Serving Central Govt Employees

Switch From

CS(MA) Rules, 1944

To CGHS

Geographical Limit

Removed

No 5 km radius restriction

Nature of Option

One-Time

Final and binding

Part I – Employee Details

Name of the Employee

Designation & Pay Level

Ministry / Department / Office

Present Residential Address

District & State of Residence

I hereby exercise my one-time option to switch from coverage under the CS(MA) Rules, 1944 to the Central Government Health Scheme (CGHS) without geographical limitation, in terms of Ministry of Health & Family Welfare OM No. Z.16025/227/2026/CGHS-III/EHS(8421134) dated 17-09-2026.

Part II – Undertaking

No Dual Benefits

Neither I nor any member of my eligible family shall simultaneously claim or avail medical facilities/reimbursements under the CS(MA) Rules, 1944 once enrolled under CGHS.

Authorization for Deduction

I authorize my Head of Office / DDO to deduct the prescribed monthly CGHS subscription from my pay and allowances on a continuous basis.

No TA/DA

I understand that no TA/DA shall be admissible for traveling to avail treatment/medicines under CGHS.

Liability for False Information

I am aware that furnishing false/misleading information or claiming dual benefits shall render me liable for recovery and disciplinary action under the applicable Conduct Rules.

Signature & Countersignature

Date

Place

Signature of the Employee

Countersigned by Head of Office / DDO (With Seal & Stamp)

Important Points to Note

One-Time Option: The option to switch from CS(MA) Rules, 1944 to CGHS is a one-time exercise and is final and binding.
No Geographical Limit: The 5 km radius restriction from a CGHS Wellness Centre has been removed for serving Central Government employees.
Applies to All Dependents: The option exercised by the principal beneficiary applies to all dependents; entitlement cannot be split between the two systems.
Continuous Subscription: CGHS subscription must be paid irrespective of place of residence or posting.
No Dual Benefits: Cannot avail both CGHS and CS(MA) simultaneously.
No TA/DA: No travel allowance or daily allowance for availing CGHS treatment or medicines.
Undertaking Required: Employee must furnish this undertaking against dual benefits.
Disciplinary Action: False information or dual claims will attract disciplinary action under CCS (Conduct) Rules, 1964, and recovery.
Reference OM: Ministry of Health & Family Welfare OM No. Z.16025/227/2026/CGHS-III/EHS(8421134) dated 17-09-2026.

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Official Form

Download Option & Undertaking Form

Get the official CGHS Option & Undertaking Form (PDF) to exercise your one-time option and submit it to your Head of Office / DDO.

DOWNLOAD FORM (PDF)

Reference: OM No. Z.16025/227/2026/CGHS-III/EHS(8421134) dated 17-09-2026

Frequently Asked Questions

How do I download the CGHS Option & Undertaking Form?

Click the prominent "DOWNLOAD FORM (PDF)" button at the top of this page to download the official CGHS Option & Undertaking Form directly in PDF format.

What is this form about?

This form is for serving Central Government employees who wish to exercise their one-time option to switch from coverage under the CS(MA) Rules, 1944 to the Central Government Health Scheme (CGHS) without geographical limitation.

Who can use this form?

Serving Central Government employees who are residing outside the prescribed CGHS area and presently availing facility under CS(MA) Rules, 1944 solely on account of their residence/posting outside the geographical coverage of CGHS.

What is the reference OM for this form?

The form is based on Ministry of Health & Family Welfare OM No. Z.16025/227/2026/CGHS-III/EHS(8421134) dated 17-09-2026.

Is the option to switch to CGHS available multiple times?

No. The option is a one-time exercise and once exercised, shall be final and binding, subject to the applicable eligibility criterion.

Does the option apply to family members/dependents?

Yes. The option exercised by the principal beneficiary shall apply to all dependents. The entitlement shall not be split between the two systems within the family.

Can an employee avail both CGHS and CS(MA) benefits?

No. An employee/family covered under CGHS shall not simultaneously avail or claim medical facilities under CS(MA), and vice versa.

Is TA/DA admissible for availing CGHS treatment?

No. No TA/DA shall be applicable on account of availing treatment and procurement of medicine under CGHS Rules.

Who countersigns the form?

The form must be signed by the employee and countersigned by the Head of Office / DDO with seal and stamp.

What happens if false information is furnished?

Any employee/beneficiary furnishing false, incorrect, suppressed or misleading information shall be liable for disciplinary action under CCS (Conduct) Rules, 1964, in addition to recovery of any inadmissible benefit.