The Ministry of Health has relaxed age and marital status criteria for dependent sons and brothers suffering from critical/terminal illnesses under Central Government Health Scheme (CGHS) and (Central Services (Medical Attendance) Rules)- CS(MA) Rules, 1944.
Under the new rule, CGHS/medical attendance facilities will be extended for life to dependent sons and brothers who are suffering from critical/terminal illnesses.
The Ministry also said that marriage will not be a ground for the cessation of CGHS facilities to a dependent son or brother covered under these provisions.
However, their coverage will be subject to the fulfilment of the prescribed dependency conditions and assessment by the competent Medical Board, the Ministry of Health said in an office memorandum dated September 1, 2026.
Under the previous guidelines, an unmarried dependent son was eligible for CGHS facilities up to the age of 25 years, while a permanently disabled unmarried son was also eligible for CGHS facilities for life.
Similarly, a dependent brother was eligible up to the age of 18 years, while a disabled dependent brother was covered without any age limit.
Likewise, dependent daughters and sisters are also eligible for CGHS facilities, while divorced/abandoned/separated from husband/widowed daughters and sisters are also eligible for CGHS facilities.
Diseases for which dependent sons and brothers with critical illnesses will be covered
The Health Ministry said the revised provisions are intended to cover chronic, severe, critical or terminal illnesses resulting in substantial and continuing functional impairment or inability to earn a livelihood/self-sufficiency.
These illnesses can include advanced or life-threatening malignancies, severe neurological disorders, end-stage organ diseases requiring long-term treatment/support, severe congenital or genetic disorders, and other chronic multi-system or debilitating conditions of comparable severity, as per the OM.
Who will be eligible to get CGHS treatment under the revised rules?
Explaining the eligibility criteria, the Ministry of Health said that eligibility will be determined on a case-to-case basis, taking into account the chronic/severe/critical or terminal nature of the disease, extent of functional impairment in day-to-day life, ability of the dependent to earn a livelihood or attain self-sufficiency and continuing dependency.
In cases where the patient involves multi-system diseases or complex medical conditions, a concerned specialist will assess the clinical condition and functional impairment.
Who will assess the eligibility for medical treatment of CGHS dependents?
In the case of CGHS beneficiaries, eligibility shall be assessed and recommended by decentralised Medical Boards that will be constituted at the additional directors/CGHS regional headquarters level, as applicable.
An appellate medical board will be constituted at CGHS headquarters for the consideration of appeals/references against the recommendations of the decentralised medical boards.
In the case of beneficiaries covered under the Central Services (Medical Attendance) Rules), 1944, eligibility will be assessed and recommended by the Directorate General of Health Services (DGHS).
Will CGHS facilities be extended to married dependents as per revised rules?
The Ministry clarifies that marriage will not be a ground for the cessation of CGHS facilities to a dependent son or brother covered under these provisions, whether on account of critical/terminal illness or permanent disability.
However, in such a case, dependency conditions should be satisfied, and the competent medical board/authority should recommend the continuation of coverage.
Will relaxation be extended to family members of such CGHS beneficiaries?
The order says that the relaxation of the marital-status condition will not result in any expansion of the definition of ‘family’.
The benefit will remain confined to the eligible dependent son or brother and won’t extend to their spouse or children, says the order.
Review of medical criteria is must
The Ministry of Health clarifies that the medical criteria and disease profile for such cases will be treated as a living framework and will be periodically reviewed by the designated CGHS Board in consultation with appropriate medical specialists.
