PM-JAY, CGHS and ESIC empanelment for a private clinic What each scheme empanels, the bed and accreditation rules, and what a small OPD can realistically apply for.

A single-doctor or small multi-doctor OPD clinic usually cannot be empanelled under PM-JAY or CGHS. PM-JAY covers hospital care and asks for inpatient beds; CGHS empanels hospitals and named types of centres, with bed, chair or volume thresholds and accreditation. The route open to a general practitioner is ESIC's Insurance Medical Practitioner scheme, where ESIC invites applications for areas it does not serve with its own dispensaries. A dental clinic with enough chairs can also look at CGHS. The details for each scheme follow.

Can a private clinic be empanelled under PM-JAY?

Not as an OPD. The National Health Authority's Guidelines on Hospital Empanelment and De-Empanelment (Version 3.0, November 2021) describe PM-JAY as covering "secondary and tertiary care costs of up to Rs. 5,00,000 annually for each entitled family", delivered through public and empanelled private hospitals. Section 7.1 sets the minimum criteria for a network private hospital, approved by the State Health Agency:

• "Should have at least 10 inpatient beds with adequate spacing and supporting staff as per norms." Exemption "may be given for dental and day-care procedure hospitals like Eye, ENT, and Standalone Dialysis Centres".
• Adequate and qualified medical and nursing staff physically in charge round the clock.
• Fully equipped for medical and surgical services commensurate with the specialties and beds, with a surgeon and anaesthetist available round the clock or on call where surgery or day care is offered.

In aspirational districts listed by NITI Aayog the guidelines relax the bed minimum to 5 inpatient beds, "unless providing day-care packages covered under PM-JAY", with at least one MBBS doctor. States may relax other criteria but not the minimums in Annexure 1. NHA's site lists a later version of the guidelines dated December 2022, which we could not open, so check the current version with your State Health Agency before planning around these numbers.

Can a clinic get CGHS empanelment?

CGHS empanels private healthcare organisations by category. CGHS issued fresh empanelment terms in Office Memorandum F.No.5-34/CGHS/HEC(HQ)/2025 dated 22 Dec 2025. We could not open the OM itself; NABH's notification NABH/CGHS/2026/00271 of 12 Jan 2026 summarises its eligibility criteria in Annexure-I, and the table below is from that summary.

There is no category for a general consultation clinic. A dental practice with enough chairs is the small-clinic case that fits. The older CGHS Empanelment Scheme 2017 application form also listed hospitals, exclusive eye centres, exclusive dental clinics, cancer units, diagnostic laboratories and imaging centres, and took the bed count from the registration certificate issued by the state government, local body, NABH or fire authority. Our post on NABH entry-level accreditation for small clinics explains that certification.

How can a private clinic work with ESIC?

ESIC is the one scheme that engages private practitioners for primary care. Its Standard Note on the Employees' State Insurance Scheme as on 01.01.2025 says that in newly implemented or existing areas where ESIC has no infrastructure of its own, primary care is delivered through empanelment of Insurance Medical Practitioners (IMPs) or Employer Utilisation Dispensaries. On IMPs it says:

Private Medical Practitioners are appointed as panel doctors. A panel doctor is expected to have his own consulting room and dispensary. Each panel doctor is allowed to register up to 2000 IP family units. The IMPs under the panel system are paid capitation fee (Rs.500/- per IP per year) w.e.f. 8th September, 2016 for providing medical care to the ESI beneficiaries which include consultation, basic lab investigation and cost of medicine.

The same note says ESIC revised and launched a Modified IMP Scheme at its 174th meeting on 29 May 2018, and lists IMPs, modified IMPs and modified Employer Utilisation Dispensaries as the arrangements for primary care in partially and non-implemented areas, with tie-ups with public or private hospitals and PM-JAY for secondary care. ESIC's online form for the modified IMP scheme lets an applicant choose one role (IMP, empanelled chemist or empanelled diagnostic centre) and a state, district and area, says an applicant may apply for one service category only, and refers to tenders published by area or district.

So the practical step is to watch the ESIC regional office tenders for your district, and check whether your area has an ESI dispensary already. A capitation fee per insured person per year is a different business from consultation fees: work out what the number of families you could register would pay against the consultations, basic tests and medicines the arrangement expects.

What can a small OPD realistically apply for?

Patients with private health insurance or employer cover are a separate matter. They usually pay at the counter and claim OPD expenses back from the insurer, and what they need from you is a clean bill; see our post on the OPD bill for health insurance reimbursement.