Delightfully simple, the ‘Medical 2004 Form for Reimbursement of Medical Claims of CGHS beneficieries’ is a breeze to fill-in and the submission process is extraordinarily simple. NOT.
If your near and dear is a CGHS beneficiary and received emergency in-patient treatment at a CGHS ‘non-recognised’ hospital, you are generally advised by well-wishers to buy yourself a pair of good quality sport shoes. The number of times you have to visit the offices of CGHS to seek clarification is astounding.
If your near and dear gets hit by a medical malady and requires emergency treatment, if admitting to a CGHS recognized hospital, beware that you can only admit the patient to the hospital that is recognized for that specialty. For ex: if Hospital A is recognized for nephro disorders, Hospital B for gynae disorders and Hospital C is a branch of Hospital A, for nephro emergency, you must admit the patient to Hospital A only. Admission to Hospital B & C can render your claim invalid.
In case of emergency hospitalization to a ‘CGHS non-recognized hospital’, you are generally advised to continue the treatment till the emergency subsides and you can either transfer the patient to a CGHS recognised hospital (with prior approval) or discharge the patient and bring him/her home. A ‘CGHS non-recognized’ hospital is simply a corporate hospital that charges way more than what CGHS is willing to reimburse. You may claim reimbursement and receive it on CGHS discretion only. No obligations on CGHS’s part.
Post transfer/discharge, you must obtain the ‘Medical 2004 Form for Reimbursement’ from the CGHS dispensary that your patient is attached to. Photocopies or downloaded versions from the Internet are not valid. The Medical 2004 Form requires (*=undocumented):
You will generally be provided with photocopy of the BHTs by the hospital. Be sure to get the BHTs attested by the Doctor in-charge of treatment. Also, hospitals take a lot of time to process BHT generation request and charge quite a bit for the photocopies. So, request early and visit the hospital with a load of cash on the day of collection.
* In case, you are unable to submit the reimbursement claim within the stipulated 90 days, write a letter to the Additional Director, CGHS of your city; explaining reasons for the delay obtain written permission to submit the claim within a new deadline. You must include this permission letter as an annexe in your claim-form.
When you have compiled the file with the above mentioned annexes, (*) make 2 + photocopies of the entire file. You are required to submit the original file and 1 photocopy to the CGHS Headquarters of your city and keep at-least 1 copy for your reference. CGHS will provide you a reference number on your copy. Your future communication with CGHS must include this reference number. Submission is required within 90 days from date of discharge and is accepted at the HQ only at specific dates. For ex: at CGHS HQ Kolkata; submission is accepted only on Mondays and Thursdays between 9.30a and 1.30p.
Best of luck with your claim, hope this document helped.
Download:
182 Responses
Manoj
30|Jan|2008 1It did help.. However, I have submitted a claim for my father’s treatment (with all supporting documents) in August 2006!!
I have yet to receive any response / reimbursement from CGHS (in New Delhi). Are you aware of any email id of any responsible higher official, where I can lodge a complaint (and save my sports shoes)
Rgds
Manoj
Rajib
31|Jan|2008 2To the best of my knowledge, CGHS is required to process the entire claim within a period of 90 days. In your case, almost 18 months have passed. I suggest that you write a ‘Registered Letter’ to the inquiring about the progress of the file. If no response is received or ambiguous response is received, you can use the ‘Right To Information’ act to your advantage.
Contact details of CGHS officials are available on the Min. of Health (CGHS) website (http://mohfw.nic.in/cghs.htm) and the CGHS Head Office where you submitted your claim.
In most cases, writing a letter to ‘Additional Director, CGHS, Your City’ would suffice.
Do keep me updated with any information that you feel I ought to include in the site.
TIA
deputy suptdg archl chemist chennai
22|Feb|2008 3list of area comes under cghs should be added to check the eligibility of employee
KUPPACHI RAVI
11|Mar|2008 4SIR,
I HAVE APPLIED FOR MEDICAL REIMBURSEMENT OF MY WIFE’S SPINAL OPERATION. IN THIS CONNECTION KINDLY GIVE DETAILS OF TAMILNADU GOVT. APPROVED RATES FOR DISECTOMY.
Rajib
15|Mar|2008 5Approved rates for CGHS Chennai are available at: http://mohfw.nic.in/cghs.htm
Direct link: http://mohfw.nic.in/CGHS%20RATES,CHENNAI..xls
Please note that:
1. Rates are revised all the time using internal circulars and the website is hopelessly outdated.
2. A quick search within the rates file for ‘Disectomy’ didn’t turn up any results. You will have to look carefully to determine the exact name of the procedure. In case, the rate for the procedure is not mentioned, CGHS is obliged to refund you fully, since the rates are only intended to be published where a cap is applied. i.e. rates only exist for procedures where CGHS applies a limit for refund.
HTH
Mrs Harjit
16|Mar|2008 6Sir,
My husband was suffering from cancer of larynx. he got his treatment from PGI chandigarh. Later reccurence was detected at the time of strike in PGI and we with proper permission took him to Rajiv Gandhi Cancer institute Delhi, where he recieved further treatment. When we claimed for reimbursment the amount was less than what we had paid to the hospital bills. The reason given was that we were not charged the CGHS rates by hospital authorities even though we had given the letter of reference from CGHS. Can we claim the dues from the hospital or CGHS. My husband was a class I officer from MES
Rajib
16|Mar|2008 7Dear Mrs. Harjit,
My best wishes for your husband’s full and speedy recovery.
w.r.t. CGHS rates, currently there is a controversy regarding CGHS treatment being ‘cashless’ like private medical insurance.
The only hospitals that charge on par/below CGHS approved rates are the Central Govt. & State Govt. Hospitals. Most private hospitals that are recognised by CGHS charge more than the CGHS applied rate.
During refund, CGHS re-imburses only upto the limit they have specified. The rest have to be borne by the patient. In US, this system is called Co-Pay where the insurance company pays only upto a ceiling limit per procedure or a percentage of the cost of the treatment. This system is likely to be implemented in India by the private medical insurers too.
CGHS has been revising it’s rates annually. Most of the times the rates are not keeping in sync with the actual market conditions. Hospitals in Hyderabad-Secunderabad launched a court case against CGHS demanding fair revision of rates. As a result, not even a single Pvt. hospital in th twin cities is now recognised under CGHS.
Admissions to these hospitals can be taken under emergency. During refund, CGHS will use ceiling limits they have prescribed. Also, ‘Certificate of Emergency’ is required also with ‘Essentiality Certificate’ for expensive procedures and medicines.
Hope this helps.
Amit
27|Mar|2008 8I really appreciate your efforts for helping people who are struggling for there reimbursement from CGHS .
Kindly also help me …
Unfortunately my father is detected with Prostrate cancer Stage4, We came to know about this on 8th March when he complained that he has swear pain in his back we went to Rajiv Gandhi cancer hospital (Rohini – New Delhi ) which is near to our house , they did a Bone scan and detected that my father has prostrate cancer . We stayed there for Ten days where we also went under minor surgery of his testicles .
Rajiv Gandhi staff told us that if we do not go under surgery we can use the benefits of the CGHS , the moment we go for surgery from Rajiv Gandhi they will not give any benefits from CGHS to us and they will charge full money from us , as we did not had any option we blindly followed what they said and payed them all the amount in cash .
Can you pls tell me
1) Can I reimburse this money from CGHS if yes then
2) Where should I go
3) What forms and formalities I need to do ….
Thanks a Lot for the Help !!!!!
Amit
27|Mar|2008 9Continued ….
My father is 69 years old pensioner retired from govt Job and is a CGHS member
Rajib Ghosh
27|Mar|2008 10Dear Amit,
Step 1 would be to find out if Rajiv Gandhi Cancer Hospital under CGHS Recognized Hospital. You can contact the CMO of the CGHS dispensary that your father visits to find this out.
If the hospital is recognized under CGHS, typically you are required to obtain permission at-least 24 hours in advance of any medical procedures. Permission is not required in case the procedure was performed under emergency. However, you are then required to inform the CGHS dispensary of the treatment that your father is undergoing.
To inform CGHS, you need to write a simple letter addressed to the CMO; informing him of the medical condition and treatment in progress. Include photo-copies of all documents such as admission certificate, doctor’s prescription, medical bills, bed-heat tickets etc. The photo-copies must be attested by the doctor in-charge of treatment and manager of the hospital.
In case, the treatment happened in a non-CGHS-recognized hospital, you need to obtain an ‘Emergency Certificate’ stating that the admission and subsequent treatment was on an emergency basis and required to save the life of the patient.
The actual process of claim is similar whether the patient received treatment in CGHS recognized hospital or not. The difference lies in the fact that in case of recognized hospital, the claim file is generally honored. In case of non-recognized hospital, the claim file maybe honored only if emergency can be proven. In non-emergency cases, reimbursement is limited to CGHS discretion and will depend on how you petition the officials in the cover-letter of your claim form.
I wish you best of luck with your claim and my best wishes to your father for a speedy recovery.
vishal sharma
05|May|2008 11sir,
i want to know whether the grandparents are covered under the list of cghs benefeciares dependent list. Is there any order or rule about that.
kindly tell me.
Prabu
13|May|2008 12Hi, My mother in law is diagnosed for a liver disease and advised to go for a liver transplantation.
She is a family pensioner, (father in law was working in telecom)
1. Whether CGHS facility is available for liver transplantation treatment?
2. She is not having CGHS card, is it possible to apply for now and avail the sheme?
3. Please let me know the CGHS card application process and how to get it, how long it will take to get the card
Thanks in advance
Regards
Prabu
Rajib Ghosh
14|May|2008 13Hi Prabhu,
Step 1, please verify that employees of the telecom department are eligible for CGHS Membership. If your father had a CGHS card, then your mother is eligible as a pensioner.
Typical CGHS Membership documentation requires:
1. Proof of eligibility – Husband’s pension record, clearly mentioning your mother as dependent.
2. Identity Proof (Photo ID) – Voter ID / Passport / PAN Card / Ration Card with family Photo
3. Address Proof – Telephone (BSNL) / Water / Electricity Bill
Forms are generally available on all days, but accepted and returned only on specific days. Enquire with the CGHS HQ of your town/city. Please note that patient must be present at CGHS HQ during form submission.
CGHS Membership Fee can be paid either in monthly installments or one-time for life.
CGHS Membership can take upwards of a week. Don’t expect a quick turn-around.
While CGHS doesn’t deny any specific treatment to any patient, specifics like Liver Transplant etc. need prior approval. The process of prior approval is documented elsewhere in this blog.
HTH
C.B. Sharma
27|Jun|2008 14Hello!
Can someone tell me if there is a upper limit for reimbursement of claim?My father has been running for his reimbursement for the last one year but every time he is given a new reason for non-disposal of the case.
The most recent argument is that the maximum payment for a treatment is 25,000. He had hip-replacent and the cost was approx. 70,000.
By the way, he is a freedom fighter.
I shall be grateful for inform,ation on this.
CB
Rajib Ghosh
29|Jun|2008 15Hello,
According to latest CGHS rates, “Partial Hip Replacement” is reimbursed to a max of Rs. 14000/- and “Total Hip Replacement” is reimbursed up-to Rs. 45000/-.
These rates are applicable for A-1 Cities and Semi Private Ward. Rates for other category cities will be lower. Rates for General Ward will be lower. Rates for private ward will be higher.
Reimbursement also covers hospitalisation and treatment expenses. So in case your father had Partial Hip Replacement, 25K could be a approx amount that you will receive.
Latest Rates at: http://mohfw.nic.in/CGSH%20Approved%20rates%20for%20%20A%201%20%20class%20cities.xls
DR. VIJAY CHAUDHARY
05|Jul|2008 16Hello,
I’m a retired Himachal Pradesh Govt. employee. I got my wife treatedat Ganga Ram Hospital, New Delhi for total hip raplacement . The total expense on treatment is 2lac. H.P. Govt. employees are entitled to get reimbursement at CGHS rates. can u kindly help me to know the maximum amount which I can get reimbursed.
Rajib Ghosh
07|Jul|2008 17Dear Dr. Chaudhary,
If your wife’s treatment was performed with prior approval of CGHS, you will be eligible to receive maximum compensation as per CGHS norms.
CGHS applies a ceiling limit for all procedures, supplies and fees depending on the Class of the city where the treatment was performed.
Your Reimbursement Claim will be subject to scrutiny by auditors and the reimbursement granted as per approved rates.
In an earlier comment, you can find the link to the latest CGHS approved rates for Class A cities.
HTH
chellapandian
20|Jul|2008 18I have red all your suggessions ad ideas .it was very usefull to me
kindly guide me
I have taken reference chit from gynecologist for my wife’s pregnancy for the out of station treatment (chennai) . but for that is the temprory permit is must or only the permission letter from the office will do?
or otherwise should I take private hospital treatment with preir permission. kindly advise I in the I&B ministry dept.
Rajib Ghosh
20|Jul|2008 19Hello,
If you have received formal approval from CGHS to get your wife treated at a hospital out of your city, you only need to ensure that all respective departmental permissions are in place. A temporary permit is not required.
Temporary permit is required for CGHS Beneficiaries who move to a different city for at-least 6 months and intend to receive “regular” CGHS treatment. In your wife’s case, it’s an one-time exercise required to obtain “specialized” treatment.
Do inquire with CGHS officials and make sure that all paper-work required is in place before you leave for Chennai. Failure to do so and you could face having to pay for the entire treatment on your own and the specter of chasing CGHS later to recover your money.
HTH
Sameer Chawla
25|Jul|2008 20HI Rajib, Thanks for the help its is such a frustrating process. Pls help me with the following. My dad was with Ministry of finance and is a rettired pensioner now he was admitted thrice to Batra hospital on May 14th to May 21st , June 6th to June 25th and then June 27th to July 16th. He was earlier diagnosed with a Lymphoma in his brain and later a systemic Lymphoma with brain involvement , now I was out of India and my sister and bro in law admitted him to Batra (recognised for cancer)and therefore did not get him referred through CGHS, I have been trying to inform CGHS for the last 2 weeks but they were asking for emergency certificate, which the doctors are refusing to give.
Is there a way for me to submit the bills without the emergency certificate ? do i need to get approval from additional director ??
Pls advise,
Thanks,
Sameer
Rajib Ghosh
28|Jul|2008 21Dear Sameer,
CGHS generally allows admission for reimbursement of treatment done in non-recognised hospital only if admitted in emergency.
However, submission of the emergency certificate is not mandatory along with the CGHS form. You can always meet with the Addl. Director and plead your case so that at-least part reimbursement can be received.
Please realize that it is totally up-to CGHS to grant/refuse reimbursement for such treatment.
HTH
Giriraj Verma
28|Jul|2008 22What would be reimbursment for spectacle for the pay grade of Rs. 4000/- (appx.) and what would be reimbusement for hospitalisation accomodation charges.
b sharma
16|Aug|2008 23Dear Rajib
One of our employee got admitted in emergency. he informed the doctor and also asked for an advance, doctor recommended advance. he was granted advance. When the final bill came for reimbursement, the doctors who had recommended the advance said that it was a pre planned surgery. the doctor who had operated also said it was a preplanned surgery. We are governed by CGHS rules but are not covered by CGHS. The question has come to me for decision and i want to help the employee. How the rules of CGHS can be intrepreted liberally to help the employee. We are not a CGHS city and there are no CGHS recognized private hospital in the city. The treatment was taken in a private hospital
thanks for help
namas
27|Aug|2008 24Dear Rajib
Kudos to your efforts. It is much needed one for all govt. employees. I hope you will answer my queries too.
1) My wife is pregnant. We are expecting a C-section. How do i get her admitted in Private Hospital, as such there is no CGHS recognized hospitals are offering treatment for pregnancy in my city (Bangalore). Can i get admit her in private hospital and claim only CGHS rates. CGHS doctor said i should claim from my department. they have no role in that it seems. plz explian and help me.
Sanjeev
29|Aug|2008 25Dear Rajib Sir,
I am sending my query for your kind advice;
I am working in central government and residing in the area not covered by any CGHS dispensaries in terms of office memorandum issued by CGHS.My son was having some ENT problem (CSOM ossicular discontinuing). On doctor’s advice he admitted in a private hospital (recognized by CGHS) for ear surgery. The Hospital is empanelled for single super specialty (ENT with specialized surgeries) by the CGHS as per their O.M..
Now, I want to file a claim for reimbursement of medical expenses incurred in connection with medical attendance and of treatment of central govt. servant and their families. Kindly advice;-
1.Whether any prior permission was required from the Head of department for treatment in private hospital (recognized by CGHS).
2.If yes, is any provision for post facto approval/permission.
3.Whether, administrations can deny to sanction the claim.
4.Please advice, if there is any circular/instruction in the matter, kindly make reference.
5.whether a central government employees and his family can obtain medical service from any private hospital recognized by CGHS of his choice.
sanjay
Ashok Soni
28|Sep|2008 26Hi Rajib,
Well I was just trying to find out some info on CGHS, and finally dropped on this page, very useful information on this page.
Well I do have some questions, and if you can answer them, I will be really thankful to you..
Actually my mom is in government sector and we do have a CGHS card, two years back she got a minor heart attack and then we came to know that she got a problem of PSVT, which is somehow related to heart problems, you can say cardiology problem.
Currently she is having her treatment in a government hospital in New Delhi which is G.B. Pant hospital, but I am not satisfied with the efforts doctors are doing there and I seriously want to change the treatment to some private and specialist hospital just like Apollo or Escorts Heart Hospital…
Can you please guide me through it and can tell me are these both hospitals coming under CGHS scheme and specially cardiology department.?
Please reply soon… I am waiting…
Thanks..
Regards,
Ashok Soni
Rajib Ghosh
28|Sep|2008 27Dear Mr. Ashok Soni,
Thanks for your comments on my blog.
AFAIK, Delhi is one of the few cities which boasts of the largest number of hospitals covered under CGHS.
As far as getting a specialized cardiac procedure performed at a private hospital, step 1 would be go through the latest bulleting on CGHS Hospitals in New Delhi on the Min. of Health Website. You will find the link to the MOFW-CGHS website on the left side of my blog under ‘Blogroll’.
Once you have identified the private hospitals in Delhi which ‘admit cghs patients’ with cardiac issues, you need to get a prescription for the procedure from the Govt. hospital. Typically, the prescription mentions that Patient suffers from XYZ problem and requires ABC procedure within DEF time-frame.
Armed with this prescription, you need to approach the CGHS dispensary you patient is affiliated to and request the CMO to issue you a ‘In-Patient Reference Form’. Based on the content of your Govt. Hospital Prescription and eligibility of the private hospital you are seeking, the CMO will issue you the form.
Armed with the Reference Form, you can now approach the hospital for admission and treatment.
Please note:
1. CGHS cannot deny you an eligible private hospital or force you to a govt. hospital. Only the prescription must be obtained from a Govt. Hospital based on a ‘Out-Patient Reference Form’.
2. All CGHS advises are valid for 15 days. Any form, any prescription that you obtain, action must be taken within 15 days of obtaining the document.
3. Though the private hospitals will charge as per CGHS rates for procedure and the treatment is cashless, some costs (meals, telephone, upgraded rooms, nutrition supplements, private nurse) have to be paid to the hospital by patient party.
4. If admitting at hospital with CGHS approval, approach the ‘Medical Insurance/CGHS’ cell at the hospital first to ensure that your billing is cashless and ‘CGHS’ is stamped on the patient file.
5. If admitting under emergency, approach CGHS dispensary within 24 hours of admission and submit ‘Emergency Admission’ certificate from the hospital to obtain ‘In-Patient Reference Form’. Produce this form at the hospital to ensure cashless treatment from this point on. If you have already paid some amount, either ask the hospital to refund it or obtain detailed bill so that you can claim the cash from CGHS using ‘Medical 2004 Reimbursement Form’.
HTH
Ashok Soni
29|Sep|2008 28Thanks for a quick reply Rajib… So you meant to say that instead of direct visiting any CGHS enabled private hospital, we should first take a kind of reference form from the CGHS CMO from my area, so that it would be cashless and all that.. If directly approach a private hospital and show them my CGHS card, it won’t be possible?
Second thing is as you have told me that I need to show a kind of prescription card or form from a Government hospital and then show it to CMO and then on basis of that card, CMO will issue me a preference form, so that card should be in any specific form or it’s just a normal hospital card we are having treatment from that hospital… Or we really should ask our doctor to issue us a special prescription card?
Please guide me a little on it ..
Thanks,
Regards,
Ashok Soni
Rajib Ghosh
30|Sep|2008 29Dear Mr. Ashok Soni,
Private hospitals (even if recognized by CGHS) will not entertain cashless treatment requests unless you have a ‘Reference Form’ from your CGHS dispensary.
CGHS wil issue a Reference Form only if a Govt. Hospital Doctor recommends a specific course of treatment.
To get a prescription from a govt. hospital, you need an initial ‘Out Patient Reference Form’ from CGHS dispensary.
Please have a look at: http://www./2008/05/14/obtaining-treatment-under-cghs/
I will try to upload a flow-chart in this article to make it easier to understand.
Regards
jaya kad
09|Oct|2008 30mr rajib
pl clarify
my father was not aware of the CGHS facilities as he retired from his service about 30 yrs back. he had to undergo a bypass wherin we opted for a private hospital (a CGHS member) but did not show the cghs card as we were unaware about the facilities. later we came to know and now would like to file a reimbursement claim. please let us know the procedures . though we have prepared many document still would like to know all formalities whom to ask for pemission etc.
your blog as already helped me a lot but still need guidance.
Rajib Ghosh
09|Oct|2008 31Hello Jaya,
1. I am hoping that your father held an active CGHS subscription at the time of his bypass. If not, he is not eligible for any CGHS reimbursement.
Assuming his CGHS membership was valid at the time:
2. If his bypass had to be conducted in an emergency, you need to obtain and attach a ‘Certificate of Emergency Treatment’ to the CGHS claim form. This coupled with the fact that the treatment happened at a CGHS recognised hospital is sure be favourable to your claim.
3. If bypass was not in emergency and CGHS permission was not obtained, I am afraid that although your file may-be accepted for reimbursement but the claim maybe rejected.
4. Reimbursement if any; will be as per prevailing CGHS rates at the time. Since the hospital charged you their regular rates and not the greatly reduced CGHS rates, you will not get full reimbursement. 50-60% is more likely.
5. Since CGHS prior permission was not obtained, you need to obtain the medical reimbursement claim form from the CGHS dispensary but submit your claim form to the CGHS head office in your city.
Note: although the CGHS claim form is available for download from the Ministry website, it is not accepted for filing. You must obtain the form from the dispensary.
HTH
- Rajib
D.V.Subrahmanyam
17|Nov|2008 32Sir,
Pay commission has suggested for Health Insuirance optioninstead of CGHS. It has been sated by the revuew committee orders will be issued after examination. Any order has been issued. I have retired from service om 1-10-2008. How long I can use the existing card.
D.V.Subrahmaanyam
D.V.Subrahmanyam
18|Nov|2008 33Whether any health insurance shceme is under examination by Govt in view of sixth pay commission Report. How many months one can avail CGHS beneficiary after retirement before payment of life time membership
Y.P.Varmani
20|Nov|2008 34Please mail me copy of forms for:-
1) reibursement form,
2) essentiality certificate
L.M. BHATNAGAR
11|Dec|2008 35Having retired on 30-04-2007 from New Delhi I shifted residence to Indirapuram area of Ghaziabad (UP). Since there is no CGHS dispensary in nearby area I got my CGHS card made for Vivek Vihar (New Delhi) after paying Rs.18000/ as whole life subscription. Now I find it very inconvenient to go to either RML or GTB hospitals for day to day treatment in OPD. It is understood that CGHS dispensary of Ghaziabad normally refers to pvt hospitals of Ghaziabad which provide treatment to pensioners on cash free basis, directly billing to Govt. Now my querry is ” (a) If it is wise to change to GZB dispensary for better and less crowded facilites avalable at pvt hospitals. (b) What could be the pros and cons in worst scenario? (c) What is procedure for changing the disp.
Kindly help me for my predicament.
rohit
11|Dec|2008 36I am a govt employee. My father was expired 4 years back and now my mother who is getting pension of my father, need an eye operation. Wish to know whether it is possible that this money get reimburse from CGHS if yes then what is the procedure for that..
Please Help !!!!!
sanjay singh (sanjeev)
21|Dec|2008 37Dear Rajib ji Sir,
I am re sending my small query for your kind advice; and if you can answer , I will be really thankful to you.
Sir, I am working in a central government department and residing in the area not covered by any CGHS dispensaries .
My son was having some ENT problem (CSOM ossicular discontinuing). On doctor’s advice he admitted in a private hospital (recognized by CGHS) for ear surgery. The Hospital is empanelled for single super specialty (ENT with specialized surgeries) by the CGHS as per their O.M..
Sir I had filed a claim for medical reimbursement Rs.12000/-(including Rs.8500 indoor/operation charges+3500 for cost of medicines) as a normal procedure like claim of government hospital.
Now, the departmental authority is asking for a certificate of emergency. They are saying that one can get treatment from the recognized hospital only after prior permission from the head of department and this can be relax in the case of emergency only.
Because I have not get any certificate of emergency from the doctor and also not having prior permission from the HOD; in this situation Kindly advice;-
1. Whether, I can get reimbursement of my full claim?
2. Whether, administrations can deny sanctioning the claim of indoor/operation charges.
3. or they can reject the full claim
Thanks,
Regards,
Sanjay singh
sanjay singh (sanjeev)
21|Dec|2008 38Sir my really need your kind advice
Please
Tejpal Singhal
05|Jan|2009 39Sir,
My father is pensioner from NDRI, Karnal and at the time of retirement,he is opted the option of OPD Rs. 100/- PM. Now my father is suffering from Chronical Renal Failure from last month. When i goes to NDRI to change the option they refuse that this option is not changeable and also said your father only eligible reimbursement for In-Door-Bills.
1. Can I change the option ?
2. Can our bills are reimburse on that stage ?
3. Can i stop of my father pension because i m also Govt. Employee.
Kindly suggest the best option.
Kind regards
Tejpal Singhal
reimbursement
Tejpal Singhal
05|Jan|2009 40Sir,
My father is pensioner from NDRI, Karnal and at the time of retirement,he is opted the option of OPD Rs. 100/- PM. Now my father is suffering from Chronical Renal Failure from last month. When i goes to NDRI to change the option they refuse that this option is not changeable and also said your father only eligible reimbursement for In-Door-Bills.
1. Can I change the option ?
2. Can our bills are reimburse on that stage ?
3. Can i stop of my father pension because i m also Govt. Employee.
Kindly suggest the best option.
Kind regards
Tejpal Singhal
Vinod Gulati
05|Jan|2009 41Hi,
We need latest orders with regard to entitlement
for reimbursement of Hearing aid for pensioners.
Rgrds
Deepak
17|Feb|2009 42Hi,
i have joined DRDO recently. and my father father is working in govt services Delhi Jal Board and my mother is house wife i have two sister and one brother all of my sublings are not working and no source of income expect my father my father dont have CGHS facilities
can i add my family( mother, sister and brother as dependent) for CGHS card
please, provide the information and rule that can use ful to me as per CGHS
Rajib Ghosh
18|Feb|2009 43Dear Deepak,
1. I hope that your organization provides medical cover under CGHS.
2. As long as your father is working, you cannot add him as dependent.
3. As long as your father is working, you cannot claim that any of his other children are dependent on you.
3. As long as your father is alive, you cannot claim that your mother is dependent on you.
4. Brothers are covered only till they reach the age of 18.
5. Sisters are covered only till they reach 25 or get married or get employed (whichever is earlier).
6. Handicapped unmarried & unemployed brothers and sisters are covered for life.
7. Divorced unemployed sisters are covered for life.
Please cross-check this information with the CMO of your local dispensary or Admin officer at HQ.
Deepak
18|Feb|2009 44Thanks for update.
1. let me known can i add my brother is dependent on me or my sister .(one of my sister is divorced)
2. if my father is not availing any kind of medical facilities than can i add my mother, brother or sister,sister(divorced).
3. please, let me known the rule where is written or website URL or other . as per CGHS for more information.
Deepak
18|Feb|2009 45please, clear point no: 4,5 and 7 in my case.
kamlesh kumar
26|Feb|2009 46my wife was admitted in emergency at PARAS HOSPITAL, which is not in the panel of CGHS. how can i reimburse his medical expenditure bills etc.
can u please help me
Rajib Ghosh
27|Feb|2009 47Dear Kamlesh,
Admissions under emergency to Non-CGHS hospitals is admissible as per CGHS rules.
You will have to pay for the treatment and claim re-imbursement via the Medical 2004 claim form.
Please refer to the bullet-points in the article on the website regarding ‘CGHS Medical Claim Reimbursement’. It should help you understand the process and the documentation required.
kamlesh kumar
03|Mar|2009 48thanks u very much for the kind information
Krishna Sharma
23|Mar|2009 49Hi,
My mother is covered under CGHS, but she does not have a CGHS card. (my father was a central Govt employee and she is his widow and she receives his family pension)
Would I be able to claim an emergency treatment she had to undergo a month back?
Rajib Ghosh
25|Mar|2009 50Hi Krishna,
It is surprising that your mother is covered under CGHS since she doesn’t have a CGHS card.
Reimbursement of medical bills is only allowed for active CGHS members.
Regards
Naveen Singhal
29|Mar|2009 51Dear Rajib
Exceptional work my friend. This is trully social service work. All the best in future endeavours.
Rajib Ghosh
30|Mar|2009 52Dear Naveen,
Thank you for your kind words.
I hope that net-savvy individuals like you will contribute to this site with whatever relevant information you can so that others can benefit and save their precious time and money.
Regards
Anju
01|Apr|2009 53Hi Rajib
The CMO at our dispensary insist for original discharge summary, original permission letter! even though in the medical reimbursement claim from it is explicitly mentioned “copy”. To my understanding copy either means a photocopy, or an attested duplicate. when i presented the photocopy with the claim , my claim was not accepted. since permission letter was for 3 months of treatment covering 9 admissions it was anyway not possible to submit “one original” with every claim!! i requested her to attest the photocopies , she refused. i showed her the medical reimbursement claim form requiring copies ,she did not budge. instead she insisted i should submit all my claims together for three months and attach the original on the top! i replied -that way my substantial money will be held up and hinder the future treatment. i would like to submit each claim independently and at the earliest but she wanted ” ORIGINAL” then i pointed out when the permission letter is addressed to The Medical superintendent of the hospital idealy original permission letter should be handed over to the hospital. how can CGHS demand it!? her disciple smacked “i like smart people but i dont like pple who dont listen!”… dealing with such pple is actually a daunting task!! whats ur opinion ?
Rajib Ghosh
02|Apr|2009 54Hi Anju,
To the best of my knowledge, CGHS only requires the bills to be submitted in original. All other documents can be submitted as attested copies (attestation to be performed by Doctor-in-charge) of treatment at hospital.
If the CMO refuses to listed to logic, perhaps you should approach CGHS HQ and ask them to clarify in writing. IF HQ does not oblige immediately, tell them that you can also approach them for this information under RTI.
Armed with official information, you should be able to conter the CMOs lack of knowledge.
HTH
Vipin yadav
04|May|2009 55hi rajib,
I am cghs card holder. I met with road accident and was a admitted to a non cghs recognised hospital and same hospital got recognised when i was being treated and was in ICU. hospital on request of my attendents discharged and readmitted me on paper to its cghs recognised name and referred to itself as “outside” hospital. Hospital insists that i present my case as ” readmission after my own request for discharge” in my cover later for cghs claim. Truth is there was no discharge from hospital and i was just transferred on paper from non recognised hospital to cghs recognised hospital. Hospital doesnot want to change its stand and wants me to confirm its stand in cover letter. What should i do, shall i write truth or stand by hospital .. whats best for me as well as hospital
Dr.S.V.Ramakrishna
07|May|2009 56Dear Mr. Yadav,
Hospital empanelled under CGHS is oblized to extend credit facility to CGHS beneficaries admitted under emergency on production of valid CGHS card. You may submit a seperate claim for the expenditure incurred for treatment undertaken prior to CGHS empanelment and ask hospital to give seperate bills , documents for that period. If the hopsital does not provide credit facility for the treatment after empanelment , contact Addl. Director of CGHS of your city.
Regards,
Dr.Ramakrishna
Gurpreet Singh
16|May|2009 57My grand parents are dependent on me. Does CGHS recognises grand parents as dependents. If yes under what rule.
Deepak Jain
05|Jun|2009 58Hi Sir,
My Grandpa was operated and thus submitted his claim to CGHS in March 2009. Luckily, the claim was processed on 2-April’09 with the admisible amt shown in their website. It is almost 2 months now. No bill number is allocated in the CGHS website yet. Neither we receive the reimbursement of the claim. Can you please suggest the name, address / email to whom we can write to redress this. Please help
Thanks & Regards
Deepak Jain
Deepak Jain
05|Jun|2009 59Shall I wuite to Add. Director, Rajender Nagar, Shankar Road, ND-60?
Regards
Deepak Jain
Deepak Jain
05|Jun|2009 60Shall I write to Add. Director, Rajender Nagar, Shankar Road, ND-60? We put up in Vivek Vihar (East Zone), HQ is for East Zone is Laxmi Nagar.
Rajib Ghosh
07|Jun|2009 61If you have been lucky enough to have your bill processed, please find which office is supposed to issue you your payment. Is it going to be your local dispensary or the Headoffice? Write to the officer (Addl. Dir.) requesting status report.
shiv
12|Jun|2009 62Dear Sir,
I am working in central govt. and CGHS beneficiary. Two months back I fell from my vehicle and got injured on my right knee. I went for checkup in CGHS dispensary, they referred me to go to Ortho specialists in any CGHS recognized hospital. Accordingly, I went for checkup in one of CGHS recognized hospital. They advised me to go for ACL reconstruction as I got complete acl tear on my right knee. I was also informed that though they are recognized by CGHS, they do not have CGHS code for this particular operation and quoted their rates. (54,000 for semi private). When my approached my office, they said since it is not coded one, they can not give me permission to go for this operation and insisted me to go to CGHS to obtain their approval. CGHS authorities telling me that this is upto your office, CGHS has no role in that.
Can any experts help me to get out of this problem? Also, if any member of this forum have gone for this operation, may let me know abt the cost and formalities.
Thanking you in advance.
regards
Rajib Ghosh
12|Jun|2009 63Hi Deepak,
I am not aware of Delhi’s CGHS Zoning. I suggest you contact your Dispensary and ask them under which Addl. Director’s office does their Dispensary come. You need to communicate with the specific office.
HTH
Rajib Ghosh
12|Jun|2009 64Hi Shiv,
It is sad that you are being bounced between a Private Hospital, CGHS Office & Your Office; when what you need is urgent medical care.
I suggest you:
- Visit the CGHS Dispensary and obtain ‘Out Patient Referral Form’ to visit a Doctor at a Govt. Hospital.
- Present all your records to the Doctor at the Govt. Hospital and request a treatment recommendation and associate prescription. The Govt. Doctor may require further diagnosis, since Doctor’s in India don’t trust each other.
- Once you have a prescription from a Govt. Hospital that states that you need ‘ACL Reconstruction’, you should approach your department to request for treatment at a CGHS Recognised hospital for the prescription. Even if there is not specific CGHS code, your office has to approve the prescription and forward your case to CGHS (the prescription is from a Govt. Doctor)
- Approach the Addl. Director’s office at CGHS and present your case asking for guidance and prior approval for medical treatment not specifically coded. Also, carry with you the estimates for your surgery from as many CGHS Recognized hospitals as you can.
Once you receive prior-approval, you should be able to admit yourself to a CGHS Recognized Hospital and obtain treatment of your choice.
CGHS may reject your treatment request on the following grounds:
- Treatment is cosmetic in nature. For this, please make sure that the Govt. Doctor’s prescription clearly mentions that this treatment is not cosmetic and is required to prevent you from becoming a handicapped person.
- Cost of treatment for area of body is out of limits. In this case, request for maximum reimbursement and be prepared to shell out the balance amount from your pocket.
In principle, CGHS cannot reject a treatment request simply because its not mentioned in their code-book. Patients quality of life comes first.
HTH
shiv
15|Jun|2009 65Dear Rajib Ji,
Thankkkkkkkkkkkkkkkkkkkkk uuuuuuuuuu very much for your valuable guidance. I will follow your suggestions.
JAVED
16|Jun|2009 66dear rajab Sir,
My query comes under a very rarest of rear case. My father retired on 31 Dec 07, On 18 Feb 08 (1.5 month from retirement)he suddenly had a attack of brain-hammarage and underwent treatment for one week, unfortunately he expired on 25 Feb 08 (approx 02 month from retirement). Now during all this the CGHS pensioner card could not be made and advises from various peoples was 3 month grace period exist & any treatment during this period will be covered by the old card (however this was wrong & actually 3 month grace period is for getting the card issued cghsmumbai.gov.in/htmldocs/circulars/cir23.htm) The rule was misunderstood by everybody but the competent authority who eventual rejected my reimbursement application
Now my case is
1) Unknowingly by me, DGQA (my fathers office) & CAO forwarded the case to CGHS Bikanar house on 25 Mar 08, 23 Apr 08 and 24 Apr 08 respectively
2) Bikanar house without telling us the correct procedure pulled their hand from the case & said the pl go the south zone dispensary vide letter dated 02 Jun 08 (more then a month wasted)
3) On 09 Jun 08 South zone dispensary sector-8 R K Puram was referred the case which took 03 months to give a regret letter (printed format) that no card was made with in 03 month of retirement.
4) On request they again took my file back for further consideration & again consumed 07 months to reply the same.(meanwhile I was suggested to get a pensioner card issued on my mothers name which I did & further send a healthy amount)
Pl suggest me a way out since 15 months has passed & no output has been obtained.
Regards
meghana
17|Jun|2009 67Sir,
My father is a pensioner for last 25 years and last two years bed ridden. He was working with post office. We have card of post office dispensery in Pune. We have admit him urgently for cough,fever and partial paralysis ( one side ) for diagnosis in a hospital which is not in CGHS list. He has to undergo various diagnostic tests and CT SCAN,MRI , BRONCHOSCOPY ,X-RAYS etc. He was in the hospital for 5 days.
Please guide me wheather we can claim for the expenses.
Rajib Ghosh
18|Jun|2009 68Dear Meghna,
CGHS will not reimburse you a penny if you do not follow their guidelines for obtaining treatments.
1. You need to obtain a prescription that recommends various diagnostic tests be conducted. This prescription can be generated by a CGHS Doctor (if Doctor feels he is specialized in that area) or from a Govt. Hospital Doctor (after obtaining an Out-patient referral form from CGHS).
2. Armed with the prescription, you need to approach CGHS (starting with the CMO, escalating all the way up-to Addl. Director) and request them to sanction the tests.
3. Some of the tests will be conducted at CGHS’s inhouse facilities (if available in your city) while others (more specialized tests) may be conducted at a CGHS recognized diagnostic centre (Govt. & Private institutions – your choice).
4. The tests that are available with CGHS recognized diagnostic centres, will be done for free. The tests that have been approved but not available with CGHS recognised centres, you will have to pay for them initially and submit a reimbursement claim.
If your father has already been admitted to a Non-CGHS recognized hostpital and these tests have already been conducted, the only way CGHS will consider refunding you the money, is if the admission was done in an emergency and you have obtained a suitable emergency admission certificate.
Rajib Ghosh
18|Jun|2009 69Dear Javed,
I regret to inform you that prima facie it appears that your father and his survivors are not eligible for any reimbursement from CGHS of the cost incurred in his treatment for cerebral hemorrhage.
CGHS membership after retirement is optional, and unless the pensioner actually submits his application form and pays the applicable fees, he/she is not covered by CGHS. Hence CGHS cannot be held responsible for providing health cover to your father.
On the other hand, I feel there must exist a provision in the service rules of your father’s organization/pensioner rights which cover such a gray area. More specifically, you should find out for how long is your father’s organisation liable for covering your father’s health benefits after his retirement? What automatic rights to Govt. Pensioners have, that allow them to receive some basic benefits from the Govt. so that they can continue to be covered for medical costs while they prepare to move out of the Govt. provided facilities and retire in a place of their choice.
If your father was a member of CGHS while in service, then CGHS is liable to provide you some relief towards medical expenses by your father while he was in a transition stage.
There exists an All-India Govt. Pensioners Society which may be able assist you in answering some of these questions.
meghana
19|Jun|2009 70Rajib Ghosh Sir,
Thanks for your prompt reply. I went to Swastha Sadan Pune (CGHS Head centre ) of Pune. Eventhough , POST& TELEGRAPH AND RAILWAYS come under central Govt. these DEPTS ARE EXCLUDED from CGHS. Post office dispensery do not compensate for hospitalisation of pensioner in any form. They support for medicines. I hope any other visitors to this website from P&T and Railways will remeber this facts.
Now, Please guide me further ,if I can claim for his compensation to which Govt agency.
He hold post office medical card and he is 84 years old.
I am very much impressed with the information exchange forum of this website. It is really helpful for many families.
vkunny
20|Jun|2009 71what is the procedure to reimburse the medical expences, after obtaining the medical treatments in a Private non empanneled speciality hospital under emergency situation
Suresh Rai
20|Jun|2009 72My son age 23 yrs is kidney transplanted person from CMC, Vellore. For follow up treatment he use to visit after 6 months to CMC, Vellore. He is getting credit treatment facility as I am Central Govt. Servant. His medical bills directly comes to office and they use to settle at their end as per CGHS Rules. Since all the pathological and biochemistry tests , Xray, Ultrasonography and other related test rates are higher than CGHS rates. In this case what I can do meet with gap and restore the economic stain. Kindly suggest in this regard.
Rajib Ghosh
20|Jun|2009 73Dear vkunny,
Please check this article:
http://www.healthbuzz.in/2008/01/11/cghs-medical-reimbursement/
Rajib Ghosh
22|Jun|2009 74Dear Meghana,
P&T, Railways etc. are not covered by CGHS, but they have their own system of providing health-care to their employees.
I suggest you speak to someone in the office where your father worked and find out specifics.
Rajib Ghosh
22|Jun|2009 75Dear Suresh Rai,
All tests done at Govt. Hospitals & CGHS Approved Diagnostic centres are cashless. You need to take prior approval from CGHS for such tests. Please read the article titled ‘Obtaining Treatment from CGHS’ for pointers on this.
CGHS now allows patients to also claim from Private Medical Insurance where tests, procedures etc. exceed the CGHS approved limits or where CGHS has no coverage. In case your son is covered by some private medical insurance, you can claim from them along side CGHS. First, the private firm will reimburse you to max. entitlement and then forward the claim to CGHS for the balance amount.
JAGANNADHA RAO
24|Jun|2009 76Dear Friends, good evening, can you please advise:
During tour to Home Town my son slipped in bathroom and his left eye lid and inside were break opened, soon I taken to him to the nearby Pvt. Hospital in Hyderabad.
With local anesthesia the doctor stictched both inside and outside with different threads, and given necessary medicines.
He gave me 2 bills the first amounting to Rs.1,000/- towards his charges and the 2nd amounting to Rs.810/- towards all medicines including the material used for stiching etc. It was good hospital Janapareddy Children Hospital near Diamond Point Sq., Secunderabad, A.P.
Can you please suggest which form I can use to get reimbursement for the emergency, and what are the other conditions.
please let me know.
regaards,
Jagannadha Rao
Rajib Ghosh
24|Jun|2009 77Dear Mr. Jagannadha Rao,
You need to fill the “Medical Reimbursement Form 2004″. Please obtain this form from the CGHS dispensary you are attached to (upon presentation of the bill from pvt. hospital, within 90 days from discharge) and after filling it up, duly submit it for reimbursement.
Quite a few details are missing in your post, such as where did the accident occur – Hyderabad or hometown? What was the nature of the emergency that you could not take your child to a CGHS recognised hospital? Did the treatment require hospitalization or only first aid? Has there been any follow-up care by expert doctor?
Please note that CGHS may not reimburse you for any expense that CGHS considers as non-emergency. Reimbursement for treatment in Non-recognised hospitals is only considered in case of life threatening emergencies.
Javed
28|Jun|2009 78Dear Rajab Sir,
Thank you for your help. Sir once again I would like to bring in your kind notice the entire case i.e the circumstances under which the whole episode has happened.
1. My late father got retired on 31 Dec 07
2. Admitted in hospital on 18 Feb 08 (01 Months & 18 days after retirement)
3. Expired on 25 Feb 08 ( 01 Months & 25 days after retirement)
After this setback to the family, I applied the claim for the expenses incurred during the treatment through my late father’s office under this impression that no pensioner card is required & the pre-retirement CGHS card will be valid (both me & my fathers office were under same thought of mind)
1. the claim was forwarded to accounts office from the admin section of my fathers office on 23 Apr 08
2. the same was forwarded to CGHS Bikanare house on 24 Apr 08 (under the same impression that the old card is valid)
3. Bikanare house returned the letter to the accounts office on 02 Jun 08 stating the claim may be referred to the respective zone
4. accounts office then again forwarded the same to the zonal office on 09 Jun 08
5. the CGHS zonal office then took 03 months for reaching the conclusion that no reimbursement is applicable since no pensioner card was got issued within three months of superannuation (the letter was dated 11 Sep 08 however the same was not dispatched by 20 Oct 08 & the was received by me by hand on 20 Oct 09)
6. Meanwhile I got the CGHS token card issued under my mother’s name.
7. I then requested the zonal office to again consider the case on & they retook the file to again give the same response dated 27 Feb 09 & was received by accounts office on 11 May 09
Sir, It may be possible that I have wrongly interpreted the rule, & similarly did my fathers office & correspondingly the accounts office.
Sir, after the setback I some how managed to control myself & initiated the process of claim but that was only after the grace period of 03 months which is considered as a dead-line for claming the reimbursement.
Sir once again request your good-self to kindly suggest me a way-out
Thank you
JAVED
Anju
17|Jul|2009 79Hi Rajib,
My mom expired 3 months back. The medical claims i submitted with CGHS have been cleared. Now for how long am i suppose to maintain the medical records or duplicate medical bills? By any chance can these bills be verified again by CGHS? Despite the recent “No verification requirement “order , i had cautiously submitted the duly verified bills to avoid any hassles in the future. please advise.
I also request Dr. Ramakrishna to shed light on this issue.
Thanks.
Anju
28|Jul|2009 80Hi Rajib
I am eagerly waiting for your reply
ritu jain
29|Jul|2009 81Dear Sir, i am a govt servant nad my husband has been diagnosed with end stage liver disease. what is the CGHS rate for liver transplant(if there is any)
Rajib Ghosh
30|Jul|2009 82Hi Anju,
Very wise of you to have submitted verified bills to CGHS inspite of their recent ‘no verification reqd.’ order.
Since you mentioned that your claim has already been processed and the file closed, technically you do not need to maintain the medical records or duplicate medical bills.
I am not aware of any specific statute of limitation, but it will be reasonably safe to assume that if the Govt. does not re-open the file in 3 years, it will be very hard for them to explain to the courts afterwards.
Govt. agencies in India have a random attitude towards citizen of this country. BSNL has been known to send collection agents to it’s customers claiming 30 year old dues (with applicable interest). A nice little scam it turned out to be. Govt. sponsored intimidation. The 30 year old Rs. 300 (if in fact due) becomes Rs. 43,000/-!! (calculated at 18% interest compounded annually).
You can ask CGHS Officers about statute of limitation clause specifically for the purpose of archival & maintenance of old CGHS records.
In fact, I would request you to be on the safer side and request the appropriate info by post from CGHS HQ of you city.
HTH
Rajib Ghosh
30|Jul|2009 83Dear Ritu,
A quick check of documents on net revealed that there is no specific rate for liver transplant. In general, CGHS has a ceiling rate for all treatment and the reimbursement would be strictly according to the rates defined for that city only.
Liver transplantation is not likely to be affordable or easily sanctioned. Therefore I suggest:
1. Obtain a certificate/prescription from a Specialist Doctor at a Govt. Hospital that specifies that patient requires liver transplant to continue life.
2. Obtain a quote (including donor charge, recipient charge, consultants charges, OT & related charges, Post-operative care charges) from the Govt. Hospital.
3. Also obtain a similar quote from a CGHS Recognised private hospital.
4. Approach CGHS HQ in your city with the above 3 documents and request for go-ahead and sanction for maximum allowable cost. The concerned officers at CGHS should be able to help you out with working out the costs by the aid of their updated ready-reckoner.
If the sanctioned CGHS cost is higher than the actual cost, you will have to bear the difference. Treatment at a Non-CGHS-recognised private hospital is not admissible under CGHS rules (unless in an emergency).
HTH
Anju
31|Jul|2009 84Thanks a lot Rajib you had been a great help.
Since u mentioned a BSNL scam..FYI, I am preparing to fight a similar case against the water dept. in our area for raising a ficticious bill of Rs. 1 Lac against us!
vineet
31|Aug|2009 85i want to have performa for applicaion of cghs medical claim of my husband
Rajib Ghosh
31|Aug|2009 86Hello,
You need to obtain the reimbursement form from the CGHS dispensary with which you are associated.
Please note that forms downloaded and printed from the Internet are not accepted by CGHS.
L.M. BHATNAGAR
01|Sep|2009 87To get medical claim form from CGHS dispensary is an exercise in futile,
they always refuse saying -forms not available. It is true for almost all the
dispensaries, at least in Delhi and NCR. Forms copied from internet are
generally accepted by authorities provided they are neatly printed.
Madam Vineet- you may get it with the help of some IT personal.
Rajib Ghosh
01|Sep|2009 88If the CMO of the dispensary is ok with forms downloaded and printed from the Internet, then please visit the following link to download the forms.
http://mohfw.nic.in/cghsnew/index1.asp?linkid=17&langid=1
The forms are in PDF format, hence you will need Adobe Acrobat Reader or FoxIT PDF Reader to view and print the document. I highly recommend Foxit Reader.
KS Dahiya
03|Sep|2009 89Sir,
Kindly intimate the procedure for obtaining the CGHS Card in case of its missing. Wheather a duplicate CGHS card may be obtained from the department. If yes, kindly intimate the detail procedure to be adopted in case of missing CGHS card.
KS Dahiya
Rajib Ghosh
03|Sep|2009 90Duplicate CGHS card is issued to the cardholder, by the same authority who had issued the original CGHS card.
The following steps have to be observed to obtain the Duplicate CGHS card:
1. Letter addressed to the Additional Director CGHS reporting the loss of original CGHS card . A copy to CMO I/C of the dispensary where you are registered.
2. Application (letter to Addl Dir, CGHS form) for the duplicate card should be submitted along with the following documents:
a) Copy of FIR from the Police Station,
b) Copy of complaint lodged with the police about the loss of CGHS Identity Card,
c) A copy of the report lodged with the CMO.
3. A Postal Order/DD for Rs. 5/- drawn in favor of “Pay & Accounts Officer , CGHS, New Delhi of the respective region should be enclosed for the first loss, Rs. 7/- for the second loss and Rs. 10/- for third and subsequent losses. Please verify the amounts payable.
Regards
charu
28|Sep|2009 91Sir .
My husband is a HP govt employee and i m working in BSNL.
and according to my service records , i m authorised to claim indoor treatment of my son and daughter. i show only my son and daughter are dependent on me. Can my husband claim medical reimbursement of my father-in-law for indoor treatment.
D.M. BHATTACHARYYA
16|Nov|2009 92Dear Rajib ghosh,
Would you kindly spare some time to satisfy me answering the following
questions:
(1) What is/are the precondition(s) of “Cashless” indoor medical treatment in a Govt./CGHS approved Private hospitals/Nursing Homes in Kolkata. (2) Being a retired man I, of and on visit different places in West Bengal and sometimes outside (within India). In case of emergency how can I get medical tratment in a govt./private hospitals/nursing homes under CGHS scheme. With thanks.
Rajib Ghosh
16|Nov|2009 93Dear DM Bhattacharya,
To avail of cashless in-patient treatment at CGHS recognised hospital:
1. In case of emergency, display of the CGHS card is enough for admission
2. In case of non-emergency treatment, you must obtain the following in order:
2.a Out-patient referral form from CGHS addressed to a Govt. Hospital
2.b Prescription from Govt. Hospital
2.c In-patient referral form from CGHS based on Govt. Hospital prescription
2.d Approach the CGHS recognised hospital mentioned in the in-patient referral form and obtain cashless treatment.
If travelling within India, please carry with you a list of Govt. & CGHS recognised hospitals in the area of your travel, so that in emergency you can approach the hospital with your CGHS card and obtain emergency treatment.
Please note that you cannot obtain regular treatment and medicines from CGHS dispensaries outside of your home area under normal circumstances. For example, if you are attached to Bhowanipore-Kalighat dispensary and you travel to Hyderabad for 2 weeks. Even though Hyderabad has a lot of CGHS dispensaries, you cannot approach them to obtain regular medicines since you are not associated with them. You can approach them or any CGHS recognised hospital in Hyderabad to seek emergency treatment.
If you intend to reside in a city/town other than your home-town for 3+ months, CGHS allows you to register yourself temporarily with local CGHS dispensaries so that you can avail regular treatment.
Please also note that pensioners can avail of emergency treatment on cashless basis anywhere in India whereas in-service people need to pay for their treatment and obtain reimbursement from CGHS.
CGHS does not cover medical treatment out of India.
HTH
Yogesh Sharma
19|Nov|2009 94My father is retired from Central Govt.(Ordinance) and he is getting Rs.100/- on A/c of Medical in his monthly pention. He is not availing/member of the CGHS, he has gone through Brain Surgery in emergency. My question is that can he entitle for any reimbursement from Govt. if yes, please let me know the procudure.
I will be very thankful if any body can help me out, we have already spent huge amount.
Please help…….
Yogesh Sharma
09871935586
09873282607
Rajib Ghosh
19|Nov|2009 95Dear Yogesh,
Prima facie it appears that your father is not entitled to any kind of reimbursement.
CGHS was specifically designed to help in-service and retired Govt. servants. There is no other scheme like this in India!
The only condition is that you should be a member of CGHS in the first place.
HTH
Docrajiv
09|Dec|2009 96Dear Rajib,
At the outset I would like to congratulate u for the services u are rendering to all the CGHS Benificiaries.
I have a basic query regarding the interpretation of the term ” Package Rate” even though the definition is almost elaborate. But when I refer compendium of Orders for CGHS by NABHI Publications of Apr 2009, the Rates @ Appendix I satrting page 272 says the rates are applicable for Investigation/Treatment/Procedure, which itself is a misleading term as the Rates mentioned are not Package Rates.
My interpretation on the term if taken may be..Package rate to include the sum of different Investigation+ OT Procedure as mentioned in the Appendix I table+ post operative Treatment in a patient and arrive at the final figure of Package Rate.
A case in point may be Sl No.936 in page 332 wher the patient has to undergo Craniotomy and Evacuation of Subdural Hematoma..this in itself will require an initial CT Scan/MRI to be done followed by initial assesment and stabilization of the patient with cross consulation , Blood Transfusion etc., Logically speaking in this case the Cranitomy charge of Rs 20,000/- for Class Y cities should be limited to the OT activities like OT Charges, Anaesthestist charges, Monitoring charges, Surgeons’s Charge etc., and the Investigations/follow up/recovdery fees etc., needs to be added to the above amount to arrive at a final Package Rate which may go beyond the procedure rate mentioned in the table for eg., Rs 20,00/- + CT Rate @ 1400/- + Ward Charges. Rs 400/- per day etc., reaching the final Package Rate.
Please clarify on this basic query which may help us a long way i serving our CGHS fraternity better with Quality treatment
D.M. Bhattacharyya
01|Feb|2010 97Dear Rajib Ghosh,
I have already exchanged a few communications with you on this and other sites and I have been benefitted and got well well informed on CGHS matters. I am very much thankful for the same. This time I seek your advice on a different issue. I am a Pensioner CGHS Card holder and receiving my OPD medical treatment at SSKM (PG)Hospital, Kolkata since last nine years.About nine years ago when I was first time referred to the above hospital and reported to the above hospital I was examined by one Doctor having DM(Cardiology) degree who prescribed necessary medicines which I got from CGHS Dispensary. Since then I was and am examined by junior doctors only and they prescribe medicines and advise clinical tests etc. A rubber stamp is fixed on the top of the prescription sheet showing the name of the Cardiologist when I report to the OPD Desk. Hence I am under the medical treatment of a rubber stamp only.Naturally, after third or fourth month I take cross consultations of private Super-specialists paying fees of Rs.500/600 (varies from doc to doc) and 50% of medicines and diagonistic tests prescribed by the private super-specialists do not match with the medicines tests prescribed by Hospital OPD. I am to pay for the costly medicines and diagonistic tests from my pocket. This process is going on since last nine years. Is there any way to solve the problem ? Your commente are highly solicited.
Rajib Ghosh
02|Feb|2010 98Dear Mr. Bhattacharya,
I was faced with the same predicament during my stay at Kolkata. The HoD at SSKM had just too many cases on hand to examine each one individually.
Hence his colleagues in the Dept. generally did the examination and after a cursory preview the HoD rubber stamped it.
While at Hyderabad, we are fortunate enough to visit NIMS and the HoD is actually bothered to look into critical cases and examine them himself.
IMHO, this is both a boon and curse for you. At-least I used it to my advantage in the following way:
My FIL is a critical condition patient and any kind of visit to SSKM was always very stressful for all of us. Not to mention the masses of patients present on any given day makes it impossible for any Doctor to either spend more than a 2 minutes per patient or remember previous records etc. Yet, my FIL does require a careful observation and examination.
The Doctors from private hospitals live in an entirely different world and tend to prescribe tests, procedures and medicines – some of which are neither necessary nor CGHS approved.
We stuck a balance by visiting the private chambers of the SSKM HoD, where he could examine the patient at leisure. Based on his private prescription, we could get the junior doctors to prescribe the new medicines. From time to time we also visited Consultant Doctors of other hospitals and sought their opinion. These opinions we generally showed to SSKM doctors and requested them to incorporate some of them if it made sense.
Did it cost a lot of money and time? Yes it did. While obtaining basic treatment from CGHS is a cinch, obtaining a specialists advise generally costs at-least the Private Doctor’s consultation fees.
Harish
10|Feb|2010 99There is major condition for admission in pvt non enpanneled PVT hospital, even in emergency.
No Goverment or CGHS recognised hospital should be near the residence of patient.
this declaration is required in self explainatary letter, which they may verify.
Rajib Ghosh
10|Feb|2010 100Dear Harish,
What you say is perfectly logical however it opens a new can of worms.
1. In case of emergency, even an additional travelling distance of 1 km matters. For ex: in the heavy traffic of Kolkata, sometimes travelling 1 km means a journey of 20-30 more minutes. Attempting to admit a patient to a CGHS Recognized hospital in absolute emergency may just result in him losing his life.
2. In the past, my FIL has had quite a few close shaves. In at-least one case, we had to admit him to a non-CGHS empaneled hospital and file for reimbursement later. We did receive a substantial reimbursement after waiting about one and half years.
3. What if the patient does not declare that a CGHS Recognised hospital was close by? What if he simply sticks to the facts that it was a medical emergency and receiving medical care was more important than following a sub-para in the book of CGHS rules?
4. What if it was not the patient but others (family, friends, strangers) who admitted the patient to the nearest hospital hoping to save his life? Such members of the public may not be aware of the CGHS rules or even the fact that hospitals have to empaneled with CGHS?
It will be great if you can dig up some official paper-work in this matter,
Regards
Docrajiv
12|Feb|2010 101Dear Rajib,
Awaiting a reply on Query No. 96
Regards
Docrajiv
brinder
14|Feb|2010 102Please tell me vide Memo. No. 4-18/2005-C&P (Vol. 1-Pt.(i) MCGHS (P) Division dated 20.2.2009 the essentiality certificate A&B and medical bill/receipt are not required verified from concerned doctor for reimbursement
snamas
18|Feb|2010 103Dear Mr. Rajib,
I had undergone a surgery called ACL Reconstruction on my right knee. I got prior referral from CMO concerned and permission from my Head of Office. The bill in respect to this amounting to Rs. 47,000/-. Since this surgery is not listed in the CGHS code book, my office denies to settle the bill. How can i solve this issue now? I hope you can give suggestions in this regard.
Thanks in advance.
snamas
D.M. Bhattacharyya
18|Feb|2010 104Dear Rajib Ghosh,
I would like to convey a good news to yoy that a “CLAIM ADALAT” to be held on 16.4.2010 to solve the disputed pending re-imbursement claims of CGHS Card holders of Kolkata and adjoining areas. The first time I have come to know the creation of such ADALAT. Thanks to CGHS Authority. With thanks.
manish
25|Mar|2010 105i got my wife treated in hospital recoganised under CGHS. My wife is university lecturer, she is neither entitled for medical reimbursement nor she has claimed. i opted for reimbursement. i was requested to show that working comes within the defination of dependent. please help me out urgently.
Thanks,
awaiting your advice
Manish
Rajib Ghosh
25|Mar|2010 106Dear Manish,
Since your wife is employed and that too at a high-pay job, you cannot claim her as a dependent.
She maybe married to you but definitely not dependent on your pay.
It was wise of you to have declared your wife’s employment status correctly in the claim form. False representation could have landed you in a lot of trouble.
Refer to this official definition of ‘Dependent Family members’: http://164.100.47.132/bulletinII/2009/3.7.2009.pdf
HTH
shiv
25|Mar|2010 107Dear Rajib
I am waiting for ur reply for my query at 103.
Dear Mr. Rajib,
I had undergone a surgery called ACL Reconstruction on my right knee. I got prior referral from CMO concerned and permission from my Head of Office. The bill in respect to this amounting to Rs. 47,000/-. Since this surgery is not listed in the CGHS code book, my office denies to settle the bill. How can i solve this issue now? I hope you can give suggestions in this regard.
Thanks in advance.
snamas
please do the needful.
Sujith Madhavan
30|Mar|2010 108Dear Rajib – You are providing a great service – Thanks a Lot – Sujith.
Swapan
17|Apr|2010 109Dear Rajib
It is intimated that Doctor of C.M.C., Vellore and Doctor of SSSIHMs, Bangalore (Cardiology) has advised me for angiography (CAG). Kindly intimated me whether my office can give permission to obtain such angiography (CAG) etc. at C.M.C., Vellore and reimbursed under which rule. It is stated that I am residing at Kolkata.
I am waiting for your reply.
Swapan
17|Apr|2010 110Dear Rajib
In continuation of earlier requirement it is stated that I am not covered under CGHS Scheme.
Rajib Ghosh
18|Apr|2010 111Dear Swapan,
Since you are not covered by CGHS, re-imbursement from CGHS is ruled out.
However, if you work for Govt. Dept., your Dept. probably has it’s own Health Scheme which will have a process by which you can obtain treatment at CMC Vellore and recover the costs later.
I suggest that you kindly get in touch with Primary Dispensary/Hospital setup by your organisation or Contact HRD to find our more details.
Regards
- Rajib
Rajiv
19|May|2010 112Please mail me copy of forms for:-
1) reibursement form,
2) essentiality certificate
Rajiv
19|May|2010 113what is the procedure to reimburse the medical expences, after obtaining the medical treatments in a CGHS recognized Private hospital under emergency situation.
Rajib Ghosh
19|May|2010 114Dear Rajiv,
The procedure to obtain reimbursement for medical expenses from CGHS is detailed here:
http://www.healthbuzz.in/2008/01/11/cghs-medical-reimbursement/
The forms for reimbursement related issues can be downloaded from:
http://www.healthbuzz.in/2009/09/04/forms-available-on-cghs-website-can-be-printed-and-submitted/
The essentiality certificate is a medical certificate issued by the Doctor-in-Charge of the ‘case’ at the hospital where the patient was treated. The certificate should state:
- The date/time of the admission
- The condition in which the patient was admitted
- The eventual diagnosis and treatment
- The fatality of the condition if the patient were to be left untreated/denied emergency admission.
The certificate should be on the hospital letterhead and should bear the signature and stamp of the doctor.
HTH
D.M. BHattacharyya (Howrah)
07|Jun|2010 115Dear Rajib Ghosh,
Since last 5 yrs. or so I am under OPD (Cardiology) treatment at SSKM Hospital , Kolkata under stamp of Dr. B. Mukherjee, MD In this connection pl ref my comments dt. 01.2.2010. On the first day about 8 yrs back when I reported to SSKM OPD (Cardio), to get I my name registered at the Prescription Form issuing counter and I was given a Prescription form stamped “DR.A.K. MAITY” DM but Dr. S.S. Chatterjee, DM personally examined me and wrote next date of report on the prescription. Dr. Maity, DM. retired and have been placed under “DR. B. MUKHERJEE, DM”. Since then almost 5 yrs lapsed but not a single day I have been examined by Dr. Mukherjee. Only the trainee doctors attend me at OPD. My question is that in the course of long five years the Doctor under whose stamp I am receiving treatment cannot spare ten minutes for a patient like me ? In my pinion the Suprspecialist should review the old cases periodically say, anually or bi-annually to see whether they are being treated correctly by the junior doctors. So, I am helplessly under treatment of a RUBBER STAMP.
?
Rajib Ghosh
08|Jun|2010 116Dear Mr. Bhattacharya,
I have visited SSKM with my FIL for over 4 months and I am aware of the situation there.
The sheer volume of traffic at SSKM makes it impossible for the HoD to individually examine patients. As typical process in hospitals across the country, a panel of junior doctors first examine the patient and determine the health of the patient. The case is escalated to the HoD attentions only if the patient falls in the category where HoD’s expert advise is required. Once the patient’s condition has been determined and treatment started, the patient is henceforth examined by the panel of junior doctors only as long as the patient’s condition remains more or less the same.
I request you to look at the situation from a brighter point of view: definitely your health must be relatively stable and hence did not require escalation
HTH
narmada
07|Jul|2010 117sir
my dad is an CGHS beneficiary and was on leave since 3march 2010 -9 april2010 and he applied for this benefit on 3 june 2010. but the official dont ready to make this benefit as they said my dad is too late to avail this benefit. is he realy late? are theyeligable to get this medical bill reimbursement now?
Rajib Ghosh
07|Jul|2010 118Dear Narmada,
CGHS allows reimbursement claims to be submitted within 90 days of discharge. The claim period is 1 month if the patient has availed treatment by obtaining prior permission/medical advance from CGHS.
If he was discharged from treatment on 9th April following emergency admission, then you are well within the time limit prescribed to file medical reimbursement claim.
If for some reason, a patient is unable to submit his claim within 30/90 days of discharge, you can approach the Additional Director (CGHS) of you city and apply with a petition explaining the grounds on which your claim submission was delayed. If justified, the Addl. Dir will grant special leave and you will be able to submit the file for medical claim.
HTH
- Rajib
manish tilak
16|Sep|2010 119Dear sir
m living in banglore and availing cghs facility here.
i have send my wife to agra as it is my home town and she is pregnent. please guide me how can i avail cghs facility there. in agra there isnot any cghs dispensory but some hospitals are recognise by cghs under cs (ma). please guide me.
thanking you sir
parameswara kumar
07|Dec|2010 120Hello sir
whether stckings class II for vericose veins disease reimbursable or not? if so the details & if not the reasons may be given.
Since hearing aid at a cost of 15,000/- is also reimbursable to the cGHS beneficiaries.
Thank u sir. please give reply to my mail id.
Shaurya Tayal
01|Mar|2011 121Dear Rajiv
Hope you are doing well.
My sincere thanks for your efforts in answering numerous queries. Would appreciate if you could provide us with a solution.
RAHI Care is currently operating renal care (dialysis) centers in Northern India especially in cities where CGHS is not available and no tenders have been floated for empanelment of hospitals in these cities. We do have patients whose wards are central government employees and are as such entitled to CGHS benefits. Is there a process whereby we may enlist our centers with CGHS and make them eligible for reimbursements at CGHS rates.
We are currently operating at Mandi & Solan (Himachal) and Punjab. Look forward to your response.
Thanks & Regards
Shaurya
Rajib Ghosh
01|Mar|2011 122Dear Shaurya,
Since you are operating in cities where CGHS does not operate, clearly CGHS cannot issue ‘Empanelment of Hospitals’ requests in your city.