How to Claim CGHS Medical Reimbursement (Step-by-Step Guide)

Medical expenses can be stressful, especially when treatment is taken in an emergency or at a non-empanelled hospital. The Central Government Health Scheme (CGHS) allows beneficiaries to claim reimbursement of eligible medical expenses—provided the procedure is followed correctly.

This guide explains how to claim CGHS medical reimbursement step by step, including documents required, timelines, and common mistakes to avoid.

Who Can Claim CGHS Medical Reimbursement?

You can claim reimbursement if you are a:

Serving Central Government employee
CGHS-covered pensioner or family pensioner
Dependent family member of a CGHS beneficiary

Reimbursement is generally applicable when:

Treatment is taken in a non-empanelled hospital during an emergency
Treatment is taken in an empanelled hospital but payment was made by the patient
Certain procedures are done with prior CGHS permission

Step 1: Complete the Medical Treatment

Before initiating a claim, ensure that the treatment has been fully completed and all documents are collected from the hospital.

These may include:

Discharge summary
Prescriptions
Investigation reports
Final hospital bill

⚠️ Important: Interim or advance bills are not accepted for reimbursement.

Step 2: Collect All Required Documents

Prepare a complete reimbursement file with the following documents (in original):

Mandatory Documents

CGHS reimbursement claim form (duly filled and signed)
Original hospital bills with item-wise break-up
Cash receipts and payment proofs
Discharge summary / treatment summary
Doctor’s prescription
Investigation reports (X-ray, lab reports, scans, etc.)

Additional Documents (if applicable)

Emergency certificate from hospital
Referral letter (if available)
Copy of CGHS card
Cancelled cheque / bank details (for direct credit)

Keeping documents in proper order helps in faster processing.

Step 3: Fill the CGHS Reimbursement Claim Form

The CGHS claim form must be filled carefully with:

Beneficiary details
CGHS card number
Details of treatment and hospital
Total amount claimed

Any mismatch between bills and the form can delay approval.

Step 4: Submit the Claim to the Appropriate Office

Submission depends on your status:

Serving employees:
Submit the claim to your department / office (DDO or admin section).
Pensioners:
Submit the claim directly to the CGHS Wellness Centre where your card is registered.

Step 5: CGHS Scrutiny and Rate Verification

After submission:

Bills are checked against CGHS approved rates
Non-admissible items (like toiletries, extra room rent, attendant charges, etc.) are deducted
In emergency cases, the claim is examined more carefully

This stage takes time, especially if clarification is required.

Step 6: Sanction and Payment

Once approved:

A sanction order is issued
The reimbursed amount is credited directly to your bank account

⏱️ Typical processing time:
4 to 8 weeks, depending on document completeness and workload.

What Expenses Are Usually Not Reimbursed?

Some common non-admissible items include:

Telephone, TV, food charges
Toiletries and personal items
Extra room rent beyond CGHS entitlement
Charges not supported by prescription

Understanding this helps avoid unrealistic expectations.

Common Reasons for Delay or Rejection

Missing original bills
No emergency certificate (for non-empanelled hospitals)
Mismatch in patient name / CGHS card details
Illegible or overwritten bills
Claim submitted after a long delay without justification

Tips for Faster CGHS Reimbursement

Always photocopy your entire claim set before submission
Arrange documents in the order prescribed by CGHS
Write your mobile number clearly on the form
Keep acknowledgement or inward number safely

Frequently Asked Question

Is there a time limit to submit a CGHS reimbursement claim?
Yes. Ideally, claims should be submitted within 3 months from the date of discharge. Delayed claims may be accepted with valid justification.

Final Words

CGHS medical reimbursement is a rule-based process, not discretionary. When documents are complete and procedures followed correctly, reimbursement is usually smooth—though patience is required.

This step-by-step approach should help you file your claim confidently and correctly.