Central government employees and pensioners can avail medical expense reimbursement through the Central Government Health Scheme (CGHS) by submitting the official CGHS Medical Reimbursement Form. This form lets you claim costs for hospital bills, medicines, diagnostic tests, surgeries, and more—whether the treatment was taken at a CGHS-empaneled, government, or eligible private hospital. In this detailed guide, you’ll learn who can claim, how to fill the form, required documents, sample entries, online/offline application steps, and mistakes to avoid for a faster claim process in 2025.
Quick Reference Table
| Form Name | Purpose | Eligible Users | Download | Official Source |
|---|---|---|---|---|
| CGHS Medical Reimbursement Form | Reclaim medical expenses | Central govt employees, pensioners, dependents | 📥 Download PDF | CGHS homepage |
Who Can Claim CGHS Medical Reimbursement?
- Serving central government employees under CGHS.
- Pensioners and their dependents enrolled in CGHS.
- Dependent family members: spouse, children, parents.
Typical claims: hospitalization, surgery, diagnostic tests, OPD procedures, medicines, and more.
Documents Required
- Duly filled CGHS Medical Reimbursement Form.
- Original hospital bills & itemized receipts.
- Discharge summary (for hospitalization).
- Doctor’s prescription & investigation reports.
- Referral letter (if applicable).
- CGHS Card copy.
- ID proof & bank details.
- For emergency: Emergency certificate from hospital.
How to Fill the CGHS Medical Reimbursement Form (2025)
Section 1: Applicant Details
Name, CGHS Card number, designation/PPO, address, contact info.
Section 2: Patient Information
Name of the patient, relationship, CGHS Card no.
Section 3: Treatment Details
Type of illness, hospital/clinic name & location, dates of admission/discharge or treatment.
Section 4: Financial Claim Details
Total bill amount, amount claimed, advance drawn (if any), details of individual bills (room, medicines, consultation, etc.).
Section 5: Bank Details
IFSC, account number for direct transfer.
Section 6: Declaration
Applicant’s signature, date.
Sample Filled Form Overview
- Patient Name: Shweta Sharma
- CGHS Card No: 1234567890
- Relationship: Self
- Hospital: Apollo Hospital, Delhi
- Dates: Admission – 10/09/2025, Discharge – 14/09/2025
- Total Claim: ₹45,500
- Advance Received: ₹10,000
- Bank Account: 4056XXXXXXXX, IFSC: SBIN0001234
(For detailed sample with filled columns, attach an annotated screenshot or use formatted dummy data for each field in your guide.)
Step-by-Step CGHS Claim Submission (Offline + Online)
Offline Process:
- Collect all original documents.
- Fill CGHS Medical Reimbursement Form with correct details.
- Attach all bills, prescriptions, test reports, referral letters.
- Submit to your CGHS wellness center/office and collect acknowledgment.
- Follow up in 2-3 weeks; payment is done to your bank directly.
Online Process (where available):
- Login at cghs.gov.in.
- Upload scanned medical bills, prescriptions, and form in PDF (single file).
- Fill online application form.
- Submit and note your claim/reference number.
- Track claim status online.
Processing Time & Status
- Regular claims: 15–30 working days
- Emergency/priority: 7–15 days
- Status can be checked online using the claim/reference number or by calling the CGHS helpline.
Common Mistakes to Avoid
- Missing or expired original bills.
- Incomplete form (missing fields/signature).
- Not attaching a referral or emergency certificate when required.
- Handwritten bills without GST.
- Failing to submit claim within 3 months of treatment.
Frequently Asked Questions (FAQs)
Q1: What is the last date to submit CGHS medical reimbursement claims?
A1: Claims must be submitted within 3 months from the date of completion of treatment or hospital discharge.
Q2: Can I claim reimbursement for treatment taken at a non-empaneled hospital?
A2: Yes, only in emergency cases, provided you include an emergency certificate from the hospital. Planned treatments should ideally be at CGHS-empaneled hospitals.
Q3: What happens if I forget to attach a referral letter?
A3: Claims from private hospitals without a proper CGHS referral may be rejected unless it’s an emergency. Always obtain and attach a referral letter for treatments outside CGHS facilities.
Q4: How do I know if a hospital is CGHS empaneled?
A4: The latest list of empaneled hospitals is published on the CGHS official website and is also available at your local wellness center.
Q5: Can medicines bought from outside be reimbursed?
A5: Yes, if the prescribed medicines were unavailable at CGHS dispensaries and this is certified by the Medical Officer.
Q6: How can I track the status of my claim?
A6: Log in to the CGHS portal with your beneficiary ID and reference number. Alternatively, use the helpline for updates.
Q7: What are common reasons for rejection of medical claims?
A7: Major reasons include incomplete applications, missing bills, claim submitted after the 3-month time limit, unapproved treatment, or lack of required certificates.
Q8: Is advance permission required for surgeries or expensive tests?
A8: Advance permission is required for certain surgical procedures, diagnostic tests beyond threshold limits, and for some planned treatments in private hospitals.
Q9: Can I file an appeal if my claim is rejected?
A9: Yes, submit a written appeal with supporting documents within 30 days of rejection to the CGHS office or the designated appellate authority.
Q10: Can pensioners claim under CGHS medical reimbursement?
A10: Yes, pensioners enrolled in CGHS are entitled to the same reimbursement benefits as serving employees.
Q11: Is bank account information mandatory on the form?
A11: Yes, this is essential for direct credit of your reimbursement after approval.
Q12: Can I submit scanned copies of bills for offline claims?
A12: Only original bills/receipts are accepted for offline claims. Scanned copies are valid for online submissions.