The Central Government Health Scheme (CGHS) Medical Reimbursement Form is essential for central government employees and pensioners to claim medical expenses. This comprehensive guide covers everything you need to know about the form, application process, and reimbursement procedure as per 2025 updates.
Quick Summary Table
| Form Name | CGHS Medical Reimbursement Form |
| Purpose | Claim medical expenses for treatment |
| Eligible Users | Central Government employees, pensioners, and beneficiaries |
| Valid For | 2025 (as per latest CGHS guidelines) |
| Processing Time | 15-30 days (varies by claim type) |
| Submission Mode | Online (CGHS portal) and Offline (Wellness Centers) |
What is CGHS Medical Reimbursement?
CGHS Medical Reimbursement is a facility provided by the Government of India to allow central government employees and pensioners to claim medical expenses incurred for treatment. The reimbursement covers consultation fees, diagnostic tests, medicines, hospitalization, and other approved medical procedures.
Key Features of CGHS Reimbursement
- Cashless treatment at empaneled hospitals
- Reimbursement for treatment at private facilities
- Coverage for family members
- Emergency medical coverage
- Pensioner medical benefits
Who Can Apply for CGHS Medical Reimbursement?
The following individuals are eligible to apply:
- Central Government Employees – All serving employees covered under CGHS
- Pensioners – Retired central government employees
- Family Members – Spouse, children, and dependent parents
- Members of Parliament
- Sitting and Former Judges
Types of Medical Reimbursement Claims
1. Emergency Treatment Reimbursement
For emergency medical situations where immediate treatment is required at non-empaneled hospitals.
2. Planned Treatment Reimbursement
For scheduled medical procedures, surgeries, or treatments at approved facilities.
3. Medicine Reimbursement
For medicines purchased from outside CGHS dispensaries when unavailable.
4. Diagnostic Test Reimbursement
For laboratory tests and diagnostic procedures conducted at approved centers.
Documents Required for CGHS Medical Reimbursement
To complete your reimbursement claim, prepare the following documents:
Essential Documents:
- Duly filled CGHS Medical Reimbursement Form
- Original prescriptions from registered medical practitioners
- Original bills and receipts with proper breakup
- Diagnostic test reports with lab bills
- Discharge summary (for hospitalization)
- CGHS Card photocopy
- Government ID proof
- Bank account details for direct credit
Additional Documents (if applicable):
- Referral letter from CGHS Medical Officer
- Emergency certificate (for emergency claims)
- Medical certificate justifying treatment necessity
- Advance permission letter (for certain procedures)
How to Fill the CGHS Medical Reimbursement Form
Step-by-Step Guide
Step 1: Personal Information
- Enter your name as per CGHS card
- Fill CGHS beneficiary ID
- Provide designation and office address
- Enter contact details
Step 2: Patient Details
- Name of patient (self or dependent)
- Relationship with cardholder
- Age and gender
Step 3: Treatment Information
- Nature of illness/disease
- Hospital/clinic name and address
- Date of treatment or admission
- Treatment duration
Step 4: Financial Details
- Total bill amount
- Amount claimed for reimbursement
- Break-up of expenses (room rent, doctor fees, medicines, tests)
- Previous advances (if any)
Step 5: Supporting Documents
- Attach all original bills and receipts
- Include prescriptions and reports
- Add referral letters if applicable
Step 6: Declaration & Signature
- Read the declaration carefully
- Sign and date the form
- Obtain certification from Medical Officer (if required)
CGHS Reimbursement Rate Chart 2025
| Service Type | Reimbursement Rate |
| Room Charges (General) | As per entitlement |
| ICU Charges | 100% of approved rates |
| OPD Consultation | Up to ₹500 per visit |
| Diagnostic Tests | As per NABL/CGHS rates |
| Medicines | As per CGHS formulary |
| Surgery/Procedures | As per approved package rates |
Online Application Process
Through CGHS Portal:
- Visit the official CGHS website
- Login with your credentials
- Navigate to ‘Reimbursement Claims’
- Select claim type
- Fill the online form
- Upload scanned documents (PDF format, max 5MB)
- Submit the application
- Note down the reference number
- Track claim status online
Offline Application Process
Through CGHS Wellness Center:
- Download and print the reimbursement form
- Fill all sections accurately
- Attach original documents
- Visit your nearest CGHS Wellness Center
- Submit to the reimbursement counter
- Collect acknowledgment receipt
- Follow up after 15-20 days
Processing Time and Payment
- Normal Claims: 15-30 days
- Emergency Claims: 7-15 days
- Complex Cases: 30-45 days
- Payment Mode: Direct bank transfer to registered account
Common Reasons for Claim Rejection
- Incomplete form or missing information
- Treatment not covered under CGHS
- Bills without proper breakup or GST details
- Treatment taken without prior permission (where required)
- Expired medicines or unbilled items
- Non-CGHS empaneled facility (without emergency certificate)
- Exceeding entitled limits
How to Check CGHS Reimbursement Status
Online Method:
- Visit CGHS official portal
- Login to your account
- Go to ‘Track Claim Status’
- Enter reference number
- View current status
Helpline Method:
- Call CGHS helpline: 1800-123-8900
- Provide beneficiary ID and reference number
- Get status update
Related Forms and Calculators
For comprehensive government employee services, explore these related resources:
- CGHS Card Application Form
- 7th Pay Commission Calculator
- DA Arrears Calculator
- Income Tax Form 16 for Government Employees
- Leave Encashment Form
- Pension Calculator
Important Tips for Quick Reimbursement
✓ Keep all original documents safe
✓ Submit claims within 3 months of treatment
✓ Ensure bills have proper GST details
✓ Take advance permission for planned procedures
✓ Use only CGHS empaneled hospitals when possible
✓ Maintain copies of all submitted documents
✓ Follow up regularly on claim status
✓ Verify bank account details are correct
Frequently Asked Questions (FAQs)
Q1: What is the time limit to submit CGHS reimbursement claims?
A: Claims must be submitted within 3 months from the date of treatment completion.
Q2: Can I claim reimbursement for treatment taken outside India?
A: No, CGHS reimbursement is only applicable for treatment taken within India.
Q3: Is advance permission required for all treatments?
A: Advance permission is required for certain surgical procedures, diagnostic tests above specified limits, and treatment at non-empaneled facilities (except emergencies).
Q4: How can I check empaneled hospitals under CGHS?
A: Visit the CGHS official website and check the list of empaneled hospitals in your city.
Q5: What if my claim is rejected?
A: You can file an appeal with proper justification and supporting documents within 30 days of rejection.
Q6: Can pensioners claim medical reimbursement under CGHS?
A: Yes, all CGHS card holders including pensioners can claim medical reimbursement.
Download CGHS Medical Reimbursement Form
You can download the official CGHS Medical Reimbursement Form from:
- Official CGHS Website: cghs.gov.in
- Format: PDF
- Size: Approximately 200 KB
- Language: English and Hindi versions available
Official Sources and Contact Information
Central Government Health Scheme (CGHS)
- Official Website: https://cghs.gov.in
- Email: cghs-mohfw@nic.in
- Helpline: 1800-123-8900
- Address: Nirman Bhawan, New Delhi – 110011
CGHS Helpdesk Timings:
Monday to Friday: 9:00 AM to 5:30 PM
Conclusion
The CGHS Medical Reimbursement Form is a vital document for central government employees and pensioners to claim medical expenses. By following this comprehensive guide, you can ensure smooth processing of your reimbursement claims. Always keep original documents, submit claims within the stipulated time, and follow up regularly for faster processing.
For more government forms, calculators, and updates related to central government employees, visit our website regularly.