In case of treatment in an emergency at a non-empaneled hospital or when expenses are incurred at an empaneled hospital, the beneficiary must submit a Medical Reimbursement Claim (MRC) to get reimbursed, according to rules framed by the government for the Central Government Health Scheme (CGHS).
Submission of reimbursement claim
Serving employees are required to submit the claim to their concerned department. Pensioner beneficiaries must submit it to the CMO I/C of the CGHS Wellness Centre where their CGHS card is registered. This must be done within 6 months of discharge from the hospital.
If the claim is delayed beyond 6 months, the beneficiary must provide a justification for the delay in a forwarding letter. The claim must be submitted in duplicate using the prescribed form, according to CGHS rules.
“The claim is to be submitted at the CGHS wellness Centre where the beneficiary is registered. On verification as per check list if the claim is found to be complete with all documents then an acknowledgement will be generated with a claim number in the computer module of the wellness Centre,” the rule says.
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Claim acknowledgement and follow-up
Pensioner beneficiaries and serving CGHS employees need to submit their claims at the CGHS Wellness Centre where they are registered. After verifying the claim and its documents as per the checklist, an acknowledgment with a claim number will be generated in the CGHS computer module.
Beneficiaries can use the claim number to track the status of their claim in the CGHS computer module. Additionally, they will receive SMS updates at every stage of the MRC processing.
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