Medical Reimbursement Claim – Central Government Employees
By SPEED POST
F.No.D-12015/06/ 2020-Ad.IX
Government of India
Ministry of Finance
Department of Revenue
Central Board of Direct Taxes
Room No.10, 5th Floor,
Jeevan Vihar Building,
Parliament Street, New Delhi – 110001
Dated : 28.10.2020
To
All Principal Chief Commissioner of Income Tax
All Director General of Income Tax (Inv.)
Sub : Streamlining of procedure to process of medical reimbursement claim.
Sir/Madam,
It has been observed that the medical reimbursement claims are being received in the Board, are incomplete and not subjected to any initial check. As a result a lot of time is spent on further communications resulting in delay in settlement of the claim.
2. It has therefore been decided that in future all medical claim are to be submitted to the Board on the basis of the attached Check List with proper referencing of the documents with page number and Annexure.
3. Offices of the Pr. CCIT and DGIT (lnv.) are requested for wide circulation of this advisory amongst the all subordinate offices under their control.
Yours Faithfully
Biswajit Guha
Under Secretary to the Govt. of India
Telefax: 011-23741823
Copy to : IFU/DT for information
Reimbursement of medical claims to pensioners residing in non-CGHS areas – DoT
CHECK LIST FOR PROCESSING MEDICAL CLAIM
Name & Designation of the Claimant: —————-
Office where working: —————-
Name of Patient & relationship with claimant: —————-
| S.No. | Detail about the claim | Remark | Page No.I Annexure |
| 1 | Whether the patient is a CGHS beneficiary availing benefits under the Scheme. If, so whether a copy of the CGHS Card is enclosed. | Yes/No | |
| 2 | In case of non-CGHS beneficiary, whether an AMA was appointed, and if so, whether the Appointment Order of AMA is enclosed. | Yes/No | |
| 3 | Whether Medical Claim Form (duly filled in) has been submitted | Yes/No | |
| 4 | Whether the claim was submitted within the stipulated period of three months from the date of discharge from the hospital. | Yes/No | |
| 5 | If delayed, whether reasons for delay beyond 3 months was intimated. | ||
| 6 | Name of Hospital from where the treatment was taken/is being taken. | ||
| 7 | Whether the treatment was obtained from a Government Hospital or CGHS empanelled Private Hospital. | Government Hospital/ CGHS Empanelled Hospital/Non- empanelled hospital | |
| 8 | In case of CGHS empanelled hospital, whether a copy of the Order/OM is enclosed. | Yes/No | |
| 9 | Whether the case was referred by CGHS Doctor/AMA. If so, whether a copy of the ‘Referral slip’ is enclosed. | Yes/No | |
| 10 | In case of treatment was obtained from a Private hospital under emergency, whether Emergency Certificate is enclosed in original. | Yes/No | |
| 11 | Whether the permission was taken from the concerned office. If so, whether a copy of ‘Permission letter’ is enclosed. | Prior permission or Ex-facto permission | |
| 12 | Disease(s) being treated | ||
| 13 | Whether the claim for reimbursement has been approved by the H.O.D. | Yes/No |
| 14 | Details of payments made by the employee. | ||
| 15 | Whether the treatment was obtained on credit basis. If so, whether a copy of the permission given by his/her office. | Yes/No | |
| 16 | Whether ‘prescription slips’ of ‘day-to-day report’ of the treating doctor/hospital are enclosed. | Yes/No | |
| 17 | Whether the Medical Bills of the Hospital are enclosed in original and certified. | Yes/No | |
| 18 | Total amount of bills given by the Hospital | ||
| 19 | Whether the Discharged Summary has been enclosed in original. | Yes/No | |
| 20 | Whether a table indicating each item of expenditure charged by the hospital vis-a-vis actual admissible amount as per CGHS rate/CS(MA) Rules, duly authenticated by the HoD concerned has been forwarded with the claim. | Yes/No | |
| 21 | Amount admissible for reimbursement as per CGHS/CS(MA) Rates. | Rs. | |
| 22 | A copy of CGHS rate list highlighting the treatment procedures done in the hospital. | Yes/No | |
| 23 | Outer Pouch of the Stents used for the patients in the hospital is/are enclosed in original. | Yes/No/N.A. | |
| 24 | A copy of Death Certificate was furnished (in case of death). | Yes/No/N.A. | |
| 25 | Affidavit on Stamp paper was submitted by the Claimant (in case of death) | Yes/No/N.A. | |
| 26 | Whether any medical advance was sanction. If so, the amount sanctioned and a copy of the Sanction Order to be enclosed. | Yes/No | |
| 27 | Net amount to be sanctioned (after adjustment of Medical Advance, if sanctioned) | Rs. | |
| 28 | Whether a self explanatory letter from the beneficiary if treatment taken in emergency has been enclosed. | Yes/No |
CHECK LIST FOR PROCESSING MEDICAL ADVANCE
Name & Designation of the Claimant:
Office where working:
Name of Patient & relationship with claimant:
| S.No. | Detail about the claim | Remark | Page No. |
| 1 | Whether the patient is a CGHS beneficiary availing benefits under the Scheme. If, so whether a copy of the CGHS Card is enclosed . | Yes/No | |
| 2 | In case of non-CGHS beneficiary, whether an AMA was appointed, and if so, whether the Appointment Order of AMA is enclosed. | Yes/No | |
| 3 | Name of Hospital from where the treatment is being taken/proposed to be taken. | ||
| 4 | Whether it is a Govt. Hospital or CGHS empanelled private hospital or Non-CGHS empanelled hospital | ||
| 5 | In case of CGHS empanelled hospital, whether a copy of the OM of its empanelment is enclosed . | Yes/No | |
| 6 | Whether the case was referred by CGHS Doctor/AMA. If so, whether a copy of the ‘Referral Slip’ is enclosed. | Yes/No | |
| 7 | Whether credit facility is extended to the patient. | Yes/No | |
| 8 | Whether approval of H.O.D. was obtained. | Yes/No | |
| 9 | Estimated cost for the treatment given by the hospital. | Rs. | |
| 10 | Whether the admissible amount has been restricted as per CGHS rates I CS(MA) Rules I Govt. hospital rates. | Yes/No | |
| 11 | Amount of Advance admissible for sanction | Rs. |
Proforma for item-wise expenditure charged by the hospital vis-a-vis actual admissible amount as per CGHS rate/ CS(MA) Rules, duly authenticated by the HoD concerned
Name & Designation of the Claimant:
Office where working:
Name of Patient & relationship with claimant:
Name of the Hospital and address;
Duration of the Treatment:
| SI. No. | Items | Amount Charged | Amount admissible as per CGHS rate/ CS(MA) Rules | Remarks |
| 1) | Bed Charges | Annexure – 1 | ||
| 2) | ICU Charges | Annexure -2 | ||
| 3) | Doctors’ Visit | Annexure -3 | ||
| 4) | Medicines | Annexure -4 | ||
| 5) | Lab/ Test Charges | Annexure -5 | ||
| 6) | ||||
| 7) | ||||
| 8) | ||||
| 9) | ||||
| 10) |
Checked and verified by:
Signature with stamp
Certified and authenticated by HoD
Signature with stamp
Annexure
Proforma for Item-wise details
Name of item : Medicines
| SI. No. | Date | Name of medicines | CGHS Code | Amount Charged | Amount admissible as per CGHS rate / CS(MA) Rules | Remarks |
| 1) | ||||||
| 2) | ||||||
| 3) | ||||||
| 4) | ||||||
| 5) | ||||||
| 6) | ||||||
| 7) | ||||||
| 8) | ||||||
| 9) | ||||||
| 10) |
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