Central Government Health Scheme (CGHS Mumbai)

Check List for reimbursement of claims

  • Self-explanatory note (explaining the emergency circumstances).
  • Claim form duly signed by the claimant.
    • Only the principal card holder can claim.
    • If principal card holder is no more:
      • The spouse can claim
      • Dependents can claim after enclosing affidavit/legal heir certificate along with NOC from other legal heirs
      • Nomination is only for receiving the amount towards already submitted claim
      • Any of the other relatives (who claim to be legal heir) can claim but they have to enclose legal heir/ succession certificates along with NOC from other legal heirs
  • Emergency certificate.
  • Referral letters/permission letters/govt doctors advise wherever applicable.
  • Discharge Summary (detailed OT notes are required in case of uncoded procedures/ complicated procedure /if two or more procedures are performed)
  • Bills:
    • Summary of all bills being claimed
    • Consolidated Bills
    • Detailed bills including all break up details
    • All bills to be arranged chronologically and numbered
    • If outpatient emergency treatment was obtained prior to being admitted, a separate claim should be submitted.
    • Please ensure that total of all bills enclosed matches with the amount being claimed.
  • Original Invoice (collected from hospital) towards implants/stents/valves/ costly medications etc. In case of bulk purchase, photocopy of the invoice highlighting the item used and the rate, certified by the treating doctor that the same was implanted during the procedure and is functioning well.
  • Original Payment receipts matching with amount claimed.
  • Investigation reports.
  • If original documents/bills are lost, then affidavit in prescribed format to be enclosed.
  • In cases of claim from CGHS after claiming from any health insurance, following documents collected from the insurance company (not from hospital) are to be enclosed.
    • Certificate from insurance company addressed to CGHS indicating the amount claimed (as per the bills submitted to insurance company) and the total amount finally settled. Kindly do not enclose preauthorization letters or mails.
    • Photocopies of all documents including vouchers/ bills duly certified in ink along with stamp of the insurance company.
  • Enclose the Bank NEFT details (bank mandate form / cancelled cheque) of the claimant. Do not enclose NEFT details of any other person as the ECS PAYMENT fails due to name mismatch.

Check-List-For-MCR.pdf(206 KB) 

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