Central Government Health Scheme (CGHS Mumbai)

Guidelines

We, at MRC section of the CGHS Mumbai strictly follow the laid down Ministry’s guidelines and every effort is made to reimburse the admissible amount as early as possible by following the applicable CGHS rates. We seek your kind cooperation in this regard by adhering to guidelines issued from time to time.

  • MRC will not be accepted in the Administrative Head Office of CGHS. Pensioners and CGHS staff should submit it online in their parent Wellness Centre.
  • The other city card holders are also requested to submit the claims preferably at the parent Wellness Centre of their respective CGHS city.
  • It is the responsibility of the claimant to provide all the required documents.
  • Arrange all the bills in chronological order and prepare a summary of all bills.
  • No payment can be made against Provisional or Running or Intermediate or Interim bills.
  • No payment can be made against photocopies of the bills.
  • Medicines prescribed in OPDs cannot be reimbursed because they should be collected from Wellness Centres.
  • It is mandatory to submit original invoice for reimbursement of Implants/ Stents/ Costly Medicines, etc.
  • Non-medical expenses are not covered under CGHS and hence expenditure incurred in this regard is not admissible as per CGHS Guidelines.
  • Kindly enclose the original paid proof for all the bills enclosed unless enclosed bill is "bill cum receipt".
  • A xerox set of all the documents submitted at the Wellness Center should be kept by the beneficiaries themselves for easy reference in future.
  • Amount claimed, actual amount paid to hospital (receipts) and the hospital final bill amount should tally.
  • Reimbursement is subject to examination of the case by technical screening committee.
  • All Documents should be submitted in duplicate. However, it is advisable to keep yourself, one set of all claim documents for your reference. However, in case of bills above Rs 7 lakhs submit three copies as the bill has to be forwarded to ministry for necessary financial approval.
  • Kindly make use of nomination facility.
  • Kindly enclose the bank NEFT details (only of the principal card holder) as the payment is settled by Electronic clearing system.
  • In order to minimize the economic burden on the beneficiary, it is preferable to take treatment in Govt. Hospitals/ CGHS empaneled HCOs on the advice of Govt. Specialists opinion instead of in Non-Empaneled HCOs who charge as per their rates. Cashless facility is available at empaneled hospitals even in emergency cases.

Guidelines for settlement of Medical claims of pensioners and others 

Guidelines for settlement of MRCs - particularly full reimbursement cases (June 2018) OCR(58.1KB) 

Simplification of Procedure for Treatment at Private Hospitals (OM) 

Simplification of Referral System under CGHS (Jan 2018) 

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