Reimbursement of Medical Claim-CPWD

Reimbursement of Medical Claim-CPWD

File No. 1(17)/Bt/2015/(DGW)/Med. Misc/173
Ministry of Urban Development
DG, CPWD,
(Budget Section)
Nirman Bhawan, New Delhi.

Dated the March 2015.

Subject :- Reimbursement of Medical Claim Cases (MRC( are received in IFD/CPWD are forward of this office in a very casual manner causing delay in final settlement of claims of individuals. In order to process all (MRC) case in time and smooth manner, it is expected that following check list may be adhere to before sending the cases to this office for all due examinations according the Central Government Medical Attendant Rules.

Reimbursement of Medical Claim

It is observed the Medical Reimbursement

It is observed the Medical Reimbursement Cases (MRC( are received in IFD/CPWD are forward of this office in a very casual manner causing delay in final settlement of claims of individuals. In order to process all (MRC) case in time and smooth manner, it is expected that following check list may be adhere to before sending the cases to this office for all due examinations according the Central Government Medical Attendant Rules.

(i) The copy of new CGHS Card validity.
(ii) The Original Bills along with discharge/Death summary from the Hospital
(iii) Emergency Certificate in original from Hospital should be signed by the attending medical authority with stamp and date.
(iv) Copy of Permission letter from the concerned office.
(v) In cases of death of CGHS Card holder following documents as prescribed in the modified checklist:-

(a) A copy of Death Certificate
(b) Affidavit on Stamp Paper by the Claimant attested by the Notary.
(c) No objection from other legal heir on Stamp Paper.

(vi) Whether any advance was granted in the Medical Reimbursement Claim? If so, provide the details of the same and under which rules the facility was allowed to the applicant.
(vii) Whether Credit Facility was granted for the treatment? If so, provide the details of the same and under which rules the facility was allowed to the applicant.
(viii) It has to be mentioned by the forwarding/concerned office (Chief Engineer) as to whether the funds are available with them and the amount claimed for reimbursement is as per the CGHS prescribed rate or not and it has also need to be clarified that there is no need to relaxation of rules in the instant case.
(ix) All relevant OMs pertaining to the case (item- wise reimbursement) may be placed in the file and subsequent clarificatory OMs issued by the Ministry of Health and Family Welfare.
(x) The case required to be submitted in line with the guidelines issued by the Ministry of Health and Family Welfare. The case may be submitted with the details of amount charged by the Hospital Indicating the SI. No. of the CGHS items with relevant instructions and thus arriving at the amount admissible as per the format below:-

Sl. No.	Particular/Name Item Sl. No. of CGHS items list with extract	Amount claimed	(Quantity X CGHS Rates)	Extract of relevant of instructions of CGHS placed at Flag	Amount admissible as per CGHS rates.
1.
	Total

(xi) Entitlement of various types of wards to CGHS Beneficiaries.
(xii) Availability of Budget may be confirmed by the Division concern on the basis of allocation as below:-

1. Budget Available (if all previous files approved or in process files with IFD, CPWD cleared/settled).
2. Total files approved by IFD, CPWD and pending for payment with amount.
3. Total files pending/in process with IFD with amount.

(Ashish Kumar Singh)
Director (Finance)