Medical Reimbursement Form for Government Employees

Download Medical Reimbursement Form for Government Employees 

This is a Medical Reimbursement application form for the claim of medical expenses incurred by an individual for the treatment of their family at cash. The medical reimbursement PDF form can be downloaded at the bottom of the page. Medical reimbursement is a facility in which employers reimburse employees for any general medicine or accident expenses not covered by their insurance.

Employers are legally required to pay for the portion of their employee’s medical expenses. However, a doctor’s certificate is typically needed before a reimbursement claim can be made. The Income Tax Act also exempts up to INR 15,000 towards medical reimbursements paid by employers. It is certified that the case did not require hospitalization but is one of prolonged nature, requiring medicine attendance at the our-patient department spreading over a period of more than 10 days.

Required Documents for Medical Reimbursement

• Medical Reimbursement Application Form
• Hospital Discharge Summary (Original)
• Case receipts from hospitals or chemists.
• Health Card Copy
• If an accident happens, then FIR or medico-legal certificate(MLC)

Medical Reimbursement Form for Government Employees PDF Download Link

Download Medical Reimbursement Form for Government Employees