CGHS Reimbursement – How to file Claim for treatment in Non-Empanelled Hospitals?

1. Copy of CGHS card of patient (along with copy of CGHS card of principal cardholder if patient is other than the principal cardholder)
2. Copy of permission letter, if any
3. Emergency certificate (in original), in case of emergency admission
4. Copy of discharge summery
5. Ambulance use certificate (original), if any
6. Original bills/vouchers/ cash memo etc. for the amount claimed

Other information/documents to be provided wherever applicable- 

1. Break up of investigations /tests (details of individual tests, number of tests with rates) from hospital.
2. In case of lost papers, photo copies/ duplicate copies of bills attested by treating doctor along with affidavit in prescribed format to be submitted
3. In case of death of principal cardholder affidavit as per prescribed format to be enclosed
4. In case partial settlement of claim by any insurance agency, copies of bills duly endorsed by insurance agency, mentioning that original bills have been retained by them and amount of claim settled by the agency, to be submitted.
5. The documents to be attached in case- (I) if implant used- invoice number, sticker with serial number of implant (II) if coronary stent/ s used-outer pouch of stent/ s with sticker (III)when pacemaker/ ICD) replaced-copy of warranty certificate of earlier pacemaker/ ICD)
6. The bank details in the mandate form needs to be enclosed
7. The telephone number and email ID of the beneficiary should invariably be mentioned correctly.
8. Cancelled cheque/ Photocopy of a cheque needs to be enclosed