I have a Mediclaim Insurance Policy. Due to emergency, I received treatment in a private hospital. Some amount was paid by Insurance Co.
Can I get balance from CGHS?
Yes, first the bills are to be submitted to Insurance Company. Duplicate bills and vouchers duly verified with the stamp of Insurance Company along with a certificate from Insurance Company indicating the amount for which the beneficiary has received credit from them, needs to be submitted along with the usual MRC forms and checklist. These may be submitted to CGHS by Pensioner CGHS beneficiaries and to the department by serving beneficiaries. Reimbursement would be done at CGHS rates or actual whichever is less. However, the total reimbursement from both sources should not exceed actual expenditure.
I submitted MRC for Rs. 1 Lac 20 thousand but I was reimbursed
only Rs. 45,800/-. Why total amount was notreimbursed?
Expenditure for treatment in private hospitals is considered only if the
treatment was taken under emergency. Reimbursement is done at CGHS approved rates and as per CGHS guidelines.
In emergency who are all entitled to get treatment at Private
Any beneficiary holding a Valid CGHS card.