CGHS reimbursement: file, track and challenge a deduction

A CGHS reimbursement claim succeeds or fails on the applicable beneficiary route, proof of treatment and a readable bill trail. Do not rely on an old cghs.gov.in bookmark or a universal processing promise. Use the current CGHS portal, identify whether the claimant is a serving employee or pensioner, submit promptly with the published checklist, and retain a complete copy with an acknowledgement.

Searches for how to claim CGHS reimbursement, CGHS medical reimbursement form and CGHS pensioner reimbursement are looking for the form name, the bill pack and the receiving office — not a private “claim agent”.

Do not copy another beneficiary's filing route. Put the claimant into the correct category before completing the form.

The distinction matters because deadlines and receiving authorities depend on the beneficiary category and governing instructions. An old CS(MA) order or another claimant's checklist is not proof of one universal deadline for every CGHS pensioner or every treatment.

For a card that is inactive, expired or not transferred after a city change, first restore entitlement. See how to apply or renew a CGHS card and CGHS card documents. Card status is a separate check: CGHS card status.

Common claim situations include emergency treatment, an authorised referral, treatment where the applicable CGHS process permitted reimbursement, or expenses that were not settled through cashless billing. The result is fact-specific.

• Cashless at a CGHS-empanelled hospital is the first preference for planned care. If the hospital is empanelled and refuses cashless for an entitled beneficiary, keep the refusal in writing and complain to the Additional Director CGHS of the city; reimbursement is then a fallback, not a licence to skip empanelment. Empanelment disputes are a different file: RTI for CGHS empanelment.
• Planned treatment at a non-empanelled hospital is not a routine cash-and-claim route. The published CGHS reimbursement checklist expects an original permission letter where prior permission was required, plus a signed explanation of why the patient went outside the network.
• Emergency at a non-empanelled hospital is the classic medical-reimbursement case. Calling treatment an “emergency” in a covering letter is weaker than a hospital record created when the patient arrived.
• Treatment outside India needs a special Ministry sanction. Do not assume an ordinary MRC will cover it.

For emergency treatment at a non-empanelled hospital, preserve contemporaneous evidence such as:

• the emergency or casualty record and time of admission;
• the original emergency certificate;
• the doctor's first assessment and diagnosis;
• ambulance record, if any;
• the discharge summary and procedure notes;
• an explanation of why delay or transfer was unsafe;
• itemised bills and proof of payment.

Do not alter a discharge summary or ask a hospital to backdate a certificate.

This is the practical how to claim CGHS reimbursement sequence. Use the receiving office's current checklist if it differs on a detail.

Tell the hospital you are a CGHS beneficiary at admission. If the hospital is empanelled, ask whether cashless can still be opened. If it cannot, pay and keep every original.

Ask the treating doctor, in an emergency, to record that the admission was emergency in nature, with reasons, in the admission note and discharge summary. Collect:

• itemised hospital bills — room, OT, surgeon, investigations, drugs, consumables — not a single lump-sum total;
• original cash memos and payment receipts (every test, every pharmacy slip);
• discharge summary with diagnoses and procedures;
• investigation reports tied to the bills;
• for implants, devices or stents: the invoice, batch or serial sticker, and for coronary stents the outer pouch, as the MRC form itself lists;
• referral or permission letter, if any;
• ambulance certificate, if claimed.

Photocopies in place of originals are a classic rejection. If an original is lost, the MRC form requires an affidavit in the prescribed annexure and treating-doctor attestation of the photocopies — do not invent a receipt.

CGHS has long used separate forms: MRC(S) for serving employees and MRC(P) for pensioner beneficiaries. Ministry instructions have also referred to the pensioner form as Form MRC(P) / Annexure A. Download from the current portal's downloads, not from a random PDF farm, and fill in BLOCK LETTERS as the form asks.

On the form, record:

• CGHS card number of the principal cardholder and of the patient;
• hospital name, dates of admission and discharge;
• whether the claim is OPD, indoor or investigations;
• total amount claimed, broken into the form's heads;
• bank name, account number and IFSC for e-payment;
• email and mobile number of the claimant;
• whether any medical advance was taken.

The official CGHS reimbursement checklist on the (legacy) CGHS procedure page, still the published document list used with MRC packs, says the claim is to be submitted within 3 months of discharge — serving employees to the concerned department, pensioners to the CMO-in-charge of the Wellness Centre where the card is registered. The same checklist asks that a delay of more than 90 days from discharge or treatment state the reason clearly with a request for condonation of delay.

That is a sourced CGHS checklist instruction, not a guarantee that every office will apply the same clock, and not a CS(MA) rule copied onto every pensioner. Submit without avoidable delay. If the receiving office rejects the claim as late, ask it to cite the exact current order.

A Ministry of Health and Family Welfare office memorandum dated 28 June 2024 restated the pensioner path: submit Form MRC(P) with original vouchers to the CMO-in-charge; the Wellness Centre checks the prescribed checklist (Annexure B in that OM), issues a dated acknowledgement, and generates an MRC Claim ID made available by SMS. Serving employees continue through the department unless a current instruction says otherwise.

The published checklist wants a duplicate set of the whole claim with page numbers. Number every page, add a one-line index of receipts with bill numbers and a claimed total, and scan the packet before you surrender originals.

For a physical submission, obtain a dated acknowledgement showing the recipient, page count and claim or diary number. For an online upload, save the final receipt, uploaded-file list and status screen. If the portal rejects a file, record the error and use the helpdesk or permitted physical route instead of creating duplicate claims with different totals.

Use this as a working index. The receiving authority's current checklist controls; the published CGHS MRC pack and Form MRC(S)/(P) notes ask for most of the following, self-attested, in sequence, with page numbers:

If original bills are lost, the MRC form requires an affidavit in the form's annexure and treating-specialist attestation of photocopies. If the cardholder has died, use the death annexure on the form; do not sign as the deceased.

Official Central Government hospital sites also publish medical-reimbursement forms, but they do not override the CGHS or departmental checklist for a CGHS claim.

The Ministry moved CGHS services and information to cghs.mohfw.gov.in from 28 April 2025; the older cghs.gov.in and cghs.nic.in sites were retired. Use the beneficiary login, city office details and help material on the current portal. Download MRC forms from the current downloads section even if an older circular still prints the old domain.

For a pensioner, the 28 June 2024 OM is the current published Wellness-Centre path. For a serving employee, the bill section of the office is still the usual receiving authority. Do not file a pensioner MRC(P) in a serving employee's department file, or the reverse, unless a current instruction expressly allows it.

Reimbursement is not automatically the hospital's full invoice. The authority may apply a notified package or item rate, eligibility restriction, non-admissible item rule, entitlement category or an emergency-treatment guideline. That does not permit an unexplained lump-sum deduction.

Ask for a claim-wise calculation containing:

1. amount claimed;
2. amount admitted for each major item or package;
3. rate or order applied;
4. amount disallowed and reason;
5. sanction and payment reference.

There are Ministry guidelines for considering reimbursement above approved rates in qualifying cases. Do not promise that an excess amount will be allowed. Put the exceptional medical facts and documents on record and request consideration under the current applicable instructions.

A PIB release on CGHS package-rate revision records that reimbursement follows the notified process and rates. If you believe a newer OM rate was not applied, ask for the package code and the OM used, then file a reconsideration on that paper — not a second original claim with a different total.

Searches for CGHS claim status and CGHS medical claim status want the Claim ID, not a rumour that “30–60 days is guaranteed”.

The official myCGHS services include medical reimbursement claim status, and the newer platform advertises real-time tracking. The 28 June 2024 OM says pensioner MRC status can be viewed on the CGHS web portal or the myCGHS app using the Claim ID generated at submission. Record each visible status with a date.

For an administrative delay, first use the CGHS helpdesk or grievance route and the employing department, as applicable. A CPGRAMS grievance to the Ministry of Health and Family Welfare can document prolonged service failure, but it is not a substitute for the medical-claim procedure and does not guarantee sanction.

A returned claim is usually a missing original, an uncertified emergency, an illegible investigation, a missing implant sticker, or a late filing without condonation. Answer the deficiency memo in writing, attach only what was asked, and quote the Claim ID. Do not start a parallel claim with a new total.

If reimbursement is less than expected:

• ask for the calculation worksheet and the package code or OM applied;
• check whether an excluded item (comfort item, room-rent above entitlement, unlisted disposable) was stripped — that is a rule question, not a negotiation;
• if a newer rate OM was in force on the treatment date and was not used, file a reconsideration citing that OM;
• keep the gap question separate from delay: rates can be correct even when processing is slow.

Empanelled hospitals that take cash from an entitled CGHS patient contrary to the empanelment terms should be reported to the Additional Director CGHS of the city with the admission papers. That complaint does not by itself raise the reimbursable rate.

An RTI application cannot require a doctor or sanctioning authority to approve a claim. It can obtain existing records that reveal where the file stopped and why. File with the public authority that actually holds the file — typically the Additional Director CGHS of the city, the Wellness Centre's parent office, or the CPIO of the employing department for a serving-employee claim. See RTI for a CGHS card or claim file and how to file RTI online.

Ask for certified copies of:

• diary and movement entries for the claim number;
• deficiency memo, scrutiny sheet and calculation sheet;
• note sheet and approvals concerning the claim;
• sanction, rejection or closure order;
• rule, Office Memorandum or rate list relied upon;
• payment advice or return memo;
• name and designation of the section currently holding the file;
• dispatch register entry if a query memo was allegedly issued but never received.

Do not ask, “Why have you harassed me?” Ask for the record in which the reason was recorded. Use the first-appeal guide if the records are withheld.

To: Central Public Information Officer
Office of the Additional Director, CGHS [city] / [employing department]

Subject: Request under section 6(1) of the RTI Act, 2005 — MRC / claim no. [number]

Please provide certified copies of the following records relating to medical
reimbursement claim no. [number], beneficiary [name], CGHS card no. [number],
hospital [name], admission [date] to discharge [date]:

1. Date-wise diary and movement entries of the claim file.
2. Deficiency memo, scrutiny sheet and rate-calculation worksheet.
3. Note sheet and orders of sanction, part-admission, rejection or closure.
4. The Office Memorandum, package code or rate list relied upon for each
   major deduction.
5. Payment advice, PAO reference or return memo, if any.
6. Name and designation of the officer currently holding the file.
7. Dispatch particulars of any query memo said to have been issued to me.

Please transfer any part held by another public authority under section 6(3).

To: CMO In-charge, CGHS Wellness Centre [name] /
    Bill / Establishment Section, [department]

Subject: Medical reimbursement claim — CGHS card [number] — [patient name]

I am a CGHS [serving employee / pensioner] beneficiary. [Patient] was
admitted at [hospital] from [date] to [date] for [diagnosis / procedure].
This was [emergency / authorised referral / other — state facts]. Original
emergency certificate / permission letter is enclosed.

Amount claimed as per the attached MRC form and receipt list: Rs [amount].
Bank details for e-payment are on the form and the cancelled cheque.

The packet is page-numbered 1 to [n]. A duplicate set is enclosed. Please
acknowledge with the Claim ID / diary number.

If any document is deficient, please issue a written memo. If this
submission is beyond the published window, I request condonation because
[specific reason and dates].

• Filing through an old CGHS domain instead of the current Ministry portal.
• Using MRC(P) on a serving-employee claim, or sending a pensioner packet only to the old department.
• Treating a CS(MA) deadline as a universal CGHS pensioner deadline without reading the current checklist.
• Submitting a single total bill without itemisation, break-up of tests, or payment proof.
• Omitting the first emergency record or original emergency certificate for non-empanelled treatment.
• Missing implant invoices, batch stickers or stent pouches.
• Sending originals without retaining a scan, page index and acknowledgement.
• Accepting an oral deduction without asking for the calculation and rule.
• Filing repeated duplicate claims with different totals.
• Asking RTI to order payment instead of requesting the claim records.

No. Emergency facts, beneficiary entitlement, the applicable instructions, records and CGHS rates all matter. Preserve evidence created at admission.

The published CGHS checklist uses three months from discharge and asks for a condonation request if you are more than 90 days late. Serving-employee departments may cite their own order. Submit promptly and ask the authority to cite the exact current instruction if it raises limitation.

MRC(S) for serving employees and MRC(P) for pensioners, from the current CGHS downloads. Do not rely on an unofficial “Annexure-A” PDF that does not match the live form.

Use cghs.mohfw.gov.in. The Ministry announced that the older cghs.gov.in and cghs.nic.in sites would be deactivated from 28 April 2025.

Normally no. A serving employee should follow the employing department's administrative and bill route unless a current instruction expressly provides otherwise.

Not automatically. Applicable package rates and admissibility rules can limit payment. Ask for an itemised deduction calculation.

Ask the receiving authority which duplicate-bill declaration and hospital certification it accepts. The MRC form itself provides an affidavit annexure. Do not create or alter a receipt.

Use the Claim ID from the acknowledgement on the current CGHS portal or myCGHS app. Record the status wording and date. If the screen is blank, write to the Wellness Centre or Additional Director with the acknowledgement.

CPGRAMS can route a service grievance. The competent CGHS or departmental authority still decides the medical claim under the applicable rules.

Ask for movement entries, scrutiny and calculation sheets, note sheets, the decision, the relied-upon order and payment record for your claim number.

• Apply or renew a CGHS card
• CGHS card documents
• Check CGHS card status
• When a CGHS or ECHS claim is returned for deficiency
• RTI for a CGHS card or claim
• RTI for CGHS empanelment
• File and track a CPGRAMS grievance
• File an RTI application online
• How to file a first appeal
• Use RTI to trace a payment file
• CPENGRAMS for a central pension
• Citizen RTI playbook
• RTI Wiki home

• CGHS unified digital platform
• PIB: launch and migration to the new CGHS platform, April 2025
• PIB: myCGHS services including medical-claim status
• PIB: CGHS package-rate revision and reimbursement process
• MoHFW OM 28 June 2024: procedure for pensioner MRC(P) submission and Claim ID tracking
• Official Central Government hospital forms and formats