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+{{htmlmetatags>metatag-keywords=(CGHS reimbursement claim,Central Government Health Scheme 1954,MR Medical Reimbursement form,Annexure-A CGHS,non-empanelled hospital reimbursement,CGHS emergency treatment,CGHS rates approved package,CGHS Additional Director,cghs.gov.in claim,CGHS pensioner reimbursement,90 days CGHS deadline,CGHS Manual 2024,CGHS Beneficiary Grievance Cell,RTI for CGHS,MoHFW CPGRAMS health)&metatag-description=(Step-by-step 2026 guide for central government employees and pensioners to claim CGHS medical reimbursement (MR) — for emergency or specialty treatment at non-empanelled hospitals. File the MR claim within 90 days of discharge with full bills, discharge summary, and investigation reports. Covers CGHS rate vs hospital bill gap, the 30-60 day settlement window, escalation to Additional Director and CPGRAMS, and the RTI route to CGHS PIO when claims stall.)}}
+====== How to claim CGHS reimbursement — complete 2026 guide ======
+{{ :social:auto:claim-cghs-reimbursement-2026.png?direct&1200 |How to claim CGHS reimbursement 2026 — RTI Wiki citizen guide}}
+{{page>snippets:dpdp-banner}}
+<WRAP info>
+**Quick answer.** As a CGHS beneficiary (serving central govt employee, central pensioner, sitting MP, or eligible family member of any of these), you can claim **medical reimbursement (MR)** for treatment at a **non-empanelled hospital** when (a) it was a genuine **emergency**, or (b) the required specialty was **not available** at any CGHS-empanelled hospital in your area and you took **prior permission**. File the **MR claim (Annexure-A)** within **90 days of discharge** — at your CGHS Wellness Centre dispensary, online at **cghs.gov.in**, or at the office of the **Additional Director CGHS** for your city. Settlement SLA: **30-60 days**, with credit to your bank account. You will be reimbursed at **CGHS approved rates** — not the actual hospital bill — so a gap (sometimes 30-50% of the bill) may remain unrecoverable; that gap is borne by the beneficiary. CGHS helpline 011-2306 1611 / your city CGHS HQ. Statutory anchor: CGHS Scheme launched **1954** under the Ministry of Health & Family Welfare; current **CGHS Manual 2024** + several MoHFW Office Memoranda on rates and procedures.
+</WRAP>
+===== S. Krishnan's story — "₹2.85 lakh angioplasty bill, six months pending, RTI got it moving" =====
+<WRAP center round box 80%>
+//S. Krishnan, 62, retired Joint Director (central government, Ministry of Defence), CGHS pensioner, lives in Adyar, Chennai. Active CGHS card. Suffered a sudden chest pain on 14 September 2024, was rushed to the nearest hospital — **Apollo, Greams Road** — which is not on the Chennai CGHS empanelled list for cardiology procedures. Underwent emergency angioplasty with two stents on 15 September. Discharged 19 September. Total bill: ₹2,85,000.//
+> "Apollo gave me a clean discharge summary and itemised bills. I downloaded the MR form (Annexure-A) from cghs.gov.in, attached every original bill, the discharge summary, the angiography and stent invoices with batch numbers, the cardiologist's emergency note, and my CGHS card copy. I submitted at the CGHS Wellness Centre at Anna Nagar on 7 October 2024 — within the 90-day window. I got an acknowledgement with file number. Then silence. I called the city CGHS office every two weeks. Always 'under processing'. CPGRAMS ticket I filed in December got auto-marked 'resolved' on 8 January 2025 with one line: 'Claim under process at AddDir CGHS office.' Six months gone. On 25 March 2025 I sent a one-page RTI by Speed Post to the PIO at CGHS Chennai. Three questions: (1) the current file noting and date of last action on MR claim file no. CHN/MR/2024/4823; (2) the name and designation of the dealing officer; (3) the rule under which the claim has been kept pending beyond 90 days. ₹10 IPO + ₹52 Speed Post = ₹62. Reply on day 25 (19 April 2025): 'File pending due to query on investigation report dated 15 Sept 2024 — query memo issued by AddDir on 12 Dec 2024, no reply received.' I was floored — that report was already in my original submission packet. I attached it again with a covering letter. Reimbursement was sanctioned on 30 April 2025 — ₹1,95,000 at CGHS rates. The gap of ₹90,000 came out of my own pocket. **Without that ₹62 RTI, I'm convinced the file would still be lying on someone's desk.**"
+—S. Krishnan, May 2025
+</WRAP>
+CGHS covers around **44 lakh beneficiaries** (CGHS Annual Report 2023-24) across **80 cities** through 350+ Wellness Centres. The MR (Medical Reimbursement) bucket — non-empanelled and emergency claims — accounts for about **8-12% of total CGHS claims** but contributes **disproportionately** to grievances. The single biggest issue is the **gap** between actual hospital bills and CGHS approved rates, which is **statutorily unrecoverable** — beneficiaries should choose CGHS-empanelled hospitals for planned procedures whenever possible.
+===== What this is — and the legal framework =====
+The Central Government Health Scheme was launched on **1 July 1954** under the Ministry of Health & Family Welfare (MoHFW) for central government employees and their dependents. It is governed by:
+  * **CGHS Manual 2024** (revised) — the operational rulebook; covers eligibility, package rates, MR procedure, escalation.
+  * **MoHFW Office Memoranda** issued from time to time — fixing CGHS rates for procedures (the "CGHS approved rate" list), revising package rates for surgeries, and updating empanelment criteria.
+  * **Section 17(2)(viii) of the Income Tax Act 1961** — exempts medical reimbursement (treatment at govt or empanelled hospital) from "perquisite" tax.
+  * **Article 21** — Supreme Court has held in //State of Punjab v. Mohinder Singh Chawla (1997)// and //Confederation of Ex-Servicemen Associations v. UoI (2006)// that emergency healthcare is part of the right to life; reasonable reimbursement at non-empanelled hospitals in emergencies is a constitutional obligation.
+===== Eligibility — who can claim =====
+  * **Central Government employees** in Delhi/NCR + 80 covered cities, plus all-India for entitled categories.
+  * **Central Government pensioners** (with valid CGHS pensioner card; one-time/lifetime contribution paid).
+  * **Family members** — spouse + dependent children (up to age 25 or until employed/married) + dependent parents (income limit applies — currently ₹9,000/month + DA per OM 2024).
+  * **Sitting MPs and family** (Diplomatic Wing).
+  * **Specified autonomous bodies' employees** (per separate OMs).
+  * **Ex-Governors / former Vice Presidents / former Judges of SC and HC** (specified categories).
+You must hold a **valid (active) CGHS card**. If your card has expired or you've shifted cities without transferring the card, the Wellness Centre can refuse the MR submission.
+===== When you can claim MR (and when you cannot) =====
+  * **Cashless at CGHS-empanelled hospital** — first preference. No reimbursement claim needed; the hospital bills CGHS directly. Use cghs.gov.in → "Empanelled Hospitals" search.
+  * **Planned treatment at non-empanelled hospital** — allowed only with **prior permission** from the AddDir CGHS, granted when (i) specialty unavailable in CGHS empanelled list locally, or (ii) surgeon-specific request with justification. MR claim filed after treatment.
+  * **Emergency at any hospital (CGHS or non-CGHS)** — full MR claim, no prior permission needed. The hospital must certify "treatment was emergency in nature" in the discharge summary.
+  * **Treatment outside India** — requires special MoHFW sanction (super-specialty cases only).
+  * **Cosmetic procedures, infertility treatment beyond IVF (capped), dental cosmetic work** — NOT reimbursable.
+  * **Treatment at unrecognised / non-allopathic facility without specific CGHS recognition** — NOT reimbursable.
+===== Step-by-step process =====
+==== Step 1 — During treatment: get the right paperwork ====
+This is what determines whether your claim succeeds:
+  * Inform the hospital you are a CGHS beneficiary at admission (some empanelled hospitals will switch you to cashless).
+  * For emergency: ask the treating doctor to write **"emergency in nature"** explicitly in the admission note and discharge summary, with reasons.
+  * Ask for **itemised bills** — separate room rent, OT charges, surgeon fees, consumables, investigations, drugs.
+  * Collect **all original cash memos** (every test, every drug — even pharmacy slips). Photocopies are NOT accepted at CGHS.
+  * Ask for the **discharge summary** with all diagnoses (ICD-10 codes if possible) and procedures performed.
+  * If implants used (stents, lenses, prostheses): get the **batch number stickers + invoice** of the implant separately.
+==== Step 2 — Download and fill the MR form (Annexure-A) ====
+  * Go to **cghs.gov.in** → "Forms" → download **Annexure-A — Medical Reimbursement Claim Form**.
+  * Fill in CGHS card no., beneficiary name, employee/pensioner ID, hospital name, dates of admission/discharge, total bill amount, treatment summary.
+  * Attach: original bills + discharge summary + investigation reports + prescriptions + payment receipts + (if applicable) prior permission letter + (for death) death certificate + cancelled cheque of bank account where reimbursement should be credited.
+==== Step 3 — Submit within 90 days of discharge ====
+The **90-day window** starts from the **date of discharge**. Submission options:
+  * **CGHS Wellness Centre** of your registration. Take the original packet; the dispensary clerk verifies and gives an **acknowledgement with file number**. They forward to the city's CGHS office.
+  * **Online** at cghs.gov.in → Beneficiary Login → "Medical Reimbursement Claim" → upload scans (originals to be submitted physically within 7 days).
+  * **Office of the Additional Director CGHS** for your city — direct submission for high-value or escalated cases.
+If you miss the 90-day window, file with a **delay-condonation request** explaining the reason (continued hospitalisation, family bereavement, document delays from hospital). Condonation is granted by the AddDir on case-by-case basis but is not guaranteed.
+==== Step 4 — Internal processing ====
+  * Wellness Centre clerk → Chief Medical Officer (CMO) of WC → AddDir CGHS for sanction.
+  * Calculation done at **CGHS approved rates** (not actual bill). Procedure rates from the latest MoHFW package-rate OM apply.
+  * Investigation reports cross-checked; queries (if any) raised in writing to beneficiary.
+==== Step 5 — Sanction and credit ====
+  * Sanction order issued; copy goes to PAO (Pay & Accounts Office for serving employees) or directly to bank for pensioners.
+  * Credit to your registered bank account in 7-15 days post-sanction.
+  * Standard end-to-end SLA: **30-60 days**. In practice 60-120 days is more common for non-empanelled hospital cases.
+==== Step 6 — If reimbursement is less than expected ====
+  * The "gap" between hospital bill and CGHS rate is **statutorily unrecoverable** — section 17(2) tax exemption applies up to actual reimbursement only.
+  * If you believe the rate applied is wrong (e.g., a newer OM rate not used), file a re-consideration application within 30 days of sanction order.
+  * For excluded items (consumables, certain implants), refer to the latest MoHFW OM list of permissible items.
+===== Eligibility, documents and timelines — quick table =====
+<code>
++---------------------------+-------------------------+----------------------+
+| Item                      | Specifics               | Source / Anchor      |
++---------------------------+-------------------------+----------------------+
+| Eligibility               | Central Govt employee + | CGHS Manual 2024     |
+|                           | pensioner + family      | (revised)            |
+|                           | (income-tested parents) |                      |
++---------------------------+-------------------------+----------------------+
+| Filing window             | 90 days from discharge  | CGHS Manual 2024 §57 |
+|                           | (extendable on cause)   |                      |
++---------------------------+-------------------------+----------------------+
+| Prior permission needed?  | Yes for planned non-    | CGHS Manual 2024     |
+|                           | empanelled; NO for      |                      |
+|                           | emergency               |                      |
++---------------------------+-------------------------+----------------------+
+| Claim form                | Annexure-A (MR Claim)   | cghs.gov.in / WC     |
++---------------------------+-------------------------+----------------------+
+| Reimbursement basis       | CGHS approved rates,    | MoHFW package-rate   |
+|                           | NOT actual bill         | OMs (latest)         |
++---------------------------+-------------------------+----------------------+
+| Settlement SLA            | 30-60 days (60-120 days | CGHS Citizen Charter |
+|                           | typical for non-empan.) |                      |
++---------------------------+-------------------------+----------------------+
+| Credit mode               | Direct bank credit to   | -                    |
+|                           | beneficiary account     |                      |
++---------------------------+-------------------------+----------------------+
+| Tax on reimbursement      | Exempt up to actual     | §17(2)(viii) IT Act  |
+|                           | reimbursement           |                      |
++---------------------------+-------------------------+----------------------+
+| Helpline                  | City CGHS HQ + 011-2306 | cghs.gov.in          |
+|                           | 1611 (Delhi)            |                      |
++---------------------------+-------------------------+----------------------+
+| RTI to PIO CGHS           | ₹10 IPO. BPL = free.    | RTI Act 2005         |
++---------------------------+-------------------------+----------------------+
+</code>
+===== Common reasons your MR claim gets stuck or rejected =====
+  * **Filed beyond 90 days** without a condonation request — rejected.
+  * **Non-empanelled hospital used for planned (non-emergency) treatment without prior permission** — rejected outright; only the consultation/diagnostic part may be partially reimbursed.
+  * **Emergency not certified** by hospital — claim re-categorised as planned and rejected.
+  * **Investigation reports missing or illegible** — query memo issued; if you don't reply, claim auto-closed at 90 days from query.
+  * **Cash memos not original** (only photocopies attached) — rejected.
+  * **Diagnosis code dispute** — hospital coded one way (higher CGHS rate), CGHS internal medical board re-codes lower; reimbursement reduced.
+  * **Implant invoice / batch number missing** — implant cost not reimbursed.
+  * **Items in "Excluded list"** under MoHFW OMs — disposables, comfort items, room-rent above entitlement — not reimbursed.
+  * **CGHS card not active** at the date of treatment (lapsed pensioner card; non-renewed contribution) — claim refused.
+  * **Bank account details incorrect** on Annexure-A — sanction issued but credit fails; needs reissue request.
+===== If stuck — the escalation ladder =====
+==== Rung 1 — Wellness Centre CMO ====
+Visit the WC where you submitted. Ask for the **file noting** and the **last action date**. Sometimes the issue is a simple missing document already in your possession.
+==== Rung 2 — Additional Director CGHS (city HQ) ====
+Each city has an Additional Director CGHS. Write to / visit the office. Phone numbers and emails on cghs.gov.in → "Contact Us" → city directory. Carry your acknowledgement and original documents.
+==== Rung 3 — Director CGHS (Delhi HQ) ====
+Address: //Office of the Director, Central Government Health Scheme, R.K. Puram, Sector-12, New Delhi - 110022//. Email: dircghs[at]nic[dot]in. For high-value or systemic disputes.
+==== Rung 4 — CGHS Beneficiary Grievance Cell ====
+cghs.gov.in → "Grievance" → online ticket. SLA 30 days. Tracks better than internal escalations.
+==== Rung 5 — CPGRAMS, Ministry of Health & Family Welfare ====
+pgportal.gov.in → MoHFW → CGHS. Routes to Joint Secretary's office. Higher visibility; useful when AddDir is non-responsive.
+==== Rung 6 — Central Administrative Tribunal (CAT) — for serving employees ====
+If you are a serving central govt employee and your MR claim is rejected unfairly, file an Original Application before the CAT bench having jurisdiction. Filing fee ₹50; matter decided typically in 12-18 months.
+==== Rung 7 — Right to Information (RTI) ====
+CGHS is part of the Ministry of Health & Family Welfare and is a **public authority under §2(h) of the RTI Act 2005**. Each city's CGHS office has a designated PIO (usually a Joint Director or AddDir).
+**RTI helps here when:**
+  * MR claim has been pending beyond 60 days and CGHS internal portal shows no progress — RTI for the **file noting + dealing officer + last date of action**.
+  * Reimbursement was significantly less than the bill — RTI for the **rate calculation worksheet** and the **specific MoHFW OM and package code** applied.
+  * Query memo allegedly issued but you never received it — RTI for the **dispatch register entry** and **content of the query memo**.
+  * Sanction order issued but credit not received — RTI to the **PAO / disbursing authority** for the disbursement schedule.
+  * You want to know how similar past claims were processed — RTI for **anonymised reimbursement decisions** for the same procedure code in the last 12 months (helps benchmark whether you are being short-paid).
+  * Prior permission for non-empanelled was applied for and decision pending — RTI for the **file noting + reason for delay**.
+For the actual one-page RTI template, see [[:rti-for-beginners|RTI in 12 simple steps]].
+**RTI does NOT help here when:**
+  * You want the actual hospital bill reimbursed in full (above CGHS rates) — the rate ceiling is statutory; RTI cannot lift it.
+  * Your treatment was at a non-empanelled hospital without prior permission and not an emergency — the rejection is on merits; RTI surfaces the reason but doesn't change it.
+  * You missed the 90-day window without a condonable cause — late filing rejection stands.
+  * For disputes on procedure exclusions (cosmetic, certain experimental therapies) — these are scheme exclusions; RTI gets you the rule but not the money.
+  * For a CA's tax position on the reimbursement amount — that is professional advice.
+===== FAQs =====
+**Q. My CGHS card expired the day before treatment. Can I still claim?**\\
+Pensioner cards lapse on non-payment of contribution; serving-employee cards lapse on retirement (then convert to pensioner card). If lapsed at treatment date, claim is generally rejected — renew immediately and seek condonation citing the urgency.
+**Q. Apollo charged ₹2.85 lakh for angioplasty; CGHS will pay ₹1.95 lakh. Can I claim the gap from anywhere else?**\\
+No formal route at CGHS. Some employees carry **top-up health insurance** (private mediclaim, employer's group policy) which can cover the gap on cashless or reimbursement basis. Pensioners often opt for a private senior-citizen plan to bridge this.
+**Q. The hospital is on the CGHS empanelled list but refused cashless. What can I do?**\\
+File a **complaint with the AddDir CGHS** of your city — empanelled hospitals are contractually bound to cashless for entitled CGHS beneficiaries. Repeated refusal can lead to de-empanelment.
+**Q. Can I claim reimbursement for my dependent parent's treatment?**\\
+Only if your parent's monthly income (pension + interest + rent) is **below ₹9,000 + DA** (per latest OM 2024) and they are listed as a dependent on your CGHS card. Otherwise, no.
+**Q. I'm a serving employee posted in a non-CGHS city. What are my options?**\\
+You're covered under **CS(MA) Rules 1944** (Central Services Medical Attendance Rules) — similar reimbursement structure but administered through your DDO/PAO directly, not CGHS. CGHS Wellness Centres outside the 80 covered cities don't exist; CS(MA) rates apply.
+**Q. Got a query memo asking for additional documents. How long do I have?**\\
+Typically **30 days** from the date of memo. If you cannot comply, request an extension in writing. Failure to reply auto-closes the claim.
+**Q. Is the reimbursement taxable?**\\
+No, up to the actual reimbursement amount under §17(2)(viii). The gap that you bear out-of-pocket can be claimed as a §80D / §80DDB deduction in some specific scenarios (consult a CA).
+**Q. The discharge summary doesn't mention "emergency". Can the hospital amend it?**\\
+Yes — many hospitals will issue an amended discharge summary on request, especially if the admission note mentioned emergency. Get the amendment within the 90-day window.
+===== Related on RTI Wiki =====
+  * [[:rti-for-beginners|RTI in 12 simple steps — for first-time filers]]
+  * [[:helplines:start|All Indian government helplines — one master directory]]
+  * [[:forms:start|RTI forms + state-wise fee chart]]
+  * [[:rti-for-stuck-pf-withdrawal|RTI for stuck PF withdrawal — copy-ready template]]
+  * [[:rti-for-money-and-schemes|All "money & schemes" RTI guides]]
+//Last reviewed: 26 April 2026 by RTI Wiki editorial team. CGHS rates and package OMs are revised periodically by MoHFW — verify the latest at cghs.gov.in or write to admin@bighelpers.in if you spot a stale figure.//
+{{tag>cghs medical-reimbursement annexure-a mohfw central-govt-pensioner non-empanelled-hospital emergency-treatment cghs-manual-2024 add-director-cghs cghs-grievance-cell cpgrams-mohfw cat-original-application section-17-it-act rti-cghs citizen-guide help-first 2026}}

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