Healthcare and Consumer

CGHS / ECHS Reimbursement Returned for Deficiency? How to Fix and Resubmit

Your medical reimbursement claim came back with a deficiency memo instead of a payment. Do not panic and do not assume it is rejected. A deficiency memo simply means the office wants a missing document or a clarification before it can clear your money. This guide shows you how to read the memo, fix each point, resubmit cleanly, escalate if you are ignored, and use RTI to find out where your claim is stuck.

Last reviewed: 29 May 2026 · Practical action guide · India · By the Right to Information Wiki editorial team

Quick answer

A deficiency memo is a request to complete your claim, not a rejection. Read the memo carefully and list every point it raises. Gather what is missing — usually the beneficiary card copy, original hospital bills, the referral or emergency certificate, or the discharge summary. Write a short covering letter answering each deficiency point by point, attach the documents in the same order, and resubmit against a dated acknowledgement. Keep copies of everything. If the office sits on the corrected claim, escalate to the higher authority and, for government records, file an RTI to learn the file status. For high stakes, take professional advice before any consumer forum step.

Who this guide is for

This guide is for beneficiaries of the Central Government Health Scheme (CGHS) and the Ex-Servicemen Contributory Health Scheme (ECHS) whose medical reimbursement claim has been returned with a deficiency memo or a request for missing documents. It is useful if you:

Submitted a claim for treatment taken at an empanelled or non-empanelled hospital and got a memo back asking for documents.
Had an emergency admission with no prior referral and are now being asked to justify it.
Find the memo unclear and are not sure exactly what the office wants.
Already resubmitted once and the claim has stalled again with no payment and no clear answer.

The scheme rules differ in detail. CGHS serves central government employees, pensioners, and certain other categories through Wellness Centres. ECHS serves ex-servicemen and their dependents through Polyclinics under the Department of Ex-Servicemen Welfare. Both reimburse approved treatment at approved rates, and both can return a claim for deficiencies before they pay. The practical steps below apply to either scheme, with notes where they differ.

If you are at an earlier stage and have not yet filed, see our walkthrough on how to claim CGHS reimbursement and the card guides for CGHS cards and ECHS membership.

What you can do this weekend

Friday evening

Take out the deficiency memo and read it slowly. On a fresh sheet, number every separate point it raises. A single memo often bundles several issues — a missing referral, an unsigned bill, a missing emergency certificate, or a request for original receipts. If any line is unclear, write down your question next to it so you can ask the office.

Pull out your claim file and lay everything on the table: your beneficiary card copy, the hospital bills, the discharge summary, prescriptions, investigation reports, and the referral or emergency certificate. Match each document against the points in the memo. Mark which points you can already answer and which need a fresh document from the hospital or the office.

Make clear photocopies or phone scans of every document before you do anything else. If the memo asks you to resubmit originals you have already given, you will want your own copies to reconstruct the file if something is misplaced.

Saturday

Tackle the documents you do not yet have. The most common gaps are the referral (the prior permission or referral note for planned treatment) and the emergency certificate (the hospital's certificate that an admission was a genuine emergency). For a missing referral on planned treatment, check whether you actually obtained one before treatment; if you did, attach it; if you genuinely could not, explain the circumstances in writing.

If you need a corrected bill, an itemised break-up, or an emergency certificate, write to the hospital's billing or medical records department today. Use a dated letter that lists exactly what you need. Hand it over against a stamp, or send it by a tracked method so you have proof. An empanelled hospital has obligations under its agreement with the scheme, so be firm and polite.

Reconcile the bill amounts. Reimbursement is usually limited to the scheme's approved package or rate, not the full sticker price of a private room or a non-approved item. If part of your bill is for something outside the approved list, expect that portion not to be paid, and do not let it hold up the rest. Note these items so your covering letter can address them head-on.

Sunday

Draft your covering letter. Answer the memo point by point in the same numbering the office used. For each point, say what you are attaching and label it as an annexure. A reviewer who can tick off each deficiency against your reply will clear the file far faster than one who has to hunt through a loose bundle.

Assemble the resubmission in order: covering letter on top, then annexures in the sequence your letter refers to. Paginate the bundle and add a one-line annexure index at the end of the letter. Keep a complete copy of the whole bundle for yourself.

Get it ready to submit on Monday at your CGHS Wellness Centre or ECHS Polyclinic. Plan to obtain a dated acknowledgement — a received stamp on your copy or a diary number. That acknowledgement is the single most important thing you will collect, because every later escalation depends on proving when and what you resubmitted.

Documents and evidence checklist

Document	What it proves	Where to get it
The deficiency memo itself	Exactly what the office says is missing or unclear	Returned to you by the CGHS Wellness Centre / ECHS Polyclinic
Beneficiary card copy (CGHS card / ECHS card)	You are an entitled beneficiary; ward entitlement category	Your own records; reissue request to the issuing office if lost
Original hospital bills and receipts	Amount actually paid; itemised treatment and charges	Hospital billing department
Referral / prior permission note	Planned treatment was referred or permitted in advance	Your CGHS Wellness Centre / ECHS Polyclinic (issued before treatment)
Emergency certificate	Admission was a genuine emergency where referral was not possible	Treating hospital (emergency / medical records department)
Discharge summary	Diagnosis, treatment given, dates of admission and discharge	Treating hospital
Prescriptions and investigation reports	Medicines and tests were prescribed and done as part of treatment	Treating doctor / hospital / diagnostic centre
Implant / device stickers and invoices (if any)	Cost and identity of any implant used (stent, lens, joint, etc.)	Hospital; manufacturer sticker pasted in records
Itemised bill break-up	Charges split by head so approved items can be separated	Hospital billing department
Bank details / cancelled cheque	Where the reimbursement should be credited	Your bank passbook / cheque book
Your covering letter answering the memo	Each deficiency point is addressed and matched to an annexure	You prepare it
Dated acknowledgement of resubmission	When and what you resubmitted	Received stamp / diary number from the office

Step-by-step action plan

Step 1 — Read the memo and separate every deficiency

Do not treat the memo as one blob. Break it into numbered points. A typical memo mixes simple gaps (a missing self-attested card copy) with substantive ones (no referral, or a query on whether the admission was an emergency). Knowing which is which tells you what you can fix today and what needs a document from a third party such as the hospital.

Step 2 — Confirm it is a deficiency, not a rejection

Check the wording. A deficiency memo asks you to supply something so the claim can move forward. A rejection is a reasoned decision that the claim is not payable. They are handled differently. If the document actually rejects your claim, ask for the written reasons in full, because you will need them to escalate. If it merely returns the claim for documents, your job is simply to complete and resubmit it.

Step 3 — Rebuild the document set

Work through your numbered list. For each point, decide the source: your own file, your CGHS Wellness Centre or ECHS Polyclinic (for referral or permission records), or the treating hospital (for bills, the discharge summary, the emergency certificate, and implant invoices). Request hospital documents in writing and keep proof. Self-attest copies where the scheme asks for self-attestation.

Step 4 — Handle the emergency-versus-referral question

This is the most common substantive deficiency. For planned treatment, the scheme generally expects a prior referral or permission, so attach it. For a genuine emergency, the emergency certificate and admission records carry the weight, because referral in advance is often impossible. Get a clear emergency certificate stating the date, time, presenting condition, and that admission was an emergency. Add the discharge summary and the relevant investigation reports, and explain the sequence of events plainly in your covering letter.

Step 5 — Write a point-by-point covering letter

Mirror the office's own numbering. Under each point, write one or two sentences and name the annexure that answers it. Keep the tone factual. State your name, beneficiary card number, the claim reference if any, the hospital, the dates of treatment, and the amount claimed. End with a clear request that the corrected claim be processed and the admissible amount released.

Step 6 — Resubmit and collect a dated acknowledgement

Submit the bundle at the same Wellness Centre or Polyclinic that issued the memo, unless the memo names another office. Get a received stamp on your copy or note the diary or token number. If you must send originals, prefer a tracked method or a personal handover against acknowledgement, and never let go of your only copy of anything.

Step 7 — Track the file and follow up in writing

After resubmission, give the office a reasonable period and then follow up in writing, quoting your acknowledgement number. Ask for the current status and an expected timeline. Keep each follow-up short and dated. If you submitted online through the scheme's portal, check the claim status there too and save screenshots.

Step 8 — Escalate if you are ignored

If a complete, corrected claim sits unactioned, escalate to the higher authority — the CGHS Additional Director of the city for CGHS, or the ECHS Regional Centre and Central Organisation for ECHS. Attach your acknowledgement and a one-page timeline. At this point, also consider an RTI to learn the exact file position, and for large or contested amounts take advice from a qualified professional before approaching a consumer forum.

Escalation ladder

Stage	Action	Forum / Destination	Target
1	Resubmit the corrected claim with a point-by-point covering letter	CGHS Wellness Centre / ECHS Polyclinic that issued the memo	Get a dated acknowledgement; await processing
2	Written follow-up quoting the acknowledgement number if no movement	Officer in charge of the Wellness Centre / Polyclinic	After a reasonable period with no response
3	Escalate with a one-page timeline to the higher authority	CGHS Additional Director (city) / ECHS Regional Centre and Central Organisation	If the claim stays stuck after follow-up
4	Grievance through the government grievance system	CPGRAMS (pgportal.gov.in) — addressed to the relevant ministry / department	Note the registration number
5	RTI for claim status, file noting, and reason for delay	CPIO of the CGHS / ECHS office holding your file	30 days under the RTI Act
6	Consumer complaint for deficiency in service (large or contested amount)	Appropriate Consumer Disputes Redressal Commission	Take professional advice before filing

Copy-paste resubmission letter template

Replace the text in square brackets with your own details before sending. Number your points to match the office's deficiency memo.

To, The Officer in Charge [CGHS Wellness Centre / ECHS Polyclinic Name] [Address] Date: [DD/MM/YYYY] Subject: Resubmission of medical reimbursement claim against deficiency memo dated [DD/MM/YYYY] — Beneficiary [Name], Card No. [Your CGHS/ECHS Card Number] Respected Sir / Madam, 1. I am [Your Name], a beneficiary under [CGHS / ECHS], holding card number [Card Number]. My reimbursement claim for treatment taken at [Hospital Name] from [DD/MM/YYYY] to [DD/MM/YYYY] for [diagnosis / procedure] was returned to me with a deficiency memo dated [DD/MM/YYYY]. 2. I have addressed each point raised in the memo as follows, in the same order as the memo: Point 1 [as stated in the memo]: My reply: [what you are attaching / clarifying]. Reference: Annexure [A]. Point 2 [as stated in the memo]: My reply: [what you are attaching / clarifying]. Reference: Annexure [B]. [Add further points exactly as numbered in the memo.] 3. [If applicable] The admission on [DD/MM/YYYY] was a genuine emergency. The treating hospital's emergency certificate (Annexure [C]) and the discharge summary (Annexure [D]) confirm the date, time and condition at admission. A prior referral was not possible in the circumstances described above. 4. The original bills, receipts and supporting reports are enclosed. I request that my reimbursement claim now be processed and the admissible amount released to my bank account (details at Annexure [E]). 5. I am available to provide any further clarification or original document for inspection at your office. Kindly acknowledge receipt of this resubmission. Yours faithfully, [Your Full Name] [CGHS / ECHS Card Number] [Mobile Number] [Email Address] [Postal Address] Enclosures (Annexure List): A — [e.g. Self-attested copy of beneficiary card] B — [e.g. Itemised hospital bill and receipts (originals)] C — [e.g. Emergency certificate from hospital] D — [e.g. Discharge summary] E — [e.g. Cancelled cheque / bank details] [Add or rename annexures to match your claim]

When RTI can help

CGHS is run under the Ministry of Health and Family Welfare and ECHS under the Department of Ex-Servicemen Welfare. Both are public authorities, so the Right to Information Act, 2005 applies to the records they hold about your claim. RTI is most useful when your corrected claim has gone quiet and you cannot get a straight answer about where it is stuck. You can ask the Central Public Information Officer (CPIO) of the office holding your file for:

The current status of your claim: "The present status of reimbursement claim of beneficiary [Name], card number [Number], submitted on [date] / resubmitted on [date], including the date of receipt of the resubmission and the current location of the file."
The file noting and processing trail: "Copies of the noting and order sheet on the said claim file, and the name and designation of the officer with whom the file currently rests."
The reason for delay or for any deficiency: "The reason recorded for the delay in processing, and the specific rule or instruction relied upon for each deficiency raised in the memo dated [DD/MM/YYYY]."

To file, see our step-by-step guide on filing an RTI online in India, and our note on using RTI for CGHS card and claim matters. If the office does not reply within the time limit or gives an evasive answer, use a first appeal under Section 19; our overview of the first and second appeal process explains what comes next. For an in-depth approach to using information rights in a stuck government matter, The RTI Playbook is a useful companion.

When RTI will not help

RTI has real limits in a reimbursement dispute:

RTI cannot release your money: It is a tool to get information, not to compel payment. Only the scheme authority can sanction and release the reimbursement. RTI strengthens your follow-up and any escalation; it does not replace them.
It will not extract a private hospital's internal records: If a private empanelled hospital refuses to give you a corrected bill or an emergency certificate, RTI does not apply to that private body. Pursue the hospital directly, and ask your scheme office to take up the refusal under the empanelment agreement.
It is slower than the grievance route for speed alone: If your only aim is to hurry a decision, the scheme's own escalation and CPGRAMS are usually quicker than waiting out the RTI response window. Use RTI when you specifically need the record or the recorded reasons.

Common mistakes to avoid

Treating a deficiency memo as a rejection: People often give up when the claim comes back. It is a request to complete the file, not a no. Fix the points and resubmit.
Resubmitting without a covering letter: Sending loose documents back leaves the reviewer guessing. Always answer the memo point by point in the office's own numbering.
Not getting an acknowledgement: Without a dated received stamp or diary number, you cannot prove when you resubmitted, and every later escalation weakens. Insist on acknowledgement.
Surrendering your only originals: Keep clear copies or scans of everything before you part with originals. Files do get misplaced; your copies let you rebuild.
Confusing emergency with planned treatment: For planned treatment, attach the referral or permission. For a genuine emergency, lead with the emergency certificate and explain why referral was not possible.
Expecting the full sticker price: Reimbursement is generally limited to the scheme's approved package or rate, not the entire private bill. Separate the approved portion so the admissible amount is not held up by disputed items.
Letting the file go silent: After resubmission, follow up in writing on a schedule. A claim that no one is chasing can sit untouched for months.
Going straight to court for small amounts: Exhaust the resubmission, escalation, CPGRAMS, and RTI routes first. For large or genuinely contested amounts, take advice from a qualified professional before a consumer forum.

If your difficulty is really a card or eligibility problem rather than a documents problem, our guides on the CGHS card and ECHS membership set out the basics. For escalation through the central grievance system alongside RTI, see how to use CPGRAMS and RTI together.

Frequently asked questions

What is a deficiency memo on a CGHS or ECHS reimbursement claim?

A deficiency memo is a written note from the CGHS Wellness Centre or ECHS Polyclinic telling you that your reimbursement claim cannot be processed yet because something is missing or unclear. It is not a rejection. It usually lists the specific documents or details needed, such as a missing referral, an emergency certificate, original bills, or a clarification on the treatment. You fix the listed points and resubmit the same claim.

Does a deficiency memo mean my claim is rejected?

No. A deficiency memo is a request to complete your claim, not a rejection. Your claim stays alive while you supply the missing documents. A rejection is a separate, reasoned order that the claim is not payable. If you receive an actual rejection, you can ask for the written reasons and escalate to the higher authority or, for ECHS, the parent organisation, and then to a consumer forum if needed.

How long do I have to respond to a CGHS or ECHS deficiency memo?

The memo itself usually states a period within which you must respond. There is no single nationwide deadline that fits every case, and local offices apply their own internal timelines. Treat it as urgent. Reply in writing well before any stated date, and if you need more time to obtain a document from a hospital, send a short letter asking for an extension and keep a copy of the acknowledgement.

My emergency admission had no prior referral. Will my claim still be paid?

Genuine emergencies are treated differently from planned treatment. For a real emergency, the hospital's emergency certificate and admission records are the key documents, because prior referral is often not possible. Get a clear emergency certificate from the treating hospital stating the date, time, condition, and that admission was an emergency. Attach the discharge summary and supporting investigation reports, and explain the circumstances in your covering letter.

Can I use RTI to find out the status of my CGHS or ECHS claim?

Yes. CGHS and ECHS are run by public authorities, so the Right to Information Act applies. You can file an RTI with the Central Public Information Officer of the relevant office asking for the current status of your claim, the date it was received, the noting on the file, and the reason for any delay. RTI gives you the record; it does not by itself release the payment. Use it to break a logjam and to support an escalation.

What should I do if the hospital refuses to give me a corrected bill or certificate?

First write to the hospital's billing or medical records department with a dated letter listing exactly what you need and why. Keep proof of delivery. If they still refuse, note that refusal in writing to your CGHS or ECHS office and ask them to record it. An empanelled hospital has obligations under its agreement with the scheme, so you can also flag the refusal to the scheme authority, who can take it up with the hospital directly.

Should I submit photocopies or original bills with my reimbursement claim?

Reimbursement claims are normally processed on original bills, original receipts, and original prescriptions, with supporting reports. Always keep clear photocopies or scans of everything before you submit. If a deficiency memo asks you to resubmit originals, send them by a tracked method or hand them over against a dated acknowledgement, and keep your copies so you can reconstruct the file if anything is misplaced.