General Concepts of Medical Rules
Employees and their family members are entitled to reimbursement
for medical attendance and treatment.
3 Categories of Hospital facilities are admissible for employees.
CGHS Hospitals.
Recognized Private Hospitals.
Private Hospitals (Other than Recognized).
What are the Medical facilities available for reimbursement ?
Operation for sterilization.
Treatment of sterility
Venereal diseases and Delirium Tremens
Avitaminosis and Hypovitaminosis.
Correction of eye.
Treatment for immunizing and prophylactic
purposes.
Diseases causing General debility and secondary anemia.
Confinement including at residence if
attended by Child Welfare and Maternity Centres staff;
Pre-natal and Post-natal Treatment.
Testing of eyesight for glasses for
employees only.
Blood and blood transfusion charges.
Dental Treatment
Anti-rabic treatment
cost of hepatitis Vaccine B, C & D.
What are the recognized Hospitals for
Medical Treatment ?
1
All State Government Hospitals
including District Hospitals and Municipal Hospitals
2 All Hospitals recognized by primary
health centres and dispensaries recognized by state
government for treatment of their employees and or members of their family.
3 All maternity and child welfare centres with facilities for indoor treatment
and recognized by state government.
4
Cantonment hospitals in cantonment
areas where there are no government hospitals.
5 All railway hospitals
6
All Government hospitals recognized by
state government / CGHS rules / CS(MA) Rules
7
Hospitals funded by Central / State
government.
8 Pay clinics in Bihar, Punjab , Haryana,
UP ,MP, Rajasthan and Chandigarh
9
How to Get medical Reimbursement when
treated in a Private
Hospital
An employee has to go to nearest CGHS or Government
hospital for treatment. But in some emergency cases they may be forced to
go to nearby Private hospital which may not be a recognized hospital.
In such cases the employee has to obtain an emergency
certificatefrom the
doctor of this private hospital. In this emergency certificate, the
reason for choosing the private hospital should be specified and it should be duly signed by the doctor.
How much amount can be reimbursed
for medical treatment for employees ?
There is no limit for the reimbursable amount. Full amount for the
medicines will be reimbursed and for other expenses including lab tests, scanning, operation, doctors fee etc specific rates approved
according to CS(MA) rules will be given.
Who are eligible for medical
reimbursement ?
1 Central Government employees.
2 Dependant family members of employees.
3
Who are the Dependant Family Members
eligible for Medical Reimbursement ?
1
Husband / Wife
2
Parents / Stepmother
3
For female employee, either her parents or
parents-in-law.
4
Children including adopted children.
5
For unmarried son, Till he starts
earning or attains the age of 25.
6
For Daughter, Till she starts earning or gets married.
7 No age limit for son suffering
from permanent disability.
8 Widowed daughters and dependent
divorced / separateddaughter.
9
Sisters including unmarried / divorced
/ abandoned or separated from husband / widowed sister irrespective of age
limit.
10
Minor brothers.
Forms required for Medical
Reimbursement
1 Certificate A (In
the case of Patients not admitted in hospitals)
2 97 B (claiming
medical refund in case of nonadmitted patients)
3 Certificate B (In
the case of Patients admitted in hospitals)
4 97 A (For
claiming medical refund in case of admitted patients)
5 Medical Reimbursement Form
What are the things to remember when
claiming for Medical Reimbursement ?
1
Forms selected are correct or not.
2 All the certificates are duly signed by the Doctor.
3 Seal of the hospital is included in all the bills and the
certificates.
4
In case of Private hospital, emergency certificate is also
present.
5 If insurance policy is also claimed, then total
reimbursement should not exceed the total expenditure.
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