Medical reimbursement claims often face delays due to incomplete documentation or incorrect submission procedures. To avoid such issues and expedite the claim process, the Competent Authority has laid down clear guidelines that every India Post employee should follow. This article outlines the key requirements, mandatory documents, and submission timelines to help you process your claims without any hurdles.
When is a Medical Claim Eligible?
Claims made for emergency medical treatment will only be accepted if the Competent Authority certifies the case as an emergency. If you opt for a private hospital instead of a CGHS or government facility, you must submit a certificate clearly stating the emergency nature of the case.
Required Documents – Two Sets (Original + Duplicate)
Every medical reimbursement claim must include two complete sets of documents—one original and one duplicate. Missing even a single document may lead to rejection. Here’s what to include:
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Official Representation: A written explanation by the claimant detailing why emergency treatment was necessary and why a private hospital was chosen.
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Application Form: Duly filled-in medical claim form.
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Original Medical Bills: Submit the actual bills issued by the hospital.
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Medical Reports: Attach photocopies of all relevant medical reports (tests, diagnostics, etc.).
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Discharge Summary: A copy of the hospital’s discharge report.
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CGHS Card Copies:
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For CGHS beneficiaries: Copy of the primary card and the patient’s dependent card.
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For CS(MA) claimants: Certification of dependency from the Divisional Head is mandatory.
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Distance Condition Certificate: Issued by the Divisional Head, confirming the distance and justification for choosing the hospital.
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Hospital Recognition Intimation: Certification from the Divisional Head stating whether the hospital is recognized under CGHS, State Government, or otherwise.
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Divisional Head’s Recommendations: Forwarding remarks from the Divisional Authority.
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Annexure: All prescribed annexures must be completely and correctly filled.
Submission Deadlines You Must Follow
To ensure your medical claim is processed on time, adhere to the following deadlines:
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If advance was taken: Submit your claim within 1 month from the date of discharge.
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If no advance was taken: Submit your claim within 6 months from the date of discharge.
Claims submitted without proper certification, supporting documents, or within the incorrect timeline may be delayed or rejected outright. Always cross-check your claim set using the above checklist before forwarding it to the competent office.
For queries or assistance, reach out to your Divisional Office or Medical Claims Nodal Officer.
