Prescription of Timelines under CGHS for settlement of Medical claims of Pensioner CGHS beneficiaries

Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Directorate General of CGHS

Office of the Director, CGHS
No: Z.15025/79/1/DIR/CGHS
545-A Nirman Bhawan, New Delhi
Dated the 5th October, 2016
OFFICE MEMORANDUM

Subject :- Prescription of Timelines under CGHS for settlement of Medical claims of Pensioner CGHS beneficiaries

With reference to the above subject the undersigned is directed to state that it has now been decided to define ‘Time Lines' for processing and settlement of medical claims of pensioner CGHS beneficiaries as per the details given under:

Medical Claims not requiring Special approvals

Issue of Serial No. for Medical Claim at CGHS WC
same day
Submission of physical bill to Office of AD
within 7 days
Processing of Claims by Dealing Asst. and submission to CMO(R&H)
within 10 days
Processing of Medical claims by CMO(R&H)
within 7 days
Sanction of Addl. Director and return to CMO
within 3 days
Preparation of Bill and submission to P&AO
within 7 days
(Total within 45 days)

Medical claims requiring approval of higher authorities

Total time within
60 days in Delhi
Total time within
90 days in other cities

Medical claims requiring opinion of specialists

Total time 60 days

Medical Claims requiring STC approval for full reimbursement

1st STC meeting may be conducted within 90 days

Chief Medical Officer in charge shall thoroughly check the papers initially for the completeness of the requisite documents before accepting the claim papers to ensure that the claim papers are not returned subsequently for want of some documents.
(D.C.Joshi)
Director, CGHS

Defence Accounts Pensioners Welfare Association

DAPWA came into existence on 27/10/2007 to look into the welfare of pensioners of Defence Accounts Department for settlement of their grievances with regards to their pending pension claims, expediting documentation for sanction/ issue of family pension medical claims and to provide moral support in adverse circumstances of brother pensioners.

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