CGHS Reimbursement: 3 Rules That Can Reject Your Claim

Central government employees using CGHS must now follow stricter referral rules for diagnostic tests above ₹3,000 and unlisted medical procedures. Missing these steps means your reimbursement claim can be fully rejected, leaving you to pay out of pocket.

Here's what happened: UPSC has issued a clarification requiring CGHS beneficiaries to obtain a formal referral for any diagnostic test costing more than ₹3,000 before the test is conducted.. Medical procedures not listed in the official CGHS rate schedule now require prior approval from competent authority — retrospective approvals are not entertained.. The clarification reinforces the referral chain: CGHS Wellness Centre → empanelled specialist → approved facility, with no shortcuts permitted at any stage..

What you should do: Before booking any diagnostic test, ask your CGHS Medical Officer whether the estimated cost crosses ₹3,000 — if yes, get a written referral before visiting the lab.. Check the official CGHS rate schedule (available on cghs.gov.in) to confirm your planned procedure is listed; if it isn't, apply for prior permission before the appointment.. Keep all referral letters, permission approvals, and doctor's prescriptions physically and digitally — missing even one document is the most common reason CGHS claims are rejected..

Pro tip: CGHS reimbursement claims filed within 3 months of treatment are processed faster — don't sit on your bills waiting to collect them all together.

For readers weighing their credit and loan options, our personal loan guide and CIBIL score resources put this update in context.