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Thread: Can one apply for Medical Reimbursement for the balance rejected by Insurance Co.,

  1. #1
    Senior Member Ramnath is on a distinguished road
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    Default Can one apply for Medical Reimbursement for the balance rejected by Insurance Co.,

    One employees of our office was admitted on emergency (due to accident) in a private hospital. He had claimed the amounts under Mediclaim Policy from Insurance Company.

    About Rs.10,000/- has not been admitted by the Insurance Company. He has now applied for reimbursement in our office.

    Kindly clarify whether this type of reimbursement is admissible if so, under which Order F.No./Rule No. (it may also be provided).

    Ramnath
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    Last edited by Ramnath; 22-08-2011 at 07:15 AM.

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    Senior Member tvenkatam is on a distinguished road
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    Quote Originally Posted by Ramnath View Post
    One employees of our office was admitted on emergency (due to accident) in a private hospital. He had claimed the amounts under Mediclaim Policy from Insurance Company.

    About Rs.10,000/- has not been admitted by the Insurance Company. He has now applied for reimbursement in our office.

    Kindly clarify whether this type of reimbursement is admissible if so, under which Order F.No./Rule No. (it may also be provided).

    Ramnath
    Dear friend,

    Please follow the link http://mohfw.nic.in/s11011-4-2003%2019-feb-2009.pdf

  3. #3
    Senior Member Ramnath is on a distinguished road
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    Thank u very much Mr.Venkatam. That order served the purpose.
    Ramnath
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    Last edited by Ramnath; 22-08-2011 at 07:15 AM.

  4. #4
    Junior Member nobel is on a distinguished road
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    Default medical reimburse from 2 source

    Dear Mr. Ramnath,

    From this thread it supposed that the order served the purpose..means..the balance amount rejected by the insurance company has been given by your department/ministry.
    I have same case here in my office. an amount of Rs.70,000 was spent at hospital(pvt.). patient admitted on emergency basis due to Road Accident. 46,000 was given by insurance company. rest 24,000 i paid to hospital. Now for 24,000 i submitted claim on the basis of this order. But..our office calculated as per govt. rate and said I should get less than 46,000 if I would claim it from office only. So, as Insurance company given more than that, I should not get any more as per rule. Can u give any reference how the calculation should be done? need evidence...the interpretation of our office is that if I would get less than the admissible amount as per govt. rate by the insurance company ..that difference I would get from office...which I feel a very very wrong interpretation of that order.
    Last edited by nobel; 21-02-2011 at 05:35 PM.

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    Member neon007 is on a distinguished road
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    Yes i am also facing same problem.my wife got admitted into hospital on emergency basis which cost almost 80000 . From insurance company i got 56000 and for the rest i applied to my office. But the office said that submission of bill is a fuss to me as i would not get anything from government as already i got 56000. Kindly help. The matter is very urgent. Also i am unable to get the above mentioned order.

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    Senior Member Victor is on a distinguished road
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    Quote Originally Posted by neon007 View Post
    Yes i am also facing same problem.my wife got admitted into hospital on emergency basis which cost almost 80000 . From insurance company i got 56000 and for the rest i applied to my office. But the office said that submission of bill is a fuss to me as i would not get anything from government as already i got 56000. Kindly help. The matter is very urgent. Also i am unable to get the above mentioned order.
    Reimbursement from two sources is permissible. Refer OM dated 19.2.2009 at (http://msotransparent.nic.in/writere...ile/File22.pdf).

    Victor

  7. #7
    Member neon007 is on a distinguished road
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    I saw the order, but from the order it is not clear can i get the balance amount from government or not and how much amount i can get? Please clarify.

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    Senior Member Victor is on a distinguished road
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    Quote Originally Posted by neon007 View Post
    I saw the order, but from the order it is not clear can i get the balance amount from government or not and how much amount i can get? Please clarify.
    The orders are crystal clear. You can get reimbursement as per approved package rates OR Rs. 24000, whichever is less.

    Victor

  9. #9
    Junior Member nobel is on a distinguished road
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    Quote Originally Posted by Victor View Post
    The orders are crystal clear. You can get reimbursement as per approved package rates OR Rs. 24000, whichever is less.

    Victor
    I have similar problem and after fighting a lot i got the balance from my office. They always interprettent negetavi way. I wrote to Min. of Health,Nirman Bhavan and got clarification accordingly submitted again to my office with that clarification. Then also our office send the whole case to the Health Ministry, and again after health ministry remarked in favour of me, I got it.

  10. #10
    Junior Member nobel is on a distinguished road
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    Default medical reimbursement from Insurance then balance amount from Office/CGHS

    Please find attached. I got the balance amount from my office as per the order of claim from 2 sources.

  11. #11
    Member neon007 is on a distinguished road
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    THANKS FOR YOUR COMMUNICATION. MY CASE IS ALREADY PENDING FOR 7 MONTHS AND AS I GOT INFORMATION, THE MATTER WILL BE NEGATIVE. IN THIS RESPECT, KINDLY HELP ME TO GET THOSE CLARIFICATIONS THAT YOU HAVE RECEIVED FOR MINISTRY OF HEALTH & WELFARE. YOU CAN ALSO MAIL ME AT calcutta66@rediffmail.com. IF YOU PROVIDE THOSE CLARIFICATIONS I WILL BE GRATEFUL TO YOU AND ALSO PLEASE MAKE SOME ADVISES REGARDING THE MATTER.

  12. #12
    Member neon007 is on a distinguished road
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    mr. nobel kindly help me. There is no attachment. kindly provide your sheets through fax or scan copy to myself or otherwise I will send my copy to yourself . Kindly give your email id. My one is calcutta66@rediffmail.com. Its urgent. My organisation is going on the negative attitude. Kindly help me.

  13. #13
    Member neon007 is on a distinguished road
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    It looks like nobody is interested to provide the basic information. The fact is that for bed charge of rs.1300 daily, i got rs.1000 from insurance company and for balance rs.300 , whether i can take it from government? As per my entitlement i get rs.1000 for bed charge. My office informed as i already got rs.1000 from insurance company, i will get nothing from office i.e. Remaining rs.300 is not payable to me. Kindly clarify

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    Senior Member Victor is on a distinguished road
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    Quote Originally Posted by neon007 View Post
    It looks like nobody is interested to provide the basic information. The fact is that for bed charge of rs.1300 daily, i got rs.1000 from insurance company and for balance rs.300 , whether i can take it from government? As per my entitlement i get rs.1000 for bed charge. My office informed as i already got rs.1000 from insurance company, i will get nothing from office i.e. Remaining rs.300 is not payable to me. Kindly clarify
    Reimbursement from two sources is permissible. Refer OM dated 19.2.2009 at http://msotransparent.nic.in/writere...le/File139.pdf

    Victor

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    Member neon007 is on a distinguished road
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    Thanx Victor. I have seen the above order previously but there is no clarification of my question as I asked previously. The order said reimbursement from two sources is permissible as you informed. But for bed charge if I claimed Rs.1000 from Insurance company and Rs.300 is due , which can be reimbursable from my office or not.

  16. #16
    Member neon007 is on a distinguished road
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    kindly help to get the total information about balance amount is reimbursible from my office or not. IF any of you have sanction or medical bill copy , kindly scan it and place here please. This is very urgent case and I am under deep trouble if this medical bill rejected by my office.

  17. #17
    Member neon007 is on a distinguished road
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    kindly help urgently

  18. #18
    Senior Member Ramnath is on a distinguished road
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    Pl. refer para 3 of the above referred link. The condition is that the total amount reimbursement should not exceed the total amount spent. Hence, the portion not reimbursed by Insurance company can be got reimbursed from your office. So far, in my office, though claim was 1st made, due to non-submission of particulars wanted (in compliance with Para No.3), the claim was withdrawn by the officer concerned. Hence, no copies of bills are available. Hence, comply with instructions under Para 3 and claim.

    Ramnath.
    Last edited by Ramnath; 04-04-2012 at 11:41 PM.

  19. #19
    Member neon007 is on a distinguished road
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    Thanx ramnath for your kind reply. But my question is that what is para 3 of which order you like to mention? Also want urgent help from other members regarding this urgently.

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    Senior Member Ramnath is on a distinguished road
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