Guidelines for reimbursement of Medical Bills

It is not necessary for referral of W.U.S. Health Centre beneficiary to any empanelled Hospital.  W.U.S. Health Centre beneficiaries can seek treatment from any nearby empanelled Hospital (s) whensoever the clinical condition so warrants. 

The treatment must be availed only from the Hospitals empanelled with the University of Delhi. However, in emergency (cases to be corroborated by Emergency Certificate from the treating Physician/Surgeon of the Hospital), the treatment may be availed from the nearest Hospital even if that Hospital is not on the University approved panel but for availing reimbursement of incurred expenses on treatment, nature of Emergency will have to be justified and corroborated by the Chief Medical Officer.

Beneficiaries are required to submit reimbursement bill(s) for claim of expenses incurred on Medical Treatment in Hospitals (OPD/IPD) and Authorized Medical Attendants (AMAs) online and hard copy of the same is to be submitted to the concerned Department for onward transmission to the Finance Branch-XIII of the University. All claims of medical reimbursement of incurred expenses must be submitted within six months of the availing of treatment; else the bills will be summarily rejected. 

Retired employees must submit their Hospital medical claim bills/OPD claims directly to the University Department/College from where they retired and the reimbursement of medical expenses will be made by University/College respectively.

The reimbursement of incurred expenses on treatment will be as per CGHS/AIIMS approved rules and rates. All extra charges other than the CGHS/AIIMS approved rate list will be borne by the incumbent/beneficiary.

If the test (s)/Medicine (s) have been prescribed by the Medical Officers of the WUS Health Centre only, the reimbursement of the expenses incurred on Clinico-Pathological Laboratory Test (s) / the purchase of medicines will be forwarded to the Finance Branch (XII) and the payment will be made by the Finance Branch (V), the name of the Medical Officer of WUS Health Centre should be mentioned on the cash memo/voucher.

All the beneficiaries of the WUS Health Centre are informed that the reimbursement claim bills of the expenses incurred on Clinico-Pathological Laboratory Test(s) /purchase of medicine(s) prescribed by Doctors other than Medical Officers of WUS Health Centres will not be accepted by the Health Centre. If their bill(s)/cash memo(s) bear the name of a Doctor other than WUS Health Centre, s/he should submit such medical claims to their Department/College for reimbursement of incurred expenses.

All the Medical Officers of WUS Health Centre are requested not to issue the requisition slip to the beneficiaries of Health Centre for Clinico-Pathological Laboratory Test(s)/medicine(s), if they are seeking treatment from any Hospital(s)/AMAs other than the Doctors of WUS Health Centre.

Reimbursement of expenses incurred on Clinico-Pathological Laboratory and Radiological Tests will be done only if such test facilities are not available or operational in a particular WUS Health Centre. Availability of the tests and functionality of equipment(s) must be ascertained by the beneficiary from the W.U.S. Health Centre Clinico-Pathological lab / X-Ray Department before getting the test(s) carried out in laboratories which have been empanelled by University of Delhi.