UNDERTAKING REGARDING NON SUBMISSION OF REFERRAL SLIP

UNDERTAKING REGARDING NON SUBMISSION OF REFERRAL SLIP

 What is a referral letter? 

The referral letter is a mandatory document issued by the specialist/doctors at the Wellness Centres, government hospitals, CAPF hospitals and authorized medical attendants for getting health services from network HCOs. Referral letters or slips are permission letters issued by Medical Officer/CMO of CGHS Wellness Centre/hospitals. The referral may be mentioned on the computer-generated Prescription slip. These are required to seek treatment for every planned treatment at outpatient or inpatient basis

UNDERTAKING REGARDING NON SUBMISSION OF REFERRAL SLIP

                  

I am the undersigned beneficiary of Ayushman CAPF Card Number (Ayushman CAPF Card Number), it is certified that no any CAPF/Govt/CGHS doctor are available for referral slip at ________________. Therefore, I have no referral slip in this regard. Hence, it is requested kindly to resolve the quarry please.

    Thanking You Sir,

                                                                                      Your’s faithfully,

                                                                                Name

                                                                                CAPF No.

                                                                                

#	HCO Type	Referral required?	Services (As available)	Mode	Guidelines/ Rates
1	Public HCOs, including MHA and CAPF owned facilities	No	OPD / IPD	Free services	-
			Other	Self-paid(later claim ‘Reimbursement’)	CGHS
2	Private HCOs empanelled under CGHS	Yes*	OPD/IPD/ Diagnostics	Cashless	CGHS
			Other	Self-paid(later claim ‘Reimbursement’)	CGHS
3	Private HCOs NOT empanelled under CGHS or under AB PM-JAY	Only in Emergency Cases	All	Self-paid(later claim ‘Reimbursement’)	CGHS

*In Emergency cases, referral is NOT mandatory for private HCOs (empaneled or non-empaneled).

Reimbursement for Self-Paid Medical Treatment

The beneficiary may get reimbursement in following scenarios:

Self-paid services availed at CAPF or Government owned facilities (diagnostics, implants, medicines etc.)

Self-paid services availed at non-empaneled hospitals, in case of emergency

To raise a request for reimbursement of claims, the beneficiary can login to the website (https://tms.pmjay.gov.in/) using Ayushman CAPF ID. Beneficiary will be required to provide requisite details and upload relevant documents such as prescription, referral, invoices etc. Upon approval, payment would be made to serving CAPF personnel’s bank account through UPI, as per applicable rates.

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