a. Request letter of beneficiary (CGHS pensioners and serving CGHS beneficiaries).
b. CGHS card copies of card holder and of dependent patient.
c. Duly filled Specified proforma to be filled by the Government Chest Physician clearly specifying type of equipment required along with flow rate.
d. Detailed reports (sleep studies, thyroid function tests, electrolytes, Blood gas analysis etc).
e. Affidavit to undertake maintenance of the equipment and to return the equipment to CGHS once its utility is over.
f. Undertaking from Card holder that he has not been reimbursed the cost of Oxygen Concentrator/CPAP/BiPAP in the preceding five years for the said dependent.
g. The replacement of the machine is permissible after 5 years subject to submission of condemnation /un serviceable certificate provided by the service engineer. The procedure for getting permission for replacement of the device involves the same procedure.
Permission shall be accorded after the application is examined by committee.
a. Covering letter from Card holder.
b. Duly filled claim form and bank mandate form and other relevant documents.
c. Copy of CGHS card.
d. Bill/Receipt (original) indicating the details.
e. Paid proof.
f. The original permission letters.
The reimbursement shall be restricted to ceiling rates or the actual, whichever is lower.