I am now accessing as a :

Government Of Assam Secondary Education

Apply for medical reimbursement

To apply for medical reimbursement, the applicant should submit the proposal for claim with 45 days. While submitting medical reimbursement proposal, the following information along with formats should be submitted-

Checklist:

  • Minutes of the meeting / Check List of the District Level Admissibility Board (seal & signature of the Members alongwith Admissible amount by name of incumbent concerned is mandatory to furnish along with the Admissibility Report)
  • Admissibility Report from the Jt. Director of Health Services (concerned district).
  • Authorized Medical Attendants recommendation (if applicable).
  • Referral Medical Board’s Certificate
  • Essentiality Certificate.
  • Discharge Summary/Certificate.
  • Records of Hospital.
  • Certificate from the Hospital authority.
  • Final bill / Bill summary issued by the Hospital authority.
  • Attested copy of Bank Pass Book.
  • Attested copy of G.P.F./C.P.F. Statement.
  • Attested copy of Pension Payment Order.
  • Death Certificate (if applicable).
  • Birth Certificate (if applicable).
  • Legal Heir Certificate (if applicable).
  • Original bills/vouchers etc.
  • Leave order for the treatment period (if applicable).
  • A self declaration / undertaking of no claim from other sources.
  • Dependant certificate from concerned authority (if applicable).
  • Physical Verification Certificate of concerned D.D.O.
TitleSizeDetail
PDF icon DECLARATION & Important Certificate.pdf180.25 KBswf-image