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ANNEXED DELHI GOVERNMENT HEALTH SCHEME MODIFIED CHECK LIST FOR REIMBURSEMENT OF MEDICAL CLAIMS (Claim should be submitted in duplicate) 1. DGH Token/CARD No. and place of issue : (or Ben ID of Employee/Pensioner)
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Provide your medical claim details, including the name of the medical provider, the date of service, the nature of the medical treatment, and any supporting documents such as medical receipts or reports.
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The cuserslenovodesktopwebsite-formsmedical claimdgehs appln formdoc is a document used for submitting medical claims to a specific health program or insurance provider.
Individuals who are seeking reimbursement for medical expenses covered under a particular health insurance plan or program are required to file this form.
To fill out the form, provide personal information such as name, contact details, policy number, as well as details of the medical expenses, including dates and amounts. Ensure all sections are completed accurately.
The purpose of the form is to formally request reimbursement for eligible medical expenses incurred by the insured individual.
The form must include personal identification details, insurance policy information, a list of medical services rendered, dates of treatment, and costs associated with each service.
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