Emergency Medical Certificate for Reimbursement: Complete Guide (2026)

When a patient receives emergency treatment at a non-empanelled hospital — accident, sudden cardiac event, stroke or critical OB-GYN emergency — reimbursement from CGHS, ESIC, corporate mediclaim or PM-JAY requires a specific emergency medical certificate from the treating hospital.

What is an emergency medical certificate?

It is a written declaration from the treating doctor that the patient required immediate emergency care which could not be delayed for transfer to an empanelled facility. Without this certificate, insurers and government schemes routinely reject the reimbursement claim or pay only the empanelled rate.

Mandatory content

• Patient name, age and beneficiary ID (CGHS card, ESIC number, employee ID)
• Date and time of admission
• Presenting complaints and emergency diagnosis
• Reason why care could not be delayed (medical justification)
• Treatment provided in the first 24–48 hours
• Treating doctor's registration number, signature and hospital stamp

CGHS reimbursement specifics

Central government employees and pensioners on CGHS must submit Form Med 97, the original emergency certificate, original bills, discharge summary, prescription, and investigation reports within three months of discharge. The CGHS additional director's office processes the claim within 4–6 weeks.

ESIC emergency benefits

ESIC beneficiaries receiving emergency treatment at non-empanelled hospitals must submit Form ESIC-32 or the prescribed reimbursement form along with the emergency certificate to their local ESIC branch within 30 days. ESIC may reimburse at empanelled rates or full actual rates depending on the emergency category.

Corporate mediclaim and IRDAI policies

For corporate group insurance and individual IRDAI-regulated mediclaim, the emergency certificate combined with the discharge summary forms the core of the cashless or reimbursement claim. TPAs typically settle within 15–30 days from receipt of complete documentation.

PM-JAY and state government schemes

PM-JAY (Ayushman Bharat) treatment at empanelled hospitals is cashless, but emergency treatment at non-empanelled hospitals requires post-facto sanction from the State Health Agency with a detailed emergency certificate.

Best practices to avoid claim rejection

Inform the hospital of your scheme at the time of admission, request the emergency certificate before discharge, retain originals plus colour scans, file the claim within the prescribed window, and follow up in writing every 15 days until settlement.