Government of the Pakistan, Ministry of Health has already issued Notification No. F.5-38/2001-Chief (II) dated 16-03-2006 in connection with guidelines for submission and scrutiny of the medical claims.

The Guidelines for Submission and Scrutiny of the Medical Claims

1. The Guidelines for Submission and Scrutiny of the Medical Claims are as under:
2. Only the attached prescribed application form be used.
3. Proper prescription bearing O.P.D No, name, age, sex and disease of the patient and admission/discharge slip (in case of indoor treatment) be attached in support of the claim.
4. Names of quantity of the medicines purchases by the claimant be enclosed with the application for reimbursement.
5. Application must be countersigned by any one of the officers mentioned at the copy of the Notification.
6. In case of patient is referred to some other hospital by his authorized Medical Attendant of such referral letter/move sanction, as the case may be be attached with the claim.
7. Cost of treatment taken from the un-authorized hospital/private clinic of doctor (even if he/she serving in any Govt hospital) is not admissible.
8. Only the receipts written on the proper hospital printed form/prescription slip duly stamped is be accepted.
9. Cash memos must be on proper form with licence No. of the chemist and signed by the authorized Medical Attendant.
10. Cost of Unani, Ayurvedic and Homeopathic medicines will not be reimbursed.
11. Transportation charges of the patient are not to be reimbursed.
12. Cost of laboratory tests taken from authorized/un-authorized hospital /laboratory are admissible on the basis of reference by the authorized Medical Attendant only.
13. The const of vaccine (s), blood and products is admissible.
14. The cost of the following items is not reimbursable:

• Cost of organs and tissues in case of transplants
• Soap and detergents
• Food supplements
• Toilets and cosmetic goods
• Thermometers
• Expenses incurred on medical treatment abroad

15. The cost of the following items is reimbursable:

• Antiseptic liquids as prescribed
• Disposables as prescribed

16. “Dental treatment” includes treatment of alveolar (gum and jaws bones) diseases, extraction of teeth, treatment for dental caries, gingivitis, pyorrhoea and filling (temporary or permanent) of dental cavitiesincluding root canal treatment, scaling but does not include dental implants, orthodontic application, bridging, crowining and provision of dentures.

17. In addition to above, if any patient has to get medical treatment from any un-authorized/private hospital/military hospital/clinic, in emergency, he is required to produce emergency certificate from the treating doctor showing, nature of disease and treatment given, duly countersigned by the nearest Authorized Medical Attendant (AMA) as specified in para 4 of the guidelines. This superceeds the Ministry of Health’s circular No. F.1-1/2005-MR-I dated 17-11-2005.