Medical Reimbursement Form PDF

Medical reimbursement form is an important document used for claiming medical expenses that you have paid in cash for treating yourself or your family members. By submitting the original bills along with this form to your employer, you can get back the money spent, provided it does not exceed the limit of Rs 15,000 per financial year without any tax deduction.

Medical reimbursement helps employees recover uninsured costs for general medicine or accident treatment from their employers. To make things simple, you can easily download the Medical Reimbursement Form PDF from the link at the bottom of the page and start your claim process smoothly.

How to Fill the Medical Reimbursement Form Correctly

Key Information Needed in the Medical Reimbursement Form

• Name and Designation of the Government Employee
• Office where Employed
• Place of Duty
• Permanent Address
• Name of the Patient and their relation to the Government servant
• Details of the Amount Claimed
• Hospital Treatment details
• Any other important information related to the medical claim

Who Can Apply for Medical Reimbursement?

• The employee must have paid for the medical treatment themselves.
• The expenses should be for medical care of the employee or their family members.
• The employer will reimburse the expenses submitted within the allowed limit.
• The total medical reimbursement cannot go beyond Rs 15,000 in a financial year.

Documents Needed Alongside the Medical Reimbursement Form

• Filled Medical Reimbursement Application Form
• Original Hospital Discharge Summary
• Receipts from hospitals or chemists
• Copy of the Health Card
• If treatment is due to an accident, then FIR or medico-legal certificate (MLC)
• Any other related documents

Medical reimbursement is a helpful facility that returns some part of health expenses to employees. According to the Income Tax Act, such reimbursements up to Rs 15,000 are exempt from tax, making it easier for employees to manage medical costs.

This certificate confirms that the treatment was outpatient but required medical care for more than 10 days and did not involve hospitalization.

For easy claim submission, you can download the Medical Reimbursement Form PDF from the link below and start your application without any hassle. 📄