Clarifications on Health Scheme
Government of West Bengal
Finance Department
Audit Branch
Medical Cell
Finance Department
Audit Branch
Medical Cell
No. 11254-F (MED) Dt. 16-12-2011
Memorandum
The West Bengal Health Scheme, 2008 came into effect from 01-06-2009. Now, the cost of medical treatment in non-empanelled private Health Care Organisation is also reimbursable under certain conditions. Request for clarifications of some points laid down in the said Scheme after its amendments are being received by this department from various corners.
After careful consideration of the matter, the undersigned is directed by order of the Governor to offer the following para-wise clarifications for information and guidance of all concerned.
| Sl. No | Issues | Clarifications |
|---|---|---|
| 1 | Employees/ pensioners enrolled under the West Bengal Health Scheme, 2008 and their dependent family members availing themselves of the medical treatment in non-empaneled private hospitals/ nursing homes prior to issue of the Notification No. 10539-F (MED), dt. 21-11-2011. Whether the costs of such medical treatment will be reimbursed? |
Eligible for the benefits of the Scheme as per the prescribed scale as notified under Order No. 10539-F (MED), dt. 21-11-2011 for indoor treatment only w.e.f. the date of their enrolment under the Scheme. Such cases are to be settled with approval of the Secretary of the Administrative Department. |
| 2 | For medical treatment in non-empaneled private hospital/ nursing home, cost of packages, bed rent, investigation charges, doctor’s fee, implants, etc. are reimbursable up to 80% or 60%, as the case may be, of approved rates under the Health Scheme on the basis of bed capacity of the hospital / nursing home under Notification No. 10539-F (MED), dt. 21-11-2011. What will be reimbursable rate for the medicines and consumables? |
Cost of admissible medicines and consumables will be reimbursed up to 80% or 60% of the actual costs, as the case may be. |
| 3 | Employees/ pensioners enrolled under the West Bengal Health Scheme, 2008 and their dependent family members availing themselves of the medical treatment in private hospitals/ nursing homes that were empaneled initially but it became non-empaneled for a short period due to expiry of contract and then the contract was renewed and it became empaneled under the Health Scheme again. Whether the costs of medical treatment done during the non-empanelled period will be reimbursed? |
Reimbursement of costs of such medical treatment may be allowed under the Scheme as per the class of the private hospital after its renewal. |
| 4 | Employees/ pensioners not taken approval of the West Bengal Health Scheme Authority under Finance Department and received medical treatment in a non-empaneled private hospital/ nursing home outside the State.Whether the costs of such medical treatment will be reimbursed? | Not eligible for the benefits of the Scheme for reimbursement of the costs as they availed themselves of the treatment without approval of the West Bengal Health Scheme Authority and as per their own volition. |
| 5 | Employees/ pensioners not taken approval of the West Bengal Health Scheme Authority under Finance Department and received medical treatment in a speciality hospital outside the State (excluding the cases where procedural delay in according approval is involved).Whether the costs of such medical treatment will be reimbursed? | Not eligible for reimbursement of the costs under the Scheme as they availed themselves of the treatment without approval of the West Bengal Health Scheme Authority. |
| 6 | State Government employees who were enrolled under West Bengal Health Scheme, 2008 while in service, are eligible for the benefits of the Health Scheme as pensioners from the day next to the date of their retirement. (vide Notification No. 8219-F (MED), dt. 19-08-2011) Whether the family pensioners are eligible for getting the benefits of the Health Scheme immediately after death of the Government employee/ Government pensioners enrolled under the Scheme? | Yes. |
Sd/-
Joint Secretary to the
Government of West Bengal,
Finance Department
Probably Related posts:
- Treatment in Private Nursing Home (80% reimbursement)
- Extension of Health Scheme to the retired AIS members
- Enrollment of retired AIS under Health Scheme
- Enrollment under Health Scheme Extended
- Class I Hospitals under West Bengal Health Scheme
9 Responses to “Clarifications on Health Scheme”
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AskWB.com
i got treatment in appollo gleaneagles hospital saltlake at opd. the attending gaestro-enterologist advised for some tests like endoscopy,usg,blood haemogram. accordingly all the tests have been done in the same hospital.now my question is as i got treatment at opd can i get the expenses for all those tests,doctors fee under wbhs 2008.sjbanerjee,aud & accnt officer
In case of OPD reimbursement is admissible for the following:
(i) Malignant diseases,
(ii) Tuberculosis,
(iii) Hepatitis B/C and other liver diseases,
(iv) Insulin-dependent diabetes,
(v) Heart diseases,
(vi) Neurological disorders/ Cerebrovascular disorders,
(vii) Malignant malaria,
(viii) Renal failure,
(ix) Thallasaemia/ Bleeding orders/ Platelet disorders,
(x) Injuries caused by accidents.
Which category do you fall under? I think none. Then the answer is negative.
I think endoscopy and usg are admissible. Please refer sl. no. 10 of the memorendum no. 797-F (MED) dated 31.01.2011 of WB Finance Deptt., Audit Branch (medical cell). It is available in website of wbfin.
sir,
memo no 9205-F (MED) dt 5/10/2009 clarify about medical allawnce deduction when one of in direct govt. employee & other in sposored school or any other where govt gives M.A. as a member of WBHS’2008. as per the order both of them have not to draw M.A.
sir,
Dr has provided an estimate of Rs100000 for ventral hernia repair (laproscopy), including disposal worth Rs57000. Will u kindly inform me about the amount reimbursable.
To abhisek roy,
govt approved rate for this is rs.18000/-(code:01023022). it is a package rate like all other surgery. an empanelled n.h is bound to operate in this rate according to order.
A GOVT. EMPLOYEE ENROLLED HIS NAME IN THE WEST BENGAL HEALTH SCHEME, 2008. HIS PARENT IS A FAMILY PENSIONER WHOSE MONTHLY BASIC FAMILY PENSION IS RS. 3300/- WHICH IS THE LOWEST FAMILY PENSION IN THE GOVT. OF WEST BENGAL. NOW THE QUESTION IS ” MAY HIS PARENT BE ENROLLED HIS/HER IN THE WEST BENGAL HEALTH SCHEME, 2008 IN ACCORDANCE WITH THE MEMORANDUM ISSUED UNDER NO. 10734-F(MED), DT. 18-11-2010 OF FINANCE DEPTT., AUDIT BRANCH, MEDICAL CELL, GOVT. OF WEST BENGAL “?
Sir,
My heart by-pass surgery( CABG ) has been done on April’2010 at the Mission Hospital. Now Dr. Satyajit Bose advised me for Cardiac MRI .Will you kindly inform me about the amount reimbursable.under w.b health scheme & code no of the test. thanking you.
Whether vaccination of children is reimbursable under wbhs2008?