Government of West Bengal
No. 811-F(Med)WB Date: 16-07-2015
Sub:- Procedure for settlement of Cashless treatment bills amounting more than Rupees One lakh under West Bengal Health For All Employees and Pensioners Cashless Medical Treatment Scheme, 2014.
Government of West 8engal Introduced “West Bengal Health For All Employees and Pensioners Cashless Medical Treatment Scheme, 2014” (hereinafter called the said scheme) for the benefit of State Government Employees, State Government Pensioners, All India Service (AIS) Officers, AIS Pensioners including their eligible dependent members of the family. As per the existing provisions of the said scheme claim upto Rupees One lakh towards medical cost as admissible can be settled by the Medical Cell of Finance Department after due checking and by submitting bills in PAO for epradan in the bank account of the concerned HCO. Now, the procedure for settlement of Cashless treatment bills amounting more than Rupees One lakh prescribed below
1. Medical cell of FD will take the following actions-
i. Sanction up to Rupees One lakh of admissible claim under Cashless scheme;
ii. Submit bill to PAO for admissible sanctioned cashless claim upto Rupees one lakh for payment to the bank account of the concerned HCO under e pradan after deduction of TDS;
iii. Issue “Cashless Admissible Reimbursement Certificate” for the balance admissible amount in favour of the Government Employee / Pensioners after examination of the HCO’s claim bill;
iv. Send the “Cashless Admissible Reimbursement Certificate” to the e-mail address of the beneficiary, and simultaneously uploaded in the Health Scheme portal to make it available to the DDO of the beneficiary and the Treasury/PAO using their respective log in ID and password.
2. Government Employee / Government Pensioner will do the following:-
i. The beneficiary will produce to the DDO of the office where he/she is employed/ was last employed in case of in-service employees/retired employees respectively, the “Cashless Admissible Reimbursement Certificate” along with original Money Receipts issued by the HCO in support of the payment made by him/her for the balance amount of the HCO’s claim. i.e., admissible amount minus the amount to be paid to the HCO directly under cashless scheme.
ii Prepare Essentiality -cum -Statement of Expenditure in Form D2 or Form IV2 as applicable on the basis of amount sanctioned in “Cashless Admissible Reimbursement Certificate” (Annex-I).
iii. Related OPD treatment cost may be claimed in Form D2 /IV2 in the appropriate column as per clause 9 of WBHS 2008 if it is advised by the treating doctor.
iv. Attached Original Money Receipts / Vouchers regarding payment to the HCO.
v. Attached photocopy of bill as obtained from the HCO.
3. The Head of Office / Competent Authority / ODO of the beneficiary will do the following:-
Take necessary action for sanction of the amount as per FD Notification No. 4201-F(Med) dt. 13.08.2014 for which “Cashless Admissible Reimbursement Certificate” will have been issued by the FD Medical Cell and for which original Money Receipts /vouchers are submitted by the beneficiary;
ii. Submit reimbursement claim of the beneficiary to the Treasury/PAO for the balance sanctioned amount in “Cashless Admissible Reimbursement Certificate” to be paid to the Govt Employees / Pensioners bank account under e-pradan system.
4. The government employees covered under the scheme will be allowed to take advance of 80% of the estimated cost for treatment minus Rupees One lakh, if the total estimated cost of treatment exceeds Rupees One lakh.
5. Empanelled HCO will do the following:-
i. Original Money receipt to be provided to Government Employee / Pensioner regarding his/ her actual payment portion only.
ii. Photocopy of details bills to be provided to Govt Employee / Pensioner.
This has the approval of Group- T of Finance Department vide their U.O. No. 0240 dated 01-07-2015.
End: Proforma of “Cashless Admissible Reimbursement Certificate” in Annexure-I
By order of the Governor
Principal Secretary to the
Government of West Bengal