Cashless Treatment for State Govt Employees and Pensioners

Government of West Bengal
Finance Department
Nabanna, Howrah

No. 4656-F(MED) Dated: 05.09.2014

NOTIFICATION

The government employees and pensioners covered by the West Bengal Health Scheme, 2008 are now getting the facility of medical treatment in Government hospitals, in hospitals managed by local bodies like municipalities, in State aided hospitals and in selected Speciality Hospitals outside the State. The employees and pensioners can also get the facility of medical treatment in empanelled Private Hospitals, Nursing Homes, Institutions, Clinics, Laboratories, Diagnostic Centres within the State of West Bengal and National Capital Region (NCR) at Delhi (commonly called ‘Health Care Organisations’ or HCO) as defined in this Department’s Notification No. 3473-F dt. 11.5.09 by making payment of the charges for medical attendance and treatment to the HCO concerned. The State Government now allows advance up to 80 percent of the estimated cost of treatment to the government employees for availing of this facility. For some time past Government has been considering for providing cashless medical treatment facility to the employees and pensioners of the State Government.

2. With a view to providing cashless medical treatment facility to State Government officers and employees, State Government pensioners including family pensioners, All India Service (AIS) officers, AIS pensioners including family pensioners, and their eligible family members in private empanelled hospitals within the State, the State Government has recently notified the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014 vide notification no. 4476-F(MED) dt. 28.8.2014. In terms of the said scheme, cashless treatment is allowed only in respect of the approved package rates annexed to the scheme. It has however been felt that in order to widen the coverage of the cashless part of the treatment, the scheme may be kept open for all kinds of indoor treatments as allowed under WBHS, 2008 and not restricted to the package rates annexed to the notification dated 28-08-2014. This facility will be extended in addition to and not in derogation of the existing WBHS 2008.

3. In the new scheme, cashless medical treatment up to Rupees one lakh will be provided to the beneficiaries for undergoing treatment in private empanelled hospitals within the state including NCR. In case of the beneficiaries whose treatment cost is more than Rupees one lakh, the treatment cost up to Rupees one lakh will be covered under this scheme. The balance amount over and above the ceiling of Rupees one lakh will have to be paid by the beneficiary concerned to the HCO. The government employees covered under the scheme will be allowed to take advance of 80 percent of the estimated cost for treatment minus Rupees one lakh, if the total estimated cost of treatment exceeds Rupees one lakh.

4. Therefore, in partial modification of this Department’s Notification dated 28-08-2014 mentioned above, the Governor is now pleased to extend the facility of cashless treatment in private empanelled hospitals within the state to all classes of indoor medical attendance and treatment covered by the WBHS 2008 upto a ceiling of Rupees one lakh. The Governor is further pleased to order that following procedure will be adopted to provide cashless medical treatment facility to the eligible beneficiaries up to a ceiling of Rupees one lakh only.

i) Existing card holders under WBHS 2008 will have to apply on line for enrolment following the procedure given in health scheme portal of Finance Department’s website http://wbfin.nic.in for getting the benefit of cashless treatment. They will have to register themselves for the cashless scheme using their GPF A/c No. as login ID with date of birth as password. The enrolled pensioners/family pensioners will have to register using their PPO No as login ID with date of birth as password. Names of employees/pensioners/family pensioners and their eligible family members to whom cards have already been issued shall also have to be entered as beneficiary under the Scheme. Detailed procedure and guidelines for online application will be provided in the website mentioned above.

ii) After registration, three print outs of the application form should be taken. A stamp size recent colour photograph of each of the beneficiary will then have to be pasted at the earmarked place on all the three copies of the application. The beneficiaries will also be required to put their respective signature at the earmarked place on all the three copies of the application. In case of a child below twelve years of age. natural or legal guardian will put signature on behalf of his ward. Then those applications along with one stamp size photograph of each beneficiary will have to be submitted to the respective DDOs. DDOs will return one copy to the employee concerned after affixing his signature and seal as an acknowledgement of receipt and retain the second copy in the respective office for record. The third copy of the application duly authenticated by the DDO will have to be sent to the Medical Cell, Finance Department. Writers’ Buildings, Kolkata – 1.

iii) Similar procedure will have to be followed by the pensioners/family pensioners. The pensioners will have to submit the print out of the uploaded applications to their respective Pension Sanctioning Authority (hereinafter called ‘PSA’).

iv) The DDO/PSA will verify the authenticity of the particulars entered and will confirm the particulars of the application in the Health Scheme Module using DDO Code as the login ID. After confirmation, enrolment certificate will be generated online. DDOs will download and print the beneficiary wise enrolment certificate and hand over the same to the employee/pensioner as the case may be beneficiary wise after affixing his signature and affixing and attesting the photograph(s). This enrolment certificate will serve as Health Card till such time formal Health Cards are issued. Photocopy will be retained in the respective office for record.

v) In case of transfer of employees from one DDO to another DDO, the present DDO will enter the new DDO code as applicable for that employee in the http://wbfin.nic.in. Similarly, in case of pensioners/family pensioners who are availing medical benefit in any office other than his PSA in terms of memo no. 10795-F(MED) dt. 22.11.2010 and memo no. 8246-F(MED) dt. 28.9.2012, PSA will enter the new DDO Code for that pensioner/family pensioner

5. Similar procedure will have to be followed by a new Government employee/pensioner who may opt to get enrolled into the scheme for the first time.

6. The beneficiary will be required to produce this enrolment certificate before the approved Health Care Organisation (HCO) (website of Finance Department may be consulted for up to date approved list of such HCOs) for undergoing cashless medical treatment as provided in the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014.

7. For undergoing cashless indoor medical treatment no advance authorization will be required by the HCO. On production of the enrolment certificate by the beneficiary, the HCO will login to the aforementioned website for verification of the enrolment. After being satisfied that the beneficiary is enrolled, the medical treatment will be extended in terms of the provisions of West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014, as amended.

8. No charges of any sort are to be realized from the beneficiary enrolled under the present scheme up to Rupees one lakh. At the time of discharge only a bill showing the charges of treatment as well as the relevant Code No(s) will be handed over to the beneficiary under receipt.

9. In case of HCOs in Kolkata, the receipted bill along with copies of all prescriptions, reports, bills etc as are ordinarily required to be given by the hospital authority to the patient party for seeking reimbursement in terms of the provisions of WBHS 2008. will now be required to be sent to the respective Government department of the employee/pensioner as per his declaration. The name of the ‘department’ in which the employee is posted immediately prior to his seeking treatment for self or his eligible family member in a HCO will be treated as the ‘department’ for this purpose. In case of employees of government offices located in regional offices in the districts, who may seek medical treatment in a HCO located within Kolkata region, the department which administratively controls the office of the employee will be treated as the ‘department’ for this purpose. The concerned department, after due scrutiny of the bills, will authorize payment to be made to the concerned HCO for the cashless part of the treatment rendered through online procedure to the Medical Cell of the Finance Department. In case of pensioners/family pensioners, the name of the ‘department’ will be the administrative department which controls the PSA.

10. In respect of the HCOs of a particular district, the receipted bill along with copies of all prescriptions, reports, bills etc as are ordinarily required to be given by the hospital authority to the patient party for seeking reimbursement in terms of the WBHS 2008. will be required to be sent to the Medical Cell of that District Magistrate for scrutiny and payment. The list of HCOs and the authorities to which the bills are to be sent is given in Annexure to this Notification.

11. In respect of bills raised by Kolkata based HCOs, Finance Department (Medical Cell) will release payment and in respect of the HCOs of a district, payment will be released by the District Magistrate to the HCO concerned (maximum of Rupees One Lakh per beneficiary) in a consolidated way. All the payments will be made within one month of receipt of the claims from the HCOs. Payment will be made by bank transfer to the nominated bank account of the HCO after deducting applicable taxes once in a month. An abstract statement of the payment released will be sent by e mail to the HCO by the Finance Department /District Magistrate.

12. In respect of HCOs located in the NCR. New Delhi, the procedure relating to districts as mentioned above will be followed mutatis mutandis with the exception that the role of District Magistrate will be substituted by that of the Resident Commissioner, New Delhi.

13. After coming into effect of this notification, no further card will be issued under WBHS 2008. The ‘WBHS 2008 will be treated as merged with the ‘West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014’ with effect from 15-09-2014. All the Circulars /Orders issued from time to time under WBHS 2008 will apply mutatis- mutandis to this new scheme of West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014. All the Government Employees/ Pensioners and their eligible dependent(s) already enrolled under the existing scheme will be considered automatically eligible for enrolment under the new scheme. The Government Employees/Pensioners and their eligible dependent(s) enrolled under the scheme will be entitled to all the benefits of the WBHS 2008 plus additional benefit of Cashless treatment upto Rupees One Lakh provided the Employee/ Pensioner enrolls himself/herself online as per the procedure mentioned in the foregoing paragraphs. For those employees/pensioners/family pensioners who do not get themselves enrolled as above will not be eligible to get the cashless treatment, but they will continue to get the existing benefits under the WBHS 2008 till 31.3.2015.

14. Government Employees/Pensioners and their eligible dependent(s) should get enrolled under the new scheme by 31st March 2015. Thereafter, no new enrolment will be made except for the new entrants to government service and subsequent retirees. New entrants and fresh pensioners/retirees will have to enroll themselves for this Scheme within two years from the date of joining/date of retirement, as the case may be. Old cards issued by any authority under WBHS 2008 would not be valid after 31.3.2015.

15. In case of districts, District Magistrates will have to open a Medical Cell in his office. The cell would be headed by one Deputy Magistrate & Deputy Collector as incharge with one Additional Treasury Officer, One Medical Officer to be deputed by the CMOH and adequate staff from the existing set up to ensure timely payment of all claims raised by the HCOs of that district. Two data entry operators may be hired by the District Magistrates for this purpose as per terms and conditions issued by the Finance Department from time to time. The District Magistrate will have a bank account in the nature of revolving fund as would be sanctioned from this department for payment to the HCO located in the districts.

16. The provisions relating to Government Authorised Agency (GAA), cashless card and authorization of treatment and settlement of treatment by GAA of the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014 will be implemented in due course. Till such time cashless medical treatment will continue as per the above procedure read with other provisions of the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014 which are not in conflict with the procedures mentioned above.

17. This notification will come into effect from 15th September, 2014.

18. Operational guidelines, clarifications, etc.-

(1) The Finance Department, in consultation with the Health and Family Welfare Department wherever necessary, shall issue operational guidelines, clarifications, etc. for implementation.

(2) If any difficulty arises in the course of implementation of the scheme, it shall be referred to the Finance Department and the decision of the Finance Department thereon shall be final and binding on all the HCOs and the beneficiaries.

By order of the Governor,

Sd/- H.K Dwivedi
Principal Secretary to the
Government of West Bengal

No. 4656-F dated 05.09.2014, Source

Annexure

List of empanelled Health Care Organisation in West Bengal and National Capital Region, Delhi

KOLKATA

BANKURA

BIRBHUM

BURDWAN

DARJEELING

HOOGLY

HOWRAH

MALDA

MIDNAPORE EAST

NADIA

24 PGNS NORTH

COOCHBEHAR

MURSHIDABAD

New Delhi