Finance, DCARC , WBHS đī¸ 34
In the event of the death of a Government employee or pensioner enrolled under WBHS while undergoing IPD treatment at an empanelled HCO, the following procedure shall apply:
Government of West Bengal
Finance Department
Medical Cell
No. 99-F(MED)WB Date: 30.06.2025
NOTIFICATION
Presently, when a Government Employee or Pensioner (including Family Pensioners) enrolled under the West Bengal Health Scheme (WBHS) dies during IPD treatment at any empanelled Health Care Organisation (HCO), the outstanding treatment bills are forwarded to the Medical Cell, Finance Department in terms of order No. 111-F(MED)WB, dated 09.02.2016. The Medical Cell then reviews and calculates the admissible amount in accordance with WBHS guidelines and forwards the claim to the concerned administrative department for payment to both the HCO and the deceased’s legal heirs, if applicable.
However, over the past few years, we have noticed delays in the final settlement of these claims due to several factors:
(i) Files are manually transferred from the Medical Cell to administrative departments, and intradepartmental processing-subject to various Heads of Offices'(HoO)/ Pension Sanctioning Authority’s (PSA) delegated financial authority is often lengthy and time-consuming.
(ii) Administrative Departments/ HoO/ PSA often encounters difficulties in obtaining separate sets of bills when payments are to be made both to the HCO and to legal heirs.
(iii) Administrative Departments and HoO/ PSA do not have ready access to empanelled HCOs’ bank account and other required payment details, which contributes to further processing delays.
In view of the above, the Government has been actively considering revisions to the existing process for settling death claims of employees or pensioners who pass away while undergoing IPD treatment at empanelled HCOs
Accordingly, the Governor is pleased to state that in the event of the death of a Government employee or pensioner enrolled under WBHS while undergoing IPD treatment at an empanelled HCO, the following procedure shall apply:
(i) The empanelled HCO will forward the outstanding treatment bills directly to the Medical Cell, Finance Department, without exception.
(ii) The Medical Cell, Finance Department will process these bills in accordance with existing WBHS guidelines. Payment will be made directly to the HCO through the cashless payment mechanism.
(iii) Claims relating to the deceased employee or pensioner shall be settled by the respective Administrative Department/ HoO/ PSA based on reference documents provided by the Medical Cell. To streamline this process, a Death Case Admissibility-cum-Reimbursement Certificate (DCARC) has been introduced. This certificate will formally confirm admissibility and enable the administrative department/ HoO/ PSA to process payments to the legal heir(s), in accordance with existing rules.
This order supersedes any earlier order(s) issued in this respect and will take immediate effect.
By Order of the Governor,
Sd/- K.A. Anwar
Secretary to the
Government of West Bengal