List of Documents for MoA under W.B. Cashless Medical Scheme
Government of West Bengal
Finance Department
Audit Branch
Medical Cell
No. 170-F (MED) WB Date 07.03.2017
From:- Sri S. K. Ram,
Special Secretary to the
Government of West Bengal
To:- The Managing Director/ Chief Executive Officer/ Medical Director/
Medical Superintendent/ Administrative Officer
……………………………………….
(Health Care Organisation/ Diagnostic Centre)
Sub:- Guidelines regarding submission of documents by the Health Care Organisations (HCOs)/ Diagnostic Centres for new/renewal of Memorandum of Agreement under West Bengal Health For All Employees and Pensioners Cashless Medical Treatment Scheme, 2014 erstwhile West Bengal Health Scheme, 2008.
Madam/ Sir,
I am directed to state that the following guideline in Annexure-I is to be followed during new/ renewal of Memorandum of Agreement (MOA).
This has the approval of the Principal Secretary of this department.
Yours faithfully,
Special Secretary to the
Government of West Bengal
No. 170-F (MED) WB Date 07.03.2017
Sub:- Guidelines regarding submission of documents by the Health Care Organisations (HCOs)/ Diagnostic Centres for new/renewal of Memorandum of Agreement under West Bengal Health For All Employees and Pensioners Cashless Medical Treatment Scheme, 2014 erstwhile West Bengal Health Scheme, 2008.
- Letter duly recommended, from the Competent Authority of Department of Health & Family Welfare, Govt of West Bengal for empanelment/ renewal for empanelrnent mentioning the type of class of HCO /Diagnostic Centre.
- Two sets of Memorandum of Agreement (MOA) on a non-judicial stamp paper of Rs. 100/- (Rupees One hundred Only) each as mentioned in FD Notification No. 141-F(MED)WB Dt 15.02.2017.
- Declaration regarding printing of MOA in the non-judicial Stamp Paper in the same manner, fashion with all clauses without any alteration as mentioned in FD Notification No. 141-F(MED)WB Dt 15.02.2017 to be submitted by the Competent Authority in the Prescribed Letter Head of the HCOs/Diagnostic Centre with his/her seal, signature and date and the page 1 of 23 to be printed in the two sets of stamp paper according to the size of Stamp Paper and page 2 of 23 to page 23 of 23 in the demy papers without any change in page setup.
- Declaration of acceptance of revised terms and conditions and rates scheduled for package, procedures and investigations by the Medical Cell, Finance Department should be submitted by the Competent Authority in the Prescribed Letter Head of the HCOs/Diagnostic Centres with his/her seal, signature and date.
- Performance Bank Guarantee at required rate as mentioned in page 22 of 23 of MOA for Five years in favour of “Special Secretary, Finance (Audit) Department, Medical Cell, Govt of West Bengal, Writers Buildings, Kolkata 700001”.
- A self attested copy of up-to-date West Bengal Clinical Establishment Licence Renewal Certificate from the Competent Authority.
- Documents on total no. of beds available in the HCOs by the Competent Authority.
- A self attested copy of updated Fire Safety Licence from the Competent Authority in the same name and style with address as per West Bengal Clinical Establishment Licence Renewal Certificate.
- A self attested copy of updated No Objection Certificate to be obtained from West Bengal Pollution Control Board in the same name and style with address as per West Bengal Clinical Establishment Licence Renewal Certificate.
- A self attested copy of updated Trade Licence issued from the Competent Authority in the same name and style with address as per West Bengal Clinical Establishment Licence Renewal Certificate.
Special Secretary to the
Government of West Bengal
Finance Department