Revision of Guidelines for Advance Purchase of Medicines and Submission of OPD Claim for Reimbursement under the West Bengal Health Scheme (WBHS).
Government of West Bengal
Finance Department
Medical Cell
No.- 63-F(MED)WB Date: 08.05.2025
MEMORANDUM
Subject: Revision of Guidelines for Advance Purchase of Medicines and Submission of OPD Claim for Reimbursement under the West Bengal Health Scheme (WBHS).
At present employees/ pensioners can claim online OPD reimbursement a maximum of two (02) times within a period of six months from the date of OPD consultation. But several cases have been referred to Medical Cell, Finance Department regarding the limitation of submitting only two (02) claims within a specified period, thereby causing significant financial burden on the employee/ pensioner when the employee/ pensioner or their beneficiaries are suffering from chronic illness as stated under Clause 7(1) and 7(2) of the WBHS.
After careful consideration of the matter, the Governor is pleased to make the following guidelines for processing & submission of multiple claims, advance purchase of medicines etc. within the stipulated time period under WBHS:-
1. Regarding OPD treatment within the State:
a) Henceforth, advance purchase of medicine can be claimed on monthly basis [i.e. maximum of six (06) times against a particular consultation within a validity period of six month.]
The existing provision for advance purchase of medicines for a period up to three (03) months shall also remain in force in accordance with Memorandum No. 2618-F(MED), dated 05/04/2011.
However, consultation with the treating consultant at an interval of six (06) months from the date of the previous consultation shall continue to be a mandatory prerequisite for OPD reimbursement under Clause 7(1) and 7(2) of the West Bengal Health Scheme.
b) After settlement of an OPD claim over a particular period of time, preferring a fresh claim in respect of the same patient for the same disease(s) overlapping the said period shall not be entertained.
c) Where a particular consultant has been consulted more than once during a specified period of time for any particular disease under Clause 7(1) or 7(2) of the WBHS, the employee/ pensioner may submit a consolidated claim for reimbursement clubbing all the consultation fees and cost of other admissible items.
2. Regarding OPD treatment outside the State:
a) In cases where OPD treatment is received outside the State with prior permission and in accordance to the provision of WBHS, the employee/pensioner on the basis of the prescription/ discharge advice as issued by the treating specialist, can submit a maximum of two number of claims for reimbursement for a period of one (01) year only.
However, consultation with the treating specialist after one year shall continue to be a mandatory prerequisite for OPD reimbursement in respect of treatment outside the State in accordance with the provisions of WBHS even if the treatment is advised for an indefinite period.
b) The existing provision for advance purchase of medicines for a period maximum up to six (06) months shall remain in force, in accordance with Memorandum No. 2857-F(MED), dated 08.04.2013.
3. This order will take immediate effect.
Sd/- K.A. Anwar, IAS
Secretary to the
Government of West Bengal