Government of West Bengal
Medical Cell, Finance Department
No. 54-F(MED)WB Dated:- 22.07.2019
Reference and queries were being received from various quarters for clarifications on various aspects of the Memorandum No. 35-F (MED) dated 24/04/2018 and inclusion of some more critical diseases/ illness under this category. The matter was under active consideration of the Government for some time.
After careful consideration, the Governor is pleased to modify the said Memorandum as detailed below:
- Essentiality Certificate: The Essentiality Certificate for enrolling as a beneficiary will be required as mentioned in the following table:
|Sl. No.||Name of Disease/ illness||Essentiality Certificate|
|1||Cancer||Advice of Oncologist for suffering from Cancer and Pathological Evidence from any hospital.|
|2||Organ Transplantation (Liver, Kidney & Heart)||Clearance for Organ Transplantation from Appropriate Authority|
|3||Major Heart Surgery||Advice of Cardiac Surgeon/ Cardiologist from any hospital|
|4||Brain Tumor||Advice of Neuro-Surgeon/ Neuro Physician for suffering such illness from any hospital|
|5||Interstitial Lung Disease and COPD||Advice from Consultant of General Medicine or Specialist of Pulmonology for suffering such illness from any hospital|
|6||Cerebro Vascular Accident (CVA)||Advice of Neuro-Surgeon/ Neuro Physician for suffering such illness from any hospital|
|7||Fulminating Hepatitis||Advice from Consultant of General Medicine or Specialist of Gastroenterology for suffering such illness from any hospital|
|8||Multiple Sclerosis||Advice of Consultant of General Medicine/ Neuro Physician for suffering such illness from any hospital|
|9||Tracheomalacia||Advice from specialist of ENT for suffering such illness from any hospital|
|10||Candida Septicaemia||Advice from Consultant General Medicine for suffering such illness from any hospital|
|11||Pancreatitis||Advice from Consultant of General Medicine or Specialist of Gastroenterology for suffering such illness from any hospital|
- Enrolment: Enrolling Authority shall take a decision on the basis of an Application along with Essentiality Certificate and enrol the beneficiaries under Critical Diseases/ Illness Category for one year. Enrolling Authority shall review it after one year on application of the Government Employee/ Pensioner along with appropriate documents. If disease or illness continues, s/he shall extend fresh renewal of one year. The enrolment and renewal shall also be done in the WBHS Portal by the Enrolling Authority following the system procedure of the portal.
- Forgoing/ Quitting Medical Allowance/ Relief or Health Scheme: Beneficiary has to forgo or quit Medical Allowance/ Relief if s/he receives or enrolled in any other health scheme directly or indirectly controlled by Government of West Bengal, Government of India or any other state Government within the territory of India.
- Facility: The facility shall be restricted only for the treatment of one or more diseases/ illness mentioned in the Enrolment Certificate out of the above mentioned critical diseases/ illness. Beneficiary shall also get cashless treatment up to Rs. 1,00,000.00 (rupees one lac) and reimbursement as per clause 5, 6, 7, 9 and 14 of the notification number 7287-F, dated 19-09-2008 issued by Finance Department, Government of West Bengal.
- Beneficiaries covered under a Medical Insurance: The matter of cashless treatment or reimbursement of the cost of treatment in cases where the beneficiaries are covered under Medical Insurance company also shall be covered under Memo Nos. 3474-F dated 11.05.2009 and 6508-F(MED) dated 27.07.2012.
- Other provisions of the WBHS, as in force from time to time and applicable to the Government Employee/ Pensioner and dependent beneficiaries, shall be applicable in these cases as well.
The order shall take effect from the date of issue of the original order i.e. 24.04.2018.
By order of the Governor
H K Dwivedi, IAS
Additional Chief Secretary