Reimbursement of Medicine Cost in Non-Empanelled Hospital
Finance, Generic Medicine , WBHS
Government of West Bengal
Finance Department
Medical Cell, Writers’ Building
No. 131-F(MED)WB Dated- 30/06/2022
MEMORANDUM
The beneficiaries of WBHS get reimbursement of the cost of indoor treatment in non-empanelled private hospitals within West Bengal in terms of Finance Department’s Order No. 10539-F(MED)WB dated 21.11.2011 read with Order Nos. 11254-F(MED)WB dated 16.12.2011 and 8687-F(MED)WB dated 16.10.2012.
Several requests have already been received from different corners to clarify Clause No. (i) of Order No. 8687-F(MED)WB, dated 16.10.2012 and to specify the guidelines in details for reimbursement of cost of medicines incurred for indoor medical treatment in non-empanelled hospital within the State.
After careful consideration of the matter, the undersigned is directed by order of the Governor to offer the following clarification for information and guidance of all concerned:-
| Sl. No. | Provision | Clarification |
|---|---|---|
| 1 | Clause (i) of Order No. 8687-F(MED)WB dated 16.10.2012 states “For treatment in non-empanelled Health Care Organisations, cost of medicines in generic names may be reimbursed in full. Trade name shall not be considered by any means.” Whether the costs of medicines prescribed in Trade/ Brand name by non-empanelled Health Care Organisation within the State for indoor treatment will be reimbursed? | Yes, up to 60% or 80% (depending on the nos. of available beds of treating hospital) of cost for admissible medicines prescribed in Trade/ Brand name for indoor treatment is reimbursable. Moreover, if the medicines are prescribed in generic name only, up to 100% of cost for admissible medicines for indoor treatment is reimbursable. |
This order is applicable for all the future claims as well as claims lying pending for disposal at present under different stakeholders of WBHS.
Aloke Kumar Mukherjee, WBA & AS
Joint Secretary, Finance Department
Government of West Bengal