Reimbursement of Medical Expense from Insurance Policy


Government of West Bengal
Finance (A) Deptt., Medical Cell

No. 6508-F(MED), Date: 27.07.12


The State Government pensioners and their family members are entitled to the medical facilities of the West Bengal Health Scheme, 2008 under the Finance Department’s Memorandum no. 3475-F dtd. 11.05.09. But like the State Government employees they are not allowed to claim medical reimbursement both from the medical Insurance Company as well as the West Bengal Health Scheme, 2008. Requests for extending the said benefit to the State Government pensioners/ family pensioners are being received by this department from various corners.

Now considering all aspects, the Governor has been pleased to order that State Government pensioners/ family pensioners who were under the West Bengal Health Scheme and has taken a Medical Insurance Policy would be allowed to claim reimbursement of medical expenses both from the Insurance Company as well as the West Bengal Health Scheme, 2008 subject to the observance of the following procedure:

Medical reimbursement claim against the original voucher(s)/ cash-memo(s) would be submitted by the pensioner/ family pensioner first to the Insurance Company who would issue a certificate to the pension sanctioning authority/ competent sanctioning authority regarding the amount reimbursed to the pensioner/ family pensioner. The pensioner/ family pensioner would then prefer the medical claim along with authenticated photocopies of vouchers/ cash-memos to the concerned sanctioning authority. The sanctioning authority would then reimburse to the pensioner/ family pensioner only the balance admissible amount on the basis of approved rates i.e., admissible amount minus the amount reimbursed by the Insurance Company.

Sd/- H. K. Dwivedi
Secretary to the Government of West Bengal

No. 6508-F dated 27.07.2012, Source