Relaxation in Income Limit for Medical Treatment
Update: Inclusion of some more Critical Diseases/ Illness under WBHS
Government of West Bengal
Finance Department
Medical Cell
No. 35-F(MED)WB Dated: 24.04.2018
MEMORANDUM
For availing the medical facilities under erstwhile West Bengal Health Scheme, 2008 now known as West Bengal Health For All Employees and Pensioners Cashless Medical Treatment Scheme, 2014 (hereinafter called the Health scheme) son, minor brothers, unmarried/ widowed/ divorced daughters, unmarried/ widowed/ divorced sisters of the Government Employee/ Pensioners if they are normally residing with him/ her and their income from all sources does not exceed Rs. 1,500/-(Rupees One thousand five hundred) only per month and Parents whose monthly income does not exceed Rs. 3,500/- (Rupees Three thousand five hundred) only shall be deemed to be dependent upon the Govt. Employee/ Govt. Pensioner.
2. This department has received a large number of cases under the said scheme where the concerned Government employee/ pensioner is not able to bear huge medical expenses for medical treatment of his/ her Parents, son, minor brothers, unmarried/ widowed/ divorced daughters, unmarried/ widowed/ divorced sisters suffering from life threatening Critical diseases like (i) Cancer (ii) Liver transplant (iii) Kidney transplant and (iv) Major heart surgery, who do not come within the ambit of stipulated income limit as prescribed in the scheme. Therefore, the Government employee/ pensioners are facing huge difficulties to continue their treatment for want of money.
3. Now, the Governor is pleased to relax the income limit for parents, son, minor brother, unmarried/ widowed/ divorced daughters, unmarried/ widowed/ divorced sisters of the Government employee/ pensioner for medical treatment of the aforesaid Critical diseases.
The Government Employee/ Pensioner can enroll or include his/ her family members, as stated above, online under a new category “Relationship (Critical Diseases)“, if the dependents are not covered under any other Government Health Scheme which offers similar facilities. However, the said dependent member of the Government Employee/ Pensioner having a Medical Insurance Policy would be allowed to claim reimbursement of only residual medical expenses left after claim of the Insurance Company has been settled.
A medical claim against the original vouchers/ cash-memos would be raised by the dependent member first from the insurance company who would issue a certificate for the amount of settlement. He would then prefer his medical claim along with the certificate and photocopies of vouchers/ cash memos of the medical treatment to the concerned office. The CCA/ Head of Office/ PSO would then reimburse to the Government Employee/ Pensioner only the balance admissible amount on the basis of approved rates i.e. admissible amount minus the amount reimbursed by the insurance company.
By order of the Governor,
Special Secretary to the
Government of West Bengal