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Guidelines regarding Signature under Cashless Medical Scheme

Finance

Government of West Bengal
Finance Department
Medical Cell

No. 139-F(MED)WB/FA/MED/0/2M-100/2016 Date 23.02.2016

Notification

Sub:- Guidelines regarding signature in Certificate of Enrolment and Form -H & D4 and other documents under West Bengal Health For All Employees and Pensioners Cashless Medical Treatment Scheme, 2014

For Sometimes past it has been observed that the signature of beneficiaries /Government employees/ Government Pensioners including Family Pensioners in Form H & D4 differ in language, style/ fashion and pattern from the signature of Certificate of Enrolment and in some cases it is also seen that the Forms H and D4 are signed by the person other than the Government Employees/ Government Pensioners (including Family Pensioners), causing thereby inconvenience to a great extent in settlement of claims of the HCOs besides leaving scope for fraud/ impersonation.

In order to smooth settlement of Cashless treatment bills submitted by different Private Health Care Organisations (HCOs ) and as measure to safeguard from a fraudulent act of impersonation further guidelines regarding signature are issued for strict compliance by all concerned.

1. For Government Employee/ Government Pensioner/ Beneficiaries:-

i. Government Employee /Government Pensioner including Family Pensioner shall put his/her signature in Form H & D4 in the same language, style/ fashion and pattern as already done in his/her Certificate of Enrolment.

ii. Government Employee/ Government Pensioner including Family Pensioner shall henceforth invariably put his/her signatures in the space provided in the Certificate of Enrolment. Previously, Certificate of Enrolment was issued with beneficiary photograph duly attested by DDO and signature of the concerned dependent family member of the Government Employee/Pensioner. Now, it is decided that besides the signature of the beneficiaries in their individual Certificate of Enrolment signature of Government Employee/Pensioner is mandatory in all beneficiaries Certificate of Enrolment.

Certificate of Enrolment of beneficiaries already issued without the signature of Government Employee /Government Pensioner should invariably be signed in the appropriate place (as fixed now) by inserting either of the following words “Signature of the Government Employee” or “Signature of Government Pensioner”.

iii. In absence of Government Employee/Government Pensioner at the time of admission/ discharge from any of the concerned HCO under unavoidable circumstances patient (i.e, Beneficiary) shall sign in Form H and D4 in the same language, style /fashion and pattern as already done in his /her Certificate of Enrolment in the space provided for the signature of Government Employee/ Pensioner.

iv. It is advisable and preferable that Government Employee /Pensioner shall remain present in the HCO at the time of admission /discharge of his /her beneficiary. In case of his /her absence under unavoidable circumstances such absence should be justified by sending e-mail to the concerned HCOs or by submitting a hard copy furnishing therein reasons for such absence immediately. Such absence justification should be signed by Government Employee /Government Pensioner with same language, style /fashion and pattern of signature available in Certificate of Enrolment and duly countersigned by the authority of the concerned HCO with official seal.

v. In case of inability of a Government Employee/ Government Pensioner/ Beneficiary to sign in Form H & D4 he/ she shall put his /her LTI (Left Thumb Impression) or RTI (Right Thumb Impression) for his/her inability to put Left thumb under proper attestation by the treating doctor of the concerned HCO invariably mentioning his /her registration number.

vi. To avail higher cost implant than those mentioned in WBHS approved rate list consent letter should be provided to the concerned HCOs declaring difference amount to be paid by himself/herself with same language, style /fashion and pattern of signature available in Certificate of Enrolment and duly countersigned by the authority of the concerned HCO with official seal.

2. For Private Empanelled Health Care Organisations ( HCOs )

i. HCOs will verify the signature of Government Employee/ Government Pensioner in Form H & D4 with the same language, style /fashion and pattern of signature as available in Certificate of Enrolment.

ii. In case of absence of Government Employee /Government Pensioner at the time of admission /discharge HCO is requested to take his/her justification for absence received through HCOs e-mail ID or hard copy and submit the same duly countersigned by authority of the concerned HCO with the Final Bill Copy and in that case beneficiaries /patient may also be allowed to put his /her signature in Form H & D4 in the same language, style/fashion and pattern already made in his /her Certificate of Enrolment.

iii. In case of death of a Government Employee/Pensioner during treatment at empanelled HCO any dependent beneficiary may sign in Form H &D4 by submitting his/her Certificate of Enrolment and the signature should be similar as stated herein above. But if Government Employee/Pensioner has no other dependent beneficiaries then any other near relative with due photo identification documents such as PAN, Driving Licence, Voter ID etc may sign in

Form H & D4 during hospitalisation death with a copy of admissible photo identification document(s) mentioned above.

iv. In case of availing higher cost of implants than mentioned in WBHS approved rate list a consent letter should invariably be obtained from Government Employee/ Pensioners/ beneficiaries regarding his /her willingness to obtain higher implants with same language, style/fashion and pattern of signature available in Certificate of Enrolment and the said letter should duly be countersigned by the authority of the concerned HCO with official seal. The same should be submitted in Medical Cell, Finance Department alongwith the claim bill.

3. For DDO/Head of Office:-

i. Head of Office/ DDO should ensure that the Government Employee/ Pensioner shall sign in all dependent beneficiaries Certificate of Enrolment in appropriate place (as fixed now) just below the signature of the beneficiary.

ii. All Certificate of Enrolment of beneficiaries without the signature of Government Employee /Government Pensioner already issued should invariably be signed by the Government Employee or the Government Pensioner in the appropriate place inserting either of the following words “Signature of the Government Employee ” or “Signature of Government Pensioner” just below the signature of the beneficiary.

iii. In case of inability of a Government Employee/Government Pensioners/Beneficiary to sign his/her Application for Enrolment/ Certificate of Enrolment he/she shall put his/her LTI (Left Thumb Impression) or RTI (Right Thumb Impression) for his/her inability to put Left Thumb Impression under proper attestation by the concerned DDO/ Head of Office.

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

No. 139-F dated 23.02.2016, Source

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