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WBHS for Grant-in-aid College and University Teachers, 2017

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Government of West Bengal
Department of Higher Education,
Science and Technology & Biotechnology
C.S.Branch
Bikash Bhavan, Salt Lake, Kolkata-700091

No. 848-Edn(CS)/1M-01/2017 Date: 01/08/2017

NOTIFICATION

The proposal for providing medical benefits to the Serving Teachers including Librarians and Graduate Laboratory Instructors of Government-aided Colleges and State-aided Universities was under active consideration of the State Government for sometimes past.

After careful consideration, the Governor is now pleased hereby to provide medical benefits to the Serving Teachers including Librarians and Graduate Laboratory Instructors of Government-aided Colleges and State aided Universities and the family members thereto in the following manner under the scheme detailed below.

Scheme

1. Short title and commencement

(1) This Scheme may be called the West Bengal Health Scheme for Grant-in-aid College and University Teachers, 2017.

(2) It shall come into force on such date, as the State Government may, by notification in the Official Gazette, appoint.

2. Application

(1) This scheme shall apply to the serving teacher including Librarian and Graduate Laboratory Instructor of the Government-aided colleges and State-aided universities and his/her beneficiary.

(2) The provision of enrolment under this scheme shall be optional.

(3) A teacher shall not be entitled to draw the regular medical allowance, if opted for this scheme, with effect from the date of effect of such enrolment under clause 4.

(4) A teacher shall have the liberty to opt out of this scheme at any time.

Provided that where a teacher or his/her beneficiary has enjoyed any benefit under this scheme, such employee shall not be allowed to opt out the scheme within five years from the month following the month in which he/she enjoyed the benefit.

A teacher enrolled under this scheme shall not be eligible to be enrolled again if he/she opts out of the scheme for whatever reason.

3. Definitions

In this Scheme, unless there is anything repugnant in the subject or context-

(a) “approved rates” means such rates as may be notified by the State Government from time to time for various services, procedures and investigations required in connection with the medical attendance and treatment of a beneficiary;

(b) “beneficiary” means a dependent member of the family of a serving teacher,

(c) “clause” means a clause of the scheme;

(d) “teacher” means a full time and regular serving teacher including Librarian and Graduate Laboratory Instructor of the Government-aided Colleges and State-aided Universities of the Government of West Bengal enrolled under clause 4;

(e) “family”, in relation to a teacher, means and includes

(i) Husband or Wife, as the case may be,

(ii) Dependent Parents whose monthly income does not exceed rupees three thousand and five hundred;

(iii) Dependent Children including step-children, children related to half-blood and uterine blood, legally adopted children and unmarried daughters;

(iv) Dependent widowed/divorced daughters;

(v) Dependent Minor brothers, minor sisters;

(vi) Dependent unmarried/widowed/divorced sisters.

Note: (i) ‘Son’ is considered to be dependent till he starts earning or attains the age of 25 years, whichever is earlier. Son suffering from permanent disabilities either physically or mentally will be considered dependent without any age limit.

(ii) Unmarried daughter is eligible till she starts earning (irrespective of age).

(iii) As an exception, parents can live away from employee in another station with other members of family.

(iv) A declaration regarding the income of parents should be furnished by the employee concerned once at the beginning of every calendar year.

(f) “Form” means a Form appended to this scheme;

(g) “Government” means Government of West Bengal in the department of Higher Education, Science & Technology & Bio-technology;

(h) “hospital or institution” means such hospital or nursing home or institution as may be recognized from time to time by the Government for the purpose of availing benefits of medical attendance an treatment under this scheme;

(i) “laboratory” means such laboratory or institution as may be recognized by the Government from time to time for availing of benefits of medical attendance and treatment under this scheme,

(j) “medical attendance” means attendance for professional advice and includes pathological bacteriological, radiological or other methods of investigations for the purpose of diagnosis which are considered necessary by the attending physician and are carried out in a hospital or institution,

(k) “specified” means specified by order;

(l) “treatment” means the use of medical and surgical facilities and includes

(i) the employment of such pathological, bacteriological, radiological or other methods of investigations as are considered necessary by the attending physician,

(ii) the use of such medicines, vaccines, serum or other therapeutic substances as may be considered necessary by the attending physician,

(iii) medical and surgical services and procedures; (iv) dental treatment;

(v) accommodation according to the entitlement of the teacher;

(vi) such nursing as is ordinarily provided at the hospital or such special nursing at the hospital as the authorized medical attending physician at the hospital may certify, in writing, to be essential for the the recovery or for the prevention of serious deterioration in the condition of the patient, having regard to the nature of the disease.

4. Enrolment

(1) A teacher seeking enrolment under the scheme shall exercise his/her option in Form A (Annexure-I), in duplicate, along with an undertaking that upon enrolment under this scheme such teacher shall forgo the regular medical allowance drawn as part of monthly salary.

(2) The option referred to in sub-clause (1) shall be submitted-

(a) to the College authority in the case of Government-aided colleges. The College authority, with the Governing Body of the college will send the same to the Director of Public Instruction, WB.

(b) to the Registrar in the case of state aided universities, who will forward the same to the Joint Secretary (University Branch), Department of Higher Education, Science and Technology Biotechnology.

(3) The DPI WB or The Joint Secretary , Department of Higher Education, Science and Technology & Biotechnology, as the case may be, shall, after scrutinization of the option exercised by the teacher, issue a certificate of enrolment in Form B (Annexure-I) in favour of the employee, to be effective from the first day of the month following the month in which the certificate is issued.

(4) The DPI WB or The Joint Secretary, Department of Higher Education, Science and Technology & Biotechnology, as the case may be, shall send one copy of the certificate to the Drawing and Disbursing Officer in respect of the teacher with a direction to discontinue the drawal of regular medical allowance with effect from the first day of the month following the month in which t certificate is issued.

(5) (i) The enrolment of the existing teachers under the scheme shall be completed within 2 years from the date of notification of the enrolment process.

(ii) New entrants shall be allowed to exercise option and complete enrolment under the scheme within two years of their appointment in colleges/universities.

(6) The teachers not opting to come under this scheme within the period as specified at sub-clause 5 shall not be eligible to opt for the scheme at a later period.

(7) If husband and wife both are covered under the scheme and if one opts under the scheme, both will not be entitled to draw regular allowance.

5. Facilities

A teacher or a beneficiary of such teacher shall be entitled to the following facilities, namely:-

(a) medical attendance and treatment as an indoor patient in a hospital or an institution; and

(b) medical attendance and treatment at out patient department of a hospital or an institution, or a clinic attached to such hospital or institution for such diseases, and under such circumstances, as may be specified.

6. Medical attendance and treatment as an indoor patient in a hospital

A teacher shall be entitled to reimbursement of the cost of his/her or his/her beneficiary’s medical attendance and treatment, as an indoor patient in a hospital or an institution.

Explanation- For the purpose of this clause, the expression “cost of medical attendance and treatment shall include-

(a) the amount charged by the hospital or institution in accordance with the approved rates;

(b) the cost of medicines purchased from outside on the advice of the attending physician at the hospital or institution;

(c) the charges for such pathological, bacteriological, radiological or other methods of investigations are considered necessary by the attending physician and carried out, on the advice of the attending physician, in a laboratory or institution, other than the hospital or institution in which the patient is treated.

7. Medical attendance and treatment as an OPD (Out-Patient Department) patient in a hospital

(1) A teacher shall be entitled to reimbursement of the cost of his or his beneficiary’s medical attendance and treatment as an OPD patient in a hospital or institution in the following cases:-

(i) Malignant diseases, (Mainly cancer cases are considered as Malignant diseases)

(ii) Tuberculosis.

iii) Hepatitis B/C and other liver diseases,

(iv) Insulin-dependent diabetes, Type -2 Diabetic Melitas is not considered as Insulin-dependent Diabetes.

(v) Heart diseases,

(vi) Neurological disorders/Cerebrovascular disorders,

(vii) Malignant malaria,

(viii) Renal failure,

(ix) Thallasaemia/Bleeding orders/Platelet disorders,

(x) Injuries caused by accidents.(Animal Bite cases will come under the purview of Injuries caused by the accidents.

(xi) Rheumatoid Arthritis

(xii) Systematic Lupus Erytthematous(LUPUS)

(xii) Crohn’s Diseas

(2) A teacher or his/her beneficiary shall also be entitled to reimbursement of the cost of follow-up medical attendance and treatment relating to Neuro Surgery, Cardiac Surgery (Inducting Coronary Angioplasty and implants), Cancer Surgery/Chemotherapy/Radiotherapy, Renal Transplant, Hip/Knee replacement Surgery and Accident cases received as an OPD patient in a hospital or institution.

Explanation. – For the purpose of this clause, the expression “cost of medical attendance and treatment” shall include-

(a) the amount charged by the hospital or institution in accordance with the approved rates,

(b) the cost of medicines purchased from outside on the advice of the attending physician at the hospital or institution.

(c) the charges for such pathological, bacteriological, radiological or other methods of investigations as are considered necessary by the attending physician and carried out on the advice of the attending physician in a laboratory or institution, other than the hospital or institution in which the patient is treated.

8. Accommodation

(1) In the case of medical attendance and treatment as an indoor patient in a hospital or an institution, a teacher or his/her beneficiary shall be entitled to such accommodation as mentioned in column (4) of the Table below of the category of the teacher as mentioned in column (2), to be determined on the basis of the basic pay including dearness pay as mentioned in column (3), respectively, against the Sl. No. as mentioned in column (1) of the said Table:-

Sl. No. Category of Teacher Band pay including Grade pay Type of accommodation
(1) (2) (3) (4)
1. I Above Rs. 27,000 p.m. Private Ward
2. II Rs. 18,000 p.m. and above but below Rs. 27,000 p.m. Semi-Private Ward
3. III Below Rs. 18,000 p.m. General Ward

(2) Where the type of accommodation in a hospital does not correspond to the nomenclature as referred to in column (4) of Table to sub-clause (1) or any similar nomenclature, the Government shall, in consultation with the authorities of the hospital concerned, determine the entitlement of the beneficiary.

9. Tenure

Notwithstanding anything contained in this scheme and without prejudice to the provisions of sub-clause (2) of clause 7, the cost incurred on account of related medical attendance and treatment received in a hospital or an institution during the period upto 30 days prior to hospitalization and 30 days from the date of discharge, shall be reimbursable.

10. Issue of Identity Card to teacher and beneficiary

(1) The teacher and his/her beneficiary shall be issued a photo-identity card with a unique identification number under the seal and signature of the issuing authority.

(2) The identification number of the teacher and his/her beneficiary shall consist of three numbers, for example x/y/z where “x” denotes the code number of the teacher, “y” denotes the serial number of the beneficiary belonging to the family of the teacher (it being 1 in the ease of the teacher himself) and “z” denotes the total number of cards issued for the family of the teacher.

(3) The blank identity cards with running serial numbers shall be supplied by the Director of Public Instruction West Bengal or Joint Secretary (University Branch) of the Department of Higher Education, Science & Technology and Biotechnology, as the case may be, on the basis of the requisition received from the concerned government-aided colleges or the state-aided Universities.

(4) The identity card shall consist of two parts of which the issuing authority shall retain the first part and the second part shall be handed over to the teacher concerned.

(5) A list of teachers to whom identity cards have been issued shall be forwarded to the Drawing and Disbursing Officer.

(6) The identity card shall have a standard format and shall contain such particulars as the name, the date of birth and the relationship of the beneficiary with the teacher.

(7) The colour of the identity card shall be-

(a) yellow, in case of teachers belonging to category I as mentioned in column (2) against Sl. 1 in column (1) of Table to clause 8;

(b) pink, in case of teachers belonging to category II as mentioned in column (2) against Sl. 2 in column (1) of Table to clause 8; and

(c) white, in case of teachers belonging to category III as mentioned in column (2) against Sl. 3 in column (1) of Table to clause 8.

(8) For the purpose of availing the benefits under this scheme, the teacher or his beneficiary shall show his identity card to the hospital, laboratory or institution where he receives medical attendance and treatment.

(9) A temporary family permit in Form F (Annexure-I) may be issued to a teacher enrolled under this scheme by the Head of office for a period as may be specified, pending issue of photo-identity cards and sue temporary family permit shall entitle the teacher and his/her beneficiary to all the benefits of this scheme.

(10) The identity cards issued under this scheme shall be surrendered to the the college/university authority, at the time of retirement/resignation/on being relieved from service.

11. Claims for reimbursement of the cost of medical attendance and treatment

(1) An application for reimbursement of the cost of medical attendance and treatment shall be made by a teacher in Form C (Annexure-I).

(2) The application for settlement of claim under this scheme shall be made as follows:

(A) Indoor treatment : Three months from the date of discharge
(B) Outdoor treatment : Three months from the date of each O.P.D. consultation.

(a) to the DPI, WB or Joint Secretary (university branch), Department of Higher Education, Science & Technology and Bio-Technology, as the case may be.

(3) The application referred to in sub-clause (1) shall be accompanied with the following documents

(a) essentiality Certificates in Form D1/D2/D3 (Annexure-I);

(b) photocopy of the identity card issued to the teacher, and where the claim relates to a member of the family of the teacher, photocopy of the identity card issued to such member of the family of the teacher;

(c) all original bills verified by the hospital, laboratory or institution;

(d) all original vouchers, cash memos and money receipts,

(e) detailed lists of all medicines, laboratory tests, investigations, procedures, number of doctors’ visits, etc. with dates, duly countersigned by an authorized person of the hospital where the beneficiary as received medical attendance and treatment, along with a certificate from such authorized person that all charges are as per approved rates. In the bill prepared by the hospital, each service, procedure an investigation for which the beneficiary is charged should be specified, along with this reference number in the approved list;

(f) detailed list of all medicines purchased from outside and all laboratory tests, investigations and procedures done in a laboratory, institution or hospital other than the hospital where the patient has received medical attendance and treatment, along with a certificate from an authorized person of the hospital that such medicines had to be purchased or such laboratory tests, investigations and procedures had to be done on the advice of the attending physician of the hospital;

(g) Check List in Form E (Annexure-I).

12. Settlement of claims

(1) The application made under sub-clause (1) of clause 12 for reimbursement shall be processed by the Directorate of Public Instruction, West Bengal i.r.o teachers of Govt.-aided Colleges an by the office of the Jt. Secretary (University Branch), Deptt. of Higher Education, Science & Technology and Biotechnology for teacher of State-aided Universities and the admissible cost of medical attendance and treatment shall be worked out on the basis of the approved rates as per Finance Department s notification no. 796-F(M ) dated 31.01.2011, as revised from time to time.

(2) The sanctioning authority for reimbursement of the cost of medical attendance and treatment in the case of teachers of Govt.-aided Colleges shall be the D.P.I.,W.B.

(i) for medical attendance and treatment as an indoor patient in a hospital – Rs. 1.0 lakh

(ii) for medical attendance and treatment as an OPD patient in a hospital – Rs. 10.000.

(3) The sanctioning authority in the case of a teacher of State-aided Universities shall be the Joint Secretary (University Branch), Deptt. of Higher Education, Science & Technology and Biotechnology

(i) for medical attendance and treatment as an indoor pattern m a hospital – Rs. 1.0 lakh

(ii) for medical attendance and treatment as an OPD patient in a hospital, Rs. 10,000.

(4) The Secretary/Principal Secretary/Additional Chief Secretary of the Department of Higher Education, Science & Technology and Biotechnology where the claim exceeds these limits.

13. Treatment in a hospital or institution outside the State

(1) Notwithstanding anything contained elsewhere in this scheme, the Government may recognize specialized hospitals and institution outside the State for treatment of specific diseases.

(2) Prior approval of the Secretary/ Principal Secretary/Additional Chief Secretary of the Department of Higher Education, Science & Technology and Biotechnology shall be obtained before receiving medical attend and treatment in these hospitals or institutions.

(3) Claim for reimbursement of the cost of medical attendance and treatment in these hospitals or institutes Shall be allowed on the basis of the rates of various services provided by and investigations and procedures canned out by these hospitals/institutions in the course of medical attendance and treatment.

14. Operational guidelines, clarifications, etc.

(1) The Department of Higher Education, Science & Technology and Biotechnology, in consultation with the Finance Department (Medical Cell), wherever necessary, shall issue operational guidelines, clarifications, etc. for implementation of the scheme.

(2) If any difficulty arises in the course of implementation of the scheme, it shall be referred to the Finance Department and the decision of the Finance Department thereon shall be final.

(3) Further operational guidelines, in this regard, will be issued later on.

This is issued with the concurrence of Finance Department (Medical Cell) vide their U.O. No. 343/17 dated. 12.07.2017.

By order of the Governor,

Secretary to the
Govt. of West Bengal

No. 848-Edn dated 01.08.2017, Source