wbhealthscheme.gov.in Guidelines For Medical Treatment & Claims Settlement Under West Bengal Health Scheme

Organization : Government of West Bengal
Facility : Guidelines For Medical Treatment & Claims Settlement Under West Bengal Health Scheme

Home Page : https://wbhealthscheme.gov.in/First_page.aspx
Guidelines here :https://wbhealthscheme.gov.in/Home/wbhs_guideline_med.aspx

For Medical Treatment & Claims Settlement :

Guidelines for Receiving Medical Treatment & Settlement of Claims under the West Bengal Health Scheme :
** Receive treatment in an empanelled hospital/ Government hospital, i.e. recognized hospitals under the Health Scheme.

Related : West Bengal Health Scheme Guidelines For Treasury/Pay & Accounts Offices : www.statusin.in/2969.html

** Show Health Scheme Identity Card while receiving medical treatment in recognized hospital/ diagnostic centre. Give a photo-copy of the Identity Card to the hospital/ diagnostic centre.
** Register address of the Head of Office/ Pension Sanctioning Authority including telephone number at the time of admission for indoor treatment.
** Inform your office within three days of commencement of indoor medical attendance and treatment.
** Check whether your identification number has been mentioned in the hospital bill.
** Check whether code no.s of all the procedures/ investigations have been mentioned in the bill.
** Check whether bill for surgical procedure has been furnished following package rate with code.
** In case of indoor treatment prefer claim for reimbursement within three months from the date of discharge.
** In case of O.P.D. treatment prefer claim for reimbursement within three months of every consultation or purchase of medicines, etc.

Take permission of the West Bengal Health Scheme Authority before :
(a) Human Organ Transplantation;
(b) Cochlear Implant Surgery;
(c) Implantation of Dual Chamber Pacemaker;
(d) Implantation of more than one Drug Eluting Stents;
(e) Implantation of more than two Stents;
(f) Implantation of AICD/ CRT with AICD;
(g) Implantation of Neuro implants, viz., Deep Brain Stimulator Implants, Intra- Thecal Pumps, Spinal Chord Stimulators;
(h) Digital Hearing Aid, etc.

For medical treatment of Government employee and their family members use the following Forms of Essentiality Certificates :
** O.P.D. treatment under Clause-7 of the Health Scheme- Form D 1
** Indoor treatment and related O.P.D. treatment under Clause-6 & 9 of the Health Scheme- Form D 2
** Medical treatment done in non-empanelled hospital/ nursing home – Form D 3.

West Bengal Health Scheme :
With a view to regulate and provide medical benefits and to provide improved medical facilities to the State Government employees and their family members, a notification No.7287-F Dated 19.09.2008 was issued.

As per this notification, the Scheme had been named “West Bengal Health Scheme,2008”. Subsequently in terms of F.D. Memo No.3475-F dated 11.05.2009, WBHS 2008 has been extended to the State Government pensioners & their family members.

About Us :
Medical Cell of Finance (Audit) Department has been created in June 2009 by carving out from Group ‘P’ (Service) of that Department mainly for implementation of West Bengal Health Scheme,2008.

It also looks after the traditional medical reimbursement cases under the following rule :
i) West Bengal Services (Medical Attendance) Rules,1964.
ii) West Bengal Services (Medical benefit for State Pensioners) Rules,1998.

iii) All India Services (Medical Attendance) Rules,1954.
iv) Medical Benefits to the Ministers-in-Charge/Minister-of-State/Confidential Assistants etc.Rules,1969