WBHS

Medical Benefits for Pensioner/ Family Pensioner

Governor is now pleased to enhance the ceiling of cashless limit of each IPD treatment in private empanelled hospital to Rs. 2,00,000/- only from the existing ceiling of Rs. 1,50,000/-

Governor is pleased to appoint West Bengal Clinical Establishment Regulatory Commission (WBCERC), as the arbitrator hereafter under WBHS for resolving disputes regarding West Bengal Health Scheme.

Inclusion of State Govt. pensioner/ family pensioner and retired member of AIS of the State Cadre who are parent of government employee, as dependent beneficiary under their in-service son/daughter in WBHS.

Dialysis is a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly. This procedure is done frequently as a life saving measures for the patient suffering from renal failure (CKD-V stage).

Discontinuation of Form-H and introduction of comprehensive Form-D4 & preparation of claims in progressive manner by the private hospitals under WBHS.

Governor is now pleased to revise the existing rate list for Tata Medical Center, Rajarhat only, for treatment of the beneficiaries under West Bengal Health Scheme.

New matrix of Approving Authority for all employees and pensioners of PW Department as well as Directorates and sub-ordinate Offices will be as follows:-

Revision of financial power for sanctioning of reimbursement claims for medical treatment and attendance under West Bengal Health Scheme.

Acceptability of online purchase for medicine and mandatory submission of Cash Memo/ Tax Invoice from GST registered pharmaceutical shops in case of offline purchase of medicine.

Yes, up to 60% or 80% (depending on the nos. of available beds of treating hospital) of cost for admissible medicines prescribed in Trade/ Brand name for indoor treatment is reimbursable.

·         Last Date for Inclusion of Aadhaar Number of Beneficiary under WBHS

Governor is now pleased to extend the last date for incorporation of the Aadhaar No. for the employees/ pensioners along with their beneficiaries above the age of five years up to 31.03.2023.

·         Revision of Income Eligibility of Dependent Beneficiaries under WBHS

An amount of Rs. 8500/- for parent and Rs. 5000/- for other members of the family has been fixed as the maximum ceiling of gross income/ earning for becoming the dependent beneficiary under the Scheme.

·         Processing of OPD Claim for Heart Diseases Category in WBHS

If patient has a history of cardiac surgery like of Bypass Surgery, AICD, Valve Replacement or Implantation of Stent through Angioplasty or Implantation of Pacemaker, will get lifelong reimbursement of the cost.

·         Enhancement of Cashless Limit for IPD Treatment in Private Hospital under WBHS

Governor is now pleased to enhance the ceiling of cashless limit of each IPD treatment in private empanelled hospital up to Rs. 1,50,000/- only from the existing ceiling of Rs. 1,00,000/-.

·         Online Processing of Advance Claim through WBHS Portal

Governor is pleased to introduce the online processing of medical advance claim through WBHS Portal with the following guidelines, new set of Forms and Pro-forma Estimate from the Hospital for processing and settlement of the claim:

·         Seeking Prior Permission by Private Hospitals for Providing Certain Category of Treatment

Revision of guidelines for seeking permission by the state empanelled private hospitals from West Bengal Health Scheme Authority for providing treatment under West Bengal Health Scheme.

·         Inclusion of Covid-19 Disease/ Illness in the OPD List under WBHS

Considering the gravity of the disease/illness named ‘Covid-19’ the West Bengal Health Scheme Authority (WBHSA) has agreed to include the same as 17th (seventeenth) disease/ illness in the OPD List of WBHS.

·         Mandatory Inclusion of Aadhaar Number in database of WBHS

Last date of incorporation of Aadhar Number of existing beneficiaries above the age five years is 30.06.2022 failing of which they may face inconvenience to avail uninterrupted benefit under this scheme.

·         Revised Financial Power for Sanctioning Cost of Medical Treatment

All Head of the offices under Govt. of West Bengal have the financial power for sanctioning the reimbursement cost of medical attendance and treatment under West Bengal Health Scheme (WBHS).

·         Seeking Prior Online Permission for Treatment outside West Bengal

Introduction of online functionality for seeking prior permission of availing treatment in Enlisted Hospitals outside the State through West Bengal Health Scheme Portal.

·         State Level Training Team for organizing WBHS Reimbursement Claim

Training on processing & disbursement of reimbursement claim under West Bengal Health Scheme on ONLINE platform through WBHS and WBIFMS Portal.

·         Revised Bed Entitlement after ROPA 2019 under WBHS

Governor is pleased to prescribe the entitlement of accommodation for indoor treatment in different Hospitals including the Government Hospitals and Tata Medical Centre, Rajarhat to the beneficiaries under WBHS after ROPA-2019

·         Discontinuation of Medical Allowance/ Relief through WBHS Portal

Governor is pleased to implement ONLINE functionality for discontinuation of Medical Allowance/ Relief from the Salary/Pension of the enrolled employee and pensioner with the following directives:

·         Inclusion of some more Critical Diseases/ Illness under WBHS

The facility shall be restricted only for the treatment of one or more diseases/ illness mentioned in the Enrolment Certificate out of the above mentioned critical diseases/ illness.

·         Online Functionality for Opt-out and Termination of enrolment from WBHS

Introduction of online functionality for Opt-out and Termination of enrolment from West Bengal Health Scheme through WBHS Portal.

·         Introduction of Online Reimbursement Claim through WBHS Portal

Online processing of reimbursement claims through WBHS Portal and making payments thereof under WBIFMS in integrated web mode was under active consideration for some time past. And, in order to make the ONLINE processing of these claim more comprehensively, the existing claim Forms also modified.

·         West Bengal Health Scheme for the Beneficiaries of Grant-in-Aid Colleges and Universities under Department of Health & Family Welfare

Teachers including Librarians and Graduate Laboratory Instructors of the College of Medicine and JNM Hospital, Kalyani and Officers of the West Bengal University of Health Sciences, Salt Lake and the family members.

·         West Bengal Health Scheme for the Beneficiaries of Grant-in-Aid Colleges and Universities under Agriculture Department

For permanent Teachers/ Officers and their dependent family members of Bidhan Chandra Krishi Viswavidyalaya (BCKV) and Uttar Banga Krishi Viswavidyalaya (UBKV) and College of Agriculture under both Universities.

·         Introduction of Treasury Form 68C and 31A

Governor is pleased to introduce the two new TR forms with number TR-68C and TR-31A for drawal of fund related to claims for Reimbursement/ Advance/ Advance Adjustment under WBHS in respect of Government employees/ pensioners and Teachers /Officers of GIA Colleges & Universities.

·         Missing Head of Account for Submission of WBHS Bill

For processing of claim of West Bengal Health Scheme (WBHS) through WBHS Portal, mapping of Payment Head of Account from the end selective users (Head of Office himself/ herself or Approver of User Administration) of a Head of Office, is mandatory.

·         Extension of Age Limit of New Born Baby for availing benefits of WBHS

Extension of age limit of new born baby for availing benefits of West Bengal Health Scheme with the enrolment certificate of parents.

·         Guidelines i.r.o. IPD treatment in COVID situation under WBHS

Governor is pleased to issue a fresh guidelines for reimbursement towards the cost of any IPD treatment including COVID-19 cases in the following manner for the benefit of members enrolled under West Bengal Health Scheme.

·         Entitlement for Accommodation after ROPA, 2019 under WBHS

With the inclusion of Pay Clinic of Government Hospitals and Tata Medical Centre, Rajarhat under WBHS and due to implementation of ROPA 2019, and as such it has been felt necessary to redefine the type of accommodation which the employees and pensioner may avail at the time of indoor treatment.

·         Cashless Admissibility Reimbursement Certificate

Relaxation of proviso of Financial Power for Sanctioning Cost of Treatment for payment against Cashless Admissibility Reimbursement Certificate (CARC).

·         Health Scheme Enrollment nearest to Residence of Pensioner

To apply for the same to any office up to sub-divisional level of the department concerned nearest to the residence of the pensioner or to the office of the Sub-divisional Officer of the Sub-Division where pensioner resides.

·         West Bengal Health Scheme for the Beneficiaries of Grant-in-aid Colleges and Universities, 2017

Medical benefits to the serving Teachers including Librarians and Graduate Laboratory Instructors of Government-aided Colleges and serving Teachers and Officers of State aided Universities.

·         Cashless Medical Treatment Scheme – Last Date: 31.03.2019

Existing, retired State Government employees pensioners, Family Pensioners, AIS and retired AIS officers who have not enrolled their names under the WBHS may be allowed to enrol up to 31.03.2019.

·         Delay in Submission of Medical Reimbursement Claim

Condonation of delay beyond one year for both Indoor and OPD cases, proposal is to be submitted through the administrative department before the WBHS Authority under Finance Department.

·         Online Bill Submission by HCOs in West Bengal Health Portal

Introduction of online seeking/ grant of permission and preparation/ submission of online Bill by Health Care Organizations (HCOs) in West Bengal Health Portal.

·         Relaxation in Income Limit for Medical Treatment

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 Critical diseases.

·         Cashless Medical Treatment Scheme – Last Date: 30.09.2018

Governor is pleased to extend the last date of online application for enrolment under the cashless medical treatment scheme upto 30th September, 2018.

·         Re-Enrolment under Cashless Medical Treatment Scheme

Re-enrolment process under the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014 should be completed within 31.03.2018.

·         Enrolment under Cashless Medical Treatment Scheme (31.03.2018)

Governor is pleased to extend the last date of online application for enrolment and validity of existing card from 1st October, 2017 to 31st March, 2018.

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

Governor is pleased to provide medical benefits to the Serving Teachers incl. Librarians and Graduate Laboratory Instructors of Govt-aided Colleges and State-aided Universities.

·         Inclusion of Work Charged Employees under Health Scheme

Governor is pleased to decide that all existing staff members of work charged establishments under State Government establishments will be included under West Bengal Health Scheme.

·         Eligibility of Gr. C Employees for Enrollment under WBHS

Group- C employees as appointed under the West Bengal Services (Appointment, Probation and Absorption of Group C Employees) Rules, 2013 will also be eligible for Health Scheme.

·         Enrolment under Cashless Medical Treatment Scheme (30.09.2017)

Governor is further pleased to extend the last date of online application for enrolment under Cashless Medical Treatment Scheme from 1st April, 2017 to 30th September, 2017.

·         Empanelment of Apollo Gleneagles Hospital is Discontinued

Governor is pleased to discontinue empanelment of Apollo Gleneagles Hospital under West Bengal Health For All Employees and Pensioners Cashless Medical Treatment Scheme, 2014.

·         Uploading Photo, Signature, Blood Group – WB Health Portal

Introduction of Government Employee/ Pensioners login in West Bengal Health Portal and uploading all beneficiaries’ photo, signature and blood group at the time of Online Enrolment.

·         List of Documents for MoA under W.B. Cashless Medical Scheme

Guidelines regarding submission of documents by the Health Care Organisations for new/renewal of Memorandum of Agreement under West Bengal Cashless Medical Treatment Scheme, 2014.

·         Memorandum of Agreement for Cashless Medical Treatment

Memorandum of Agreement between the Private Health Care Organisations and State Government for empanelment to provide treatment facilities & diagnostic facilities.

·         Power cannot be Re-delegated for Medical Reimbursement

Financial Power as delegated by No. 483-F dated 26.05.2016 for sanctioning cost of medical attendance and treatment cannot further be re-delegated.

·         Revised Financial Power for Sanctioning Cost of Treatment

Governor has been pleased to revise the Financial Power for sanctioning cost of medical attendance and treatment to various designated officers.

·         Condonation of Delay for Indoor Treatment Claim

Authority may condone the cases related to delay in preferring of indoor treatment claim beyond 3 months but within 1 year from the date of discharge on reasonable ground.

·         Online Enrolment Mandatory for Reimbursement of Claim

After 31.03.2017 neither Sanction Order nor bills will be processed without system generated Certificate of Enrolment duly verified from the respective DDO.

·         Enrolment under Cashless Medical Treatment Scheme (31.03.2017)

Governor is further pleased to extend the last date of enrolment under Cashless Medical Treatment Scheme from 1st April, 2016 to 31st March, 2017.

·         Guidelines regarding Signature under Cashless Medical Scheme

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.

·         Clarifications of Cashless Medical Treatment Scheme, 2014

Whether Government Employee/ Pensioner and their eligible dependent members of the family can avail reimbursement facility with the ‘Certificate of Enrolment’ generated from Health Scheme Portal?

·         Cashless Treatment Bill amounting more than Rupees 1 Lakh

Procedure for settlement of Cashless treatment bills amounting more than Rupees One lakh under West Bengal Health For All Employees and Pensioners Cashless Medical Treatment Scheme, 2014.

·         Enrolment in Cashless Medical Scheme – Last Date: 31.03.2016

Last date of enrolment in cashless medical treatment scheme is extended upto 31.03.2016. Validity of existing health card as per WBHS-2008 also be extended upto 31st March, 2016.

·         New TR Form 68B related to Claim under Medical Scheme

Modification of TR form 68B which will be used for the purpose of drawal of fund related to the claim under Cashless Medical Treatment Scheme, 2014, from the Treasuries/ PAO’s.

·         Enrolment in Cashless Medical Scheme – Last Date Extended

Last date of enrolment under West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014 is hereby extended from 31st March to 30th September, 2015.

·         New Heads for Payment to HCOs for Cashless Medical Facility

Opening of two New Scheme Heads for Payment to Health Care Organisations for Cashless Medical Facility under West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014.

·         Submission of Bills at Medical Cell, WBHS, Finance Department

Send the receipted bill along with copies of all prescriptions, reports, bills to Medical Cell of Finance Department instead of sending the same to the respective Government department, as a temporary measure.

·         Implementation of Cashless Medical Treatment Scheme, 2014

Implementation of West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014 with respect to processing of Bills from HCOs located at Kolkata/ Districts to respective Govt. Department/ District Offices.

·         Payment Procedure of Cashless Medical Treatment (Indoor)

Receipted bill along with copies of all prescriptions, reports, bills etc. will now be required to be sent to the respective Government department of the employee/ pensioner as per his declaration.

·         Cashless Medical Treatment Facility under WBHS, 2008

To avail the benefit of the Cashless Medical Treatment under the Scheme, a Government Employee or Government Pensioner shall have to enroll afresh at WBHS Monitoring System. This link will be operational from 15.09.2014.

·         Cashless Medical Treatment – Agreement of Finance Dte & HCO

Clause 14 of the Agreement already in existence between HCOs and the Finance Department for providing medical attendance and treatment to the beneficiaries under the WBHS 2008 be treated as substituted with this.

·         Cashless Treatment for State Govt Employees and Pensioners

Cashless medical treatment up to Rupees one lakh will be provided to the beneficiaries for undergoing treatment in private empanelled hospitals within the state including NCR.

·         West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014

This scheme shall apply to all State Government employees, State Government pensioners including family pensioners and the beneficiaries who have opted for existing scheme in lieu of medical allowance.

·         Financial Power for Sanctioning Cost of Medical Treatment

Financial Power of various designated Officers for sanctioning cost of medical attendance and treatment is increased making amendment to the clause 13 (3) of the West Bengal Health Scheme, 2008.

·         Reconstitution of West Bengal Health Scheme Authority

Governor is pleased to reconstitute West Bengal Health Scheme Authority consequent upon joining two numbers of Medical Officers on re-employment to the Medical Cell of Finance Department.

·         Prior permission for Treatment outside West Bengal

All WBA & AS cadre officers are requested to take prior permission before receiving treatment, in any recognized speciality hospitals outside West Bengal.

·         Introduction of New Housing and Medical Benefits

The State Government with the objective of promoting the welfare of State Government Employees and improve their health and housing benefits has decided to introduce the following measures:

·         Extension of Time for Enrolment under WBHS upto 31.03.2015

The existing, retired State Govt employees, pensioners, family pensioners, AIS and retired AIS officers who have not enrolled their names under West Bengal Health Scheme, 2008 may be allowed to enrol their names up to 31.03.2015.

·         Cashless Benefit upto Rs. 1 lakh under WBHS

Government Employees and Pensioners enrolled under West Bengal Health Scheme, 2008 may avail themselves of Cashless benefit up to Rs. 1.00 Lakh during their indoor treatment in the empanelled hospitals under WBHS-2008.

·         Intimation to Head of Office for Medical Treatment

Governor is pleased to decide that henceforth there is no need to provide intimation to the Head of Office/ PSA before undergoing Medical Treatment.

·         Treatment of Peritoneal Dialysis (CAPD) performed at Home under WBHS

Consequent upon the depth of the disease of Renal failure West Bengal Health Scheme Authority has amicably considered the treatment of Continuous Ambulatory Peritoneal Dialysis (CAPD), also called Home Dialysis, to be started at Home.

·         West Bengal Health Scheme Authority

Governor is pleased to reconstitute West Bengal Health Scheme Authority with the following composition:

·         Eskag Senjeevani & Eye Mirosurgery & Laser Centre enlisted under WBHS

Governor is pleased to recognize Eskag Senjeevani & Eye Mirosurgery & Laser Centre for the purpose of availing benefits of medical attendance and treatment under the West Bengal Health Scheme 2008.

·         Intimation to Office before OPD Treatment

As per recommendations of West Bengal Health Scheme Authority, in case of OPD treatment, intimation to the Head of Office/ PSA is not mandatory.

·         Permission for Treatment if Cost exceeds 2.5 Lac

Permission from the West Bengal Health Scheme Authority is mandatory for performing certain procedures where the cost of treatment exceeds Rs. 2.5 Lac.

·         Enrolment of New Eye Clinic at New Delhi under WBHS

Dr. Kapur’s The Healing Touch Eye Centre, D-8, Vikas Puri, New Delhi-110018 is recognized for the purpose of availing benefit of medical attendance and treatment under the West Bengal Health Scheme, 2008.

·         Medical Advance for Outdoor Treatment under WBHS

West Bengal Health Scheme allows to draw medical advance for outdoor treatments relating to B-thallasaemia, Hepatitis C and Carcinoma including Multiple Mycloma.

·         Permission before Purchase of Digital Hearing Aid under WBHS

Prior permission of the West Bengal Health Scheme Authority will not be required for purchase of Digital Hearing Aid subject to the condition that the maximum reimbursable amount is limited to the rate mentioned under WBHS code No. 03003003.

·         Relaxation in Treatment of Cancer at Tata Memorial Hospital

For receiving treatment at Tata Memorial Hospital, Mumbai, prior permission of the West Bengal Health Scheme Authority and referral from recognized Health Care Organization will no longer be necessary.

·         Advance Purchase of Medicine when Outside West Bengal

Advance purchase of medicine for maximum period upto six months may be allowed when medicine are prescribed for indefinite period by outside hospitals.

·         Alphabetical List of Empanelled Private Hospitals/ Diagnostic Centers under WBHS

Alphabetical list of empanelled private hospitals/ diagnostic centres under West Bengal Health Scheme, 2008, with address and contact persons for the West Bengal Govt. Employees.

·         Recognition of New Health Care Organisation

Governor is pleased to recognize the following private Health Care Organisations under the West Bengal Health Scheme 2008: SHARANYA, Glocal Hospital Dubrajpur, (Unit of Glocal Health Care System Pvt. Ltd.), North Bengal Oncology Centre Pvt. Ltd.

·         Medical Advance and Reimbursement – Power of Secretaries

Secretaries shall dispose of at their level the matters of approval for Medical Advance and Medical Reimbursement cases for the State Government employees upto an amount of Rs. 2.00 lakh in each case.

·         Cost of Generic Medicines in Non-Empanelled HCO

For treatment in non-empanelled Health Care Organisations, cost of medicines in generic names may be reimbursed in full. Trade name shall not be considered by any means.

·         National Capital Region – Health Scheme

West Bengal Health Scheme, 2008 is applicable to the West Bengal State Government employees working in the National Capital Region and pensioners/ family pensioners of the State Government and their beneficiaries residing there.

·         Medical Benefits for Pensioner/ Family Pensioner

Guidelines to be adopted for change of sanctioning authority in connection with medical benefits under the W.B.H.S. 2008 for the State Government Pensioners/ Family Pensioners.

·         Further Guidelines for Empanelled Health Care Units

Not more than two packages should normally be performed or planned. Permission of the West Bengal Health Scheme Authority is necessary for more than two packages.

·         Reimbursement of Medical Expense from Insurance Policy

Pensioners/ family pensioners are also allowed to claim reimbursement of medical expenses both from the Insurance Company as well as the West Bengal Health Scheme, 2008.

·         Extension of Enrolment in WBHS upto 31.03.2013

The existing and retired employees not enrolling their names under West Bengal Health Scheme by 31.03.2013 shall not be eligible to get the benefits of the Scheme in future.

·         Speciality Hospitals under WBHS outside West Bengal

(a) AIIMS, New Delhi, (b) PGIMER, Chandigarh, (c) Tata Memorial Hospital, Mumbai, (d) NIMHANS, Bangalore, (e) Christian Medical College, Vellore, (f) Apollo Hospitals, Chennai, (g) Sankara Netralaya, Chennai (h) L.V. Prasad Eye Hospital, Hyderabad, (i) Asian Institute of Gastroenterology, Hyderabad, (j) Metro Hospital & Cancer Institute, New Delhi.

·         Class II Hospitals/ Specialty Hospitals under WBHS

Here is the latest updated list of Class – II Hospitals/ Specialty Hospital which are under West Bengal Health For All Employees And Pensioners Cashless Medical Treatment Scheme 2014.

·         Implementation of West Bengal Health Scheme, 2008

Due to late submission of option for enrollment under the Scheme Enrollment Certificate could not be issued by the authorities within the stipulated period.

·         Class I Hospitals under West Bengal Health Scheme

Here is the latest updated list of Class – I Hospitals/ Specialty Hospital which are under West Bengal Health For All Employees And Pensioners Cashless Medical Treatment Scheme 2014.

·         Guidelines for Medical Treatment under West Bengal Health Scheme

WBHS beneficiaries often face a lot of problems e.g. Improper Medical facilities from empanelled hospitals nursing homes, difficulties while reimbursement of medical bill for final settlement.

·         Clarifications on West Bengal Health Scheme, 2008

Now, the cost of medical treatment in non-empanelled private Health Care Organisation is also reimbursable under certain conditions. Request for clarifications of some points laid down in the said Scheme after its amendments are being received by this department from various corners.

·         New Bill Forms for WBHS 2008

The expenditure incurred by, and to be reimbursed to on account of medical attendance and treatment under the WBHS, 2008 may be drawn in T.R. Form. 68 and 68A.

·         Treatment in Private Nursing Home (80% reimbursement)

Cost up to 80% of the West Bengal Health Scheme approved rates may be reimbursed for the indoor medical treatment, if availed in a non-empanelled private hospital.

·         Treatment in Speciality Hospitals outside West Bengal

Cost of train journey for medical attendance and treatment in speciality hospitals outside the State with one attendant, both ways, may be reimbursed.

·         Enrollment of retired AIS under Health Scheme

Retired members of AIS shall have to pay Rs. 40,000/- (Rupees Forty Thousand) only as one-time contribution for enrollment of names under the Health Scheme.

·         Extension of Health Scheme to Retired AIS members

Governor is pleased to extend the benefits of the WBHS to retired members of AIS on payment of one-time contribution of Rs. 40,000/- only.

·         Class III Hospitals/ Specialty Hospitals under WBHS

Here is the latest updated list of Class – III Hospitals/ Specialty Hospital which are under West Bengal Health For All Employees And Pensioners Cashless Medical Treatment Scheme 2014.

·         Enlisted Diagnostics Centres under West Bengal Health Scheme

Here is the latest updated list of Class – I, Class – II and Class – III Diagnostics Centres which are under West Bengal Health For All Employees And Pensioners Cashless Medical Treatment Scheme 2014.

·         Enrollment under Health Scheme Extended

The existing and retired Govt. employees who have not yet enrolled their names under the health scheme may be allowed to enroll their names within 31.03.12.

WBHS

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