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। Medical reimbursement

Principal Resident Commissioner, Govt. of West Bengal

Medical reimbursement Sanction ।

। Medical Claim reimbursement

। [Sl. No. 13(i) of Form-E] i) Affidavit on Stamp Papers to be signed by Notary / Executive Magistrate.

ii) ‘No Objection’ on Stamp Papers from other legal heirs.

iii) ‘Death Certificate’ –

। [Sl. No. 13(h)

of Form-E]

Attested by Gr-A officer of that Departmen . Affidavit on Stamp Papers.

‘General Diary’

।

।।

Pension Sanctioning Authority (PSA) PPO No.

PPO No. Temporary Family Permit Permit

PPO No

WBHS 300/

Notification No. 8219-F (Med) dt. 19/08/2011 of Finance Department Audit Branch, Medical Cell

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। IAS WBCS(Exe) Rs.50,000 Medical reimbursement bill sanction

Secretary, P&AR Department Rs.50,000 Medical Claim Sanction Divisional

Commissioner division IAS WBCS (Exe) Officer Rs.50,000

Medical reimbursement bill sanction

Circular No. 158-Secy. P&AR / 2011 Dt. 1st September, 2011 P&AR Department, IAS Cell, Writer’s Building, Kolkata -1

। WBHS,08 non-empanelled

pvt. hospital / nursing home

। nursing home

WBHS Approved Rates X 80% WBHS Approved Rates X 60%

Actual Cost

Approved Rate ।

Finance(A) Department, Medical Cell Memo No. 8687-F (Med) Dt. 16/10/2012 non-empanelled

Generic medicine

।

Clause-7 (1) (X), WBHS, 2008)

Memo No. 9205 F (Med) dt. 05/10/2009

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।

Head of office / PSA Intimation । [Memo No. 8576-F (Med) dt. 3/12/2013 of Finance

(Audit) Department]

। [Memo No. 8576-F (Med) dt. 3/12/2013 of Finance (Audit) Department]

। Head of Account

Salary Head 12-Medical Reimbursement Under the WBHS, 2008

। Head of Account

Head of Account

2071-Pension and other Retirement Benefits -01-800-NP-002-12-Medical Reimbursement under the West Bengal Health

Scheme, 2008 under the Demand No. 18 , 2071-01-800-NP-002-12

। Indoor Outdoor ।

1. Indoor treatment Three months from the date of discharge.

2. Outdoor treatment Three months from the date of each O.P.D. consultation.

(Memo No. 2618-F (Med) Dt. 05/04/2011, Finance Department, Audit Branch, Medical Cell).

। WBHS, 08

Medicine Medicine

Patient

reimbursement Date of

purchase of medicines Memo No. 2857-F (Med) Dt. 8th

April, 2013, Finance Department,

Audit Branch

। Empanelled Hospital Medicine Prescribe

Claim reimbursement

Patient Medicine Prescribe

reimbursement Date of purchase of medicines in such case

[Memo No. 2618-F (Med) dt. 05/04/2011 of Finance Department, Audit Branch,

Medical Cell]

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। Sanctioning Authority Max. Admissible

amount

Sanctioning Authority Max. Admissible amount

Name of the Govt. employee / pensioner

with identification number

Name of the patient

Name of recognized the hospital under

the Health Scheme with code no.

Name of non-recognized hospital under the Health Scheme with address and bed capacity

Name of disease

Period of treatment

Package code for surgical procedure

Head of Account of WBHS, 2008

। allotment

Memo no. 8766-F(Y) dt. 12th

December, 2013 Finance Department, Audit Branch

Medical Reimbursement / Advances 31st March, 2014 allotment

।

। Medical Insurance Policy Medical Insurance Policy

WBHS, 08 reimbursement

। Insurance Company Medical Claim

Insurance Company reimbursement certificate issue

Cadre Controlling Authority / Head of Office

medical claim vouchers / cash-memos

Cadre Controlling Authority / Head of Office WBHS, 08

Reimbursement from sanctioning authority as per WBHS, 08 = Amount admissible as per WBHS, 08 approved rate –

Amount reimbursed by the insurance company

Rs.40000 Insurance Company

Voucher Rs.32500 Rs.40000-Rs.32500)= Rs.7500

Head of Office ।Rs.38000 Insurance

Company Rs.32500 WBHS, 08 Rs.38000-Rs.32500) = Rs.5500

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। Medical Insurance Policy WBHS

Memo No. 3475-F Dt. 11/05/2009

WBHS, 08 Medical Insurance Company WBHS

।

Medical Insurance Policy

WBHS, 08 ।

Memo No. 6508-F (Med) Dt. 27/07/2012

।

।

।

WBHS, 08 Clause-15 [Clause-16 of 796-F(Med) dt. 31/01/2011]

Sanctioning Authority

Form-E

TR-7

।

Bypass Surgery, Implantation of Pacemaker, Coronary Angioplasty with

Stenting, Kidney transplantation Sanction

Sanctioning Authority estimated cost

Sanctioning Authority Utilization Certificate

adjust

। TR Form WBHS, 08 Medical reimbursement medical advance

T.R. Form No. 68 :- Bill for Medical Charges Reimbursement

T.R. Form No. 68A :- Bill for Advance

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। unsettled

unsettled

unsettled bill payment । Caluse-17 of

Memo no. 797-F (Med) Dt. 31/01/2011 of Finance Department, Audit Branch, Medical Cell

। Temporary Family Permit’

Temporary Family Permit’

PPO No. Temporary Family Permit’

।

WBHS, 08 case settle

Medical Cell, Finance Department

discharge [Clause-18 of Memo No. 797-F dt. 31/01/2011]

। Posting office Health Scheme enrolment

Posting office PSA Pension Sanctioning Authority

। Posting office

PSA WBHS enrolment Memo No.

10795-F (Med) Dt. 22/11/2010 Finance Department, Audit Branch, Medical Cell Department

Department Department

DM Office WBHS enrolment

Posting

option Directorate office’

Form declaration PSA

enrolmen He / she has not enrolled his / her name under the Pension Sanctioning Authority or in any other office

Enrolment Certificate

(Form-II) Finance Department Memo No. 3475-F Dt. 11/05/2009 Para-4

Sanctioning Authority WBHS Clause-13

Claim Settle

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। Pension Sanctioning Authority WBHS, 08 enrolment

WBHS,08 Sanctioning Authority Memo No. 8246-F (Med) Dt. 28/09/2012 Finance Audit Department, Medical Cell Form-VII

Format PSA

PSA Form enrolment

WBHS enrolment date

Identity Cards orders Form

Medical Advance Reimbursement Settled Form

WBHS, 08

PSA enrolment Form Form PSA

WBHS enrolment Health

Scheme claim

PSA

claim PSA

medical claim settle PSA

Proforma of Form-VII

Form-VII

Prayer for change of sanctioning authority in connection with medical facilities under the West Bengal Health Scheme, 2008

(Government pensioner / family pensioner)

(Vide F.D. Memo No. 8246-F (Med) dated 28/09/2012 read with F.D. Memo No. 10795-F (Med) dated 22/11/2010)

To

The ……………………………… (Pension Sanctioning Authority)

Dear Sir,

In terms of F.D. Memo No. 8246-F (Med) dated 28/09/2012 read with F.D. Memo No. 10795-F (Med) dated 22/11/2010,

I would like to prefer my medical advance / reimbursement bills under W.B.H.S. 2008 from the

……………………………………………………………(Name of office).

I do hereby declare that no claim under WBHS, 2008 will be submitted to you after change of sanctioning authority.

I further declare that I will abide by the terms and conditions under the West Bengal Health Scheme, 2008.

Signature of the Applicant

P.P.O. No.

Enclosures:-

(1) Copy of certificate of enrollment in Form-II (If any)

(2) Copy of W.B.H.S. 2008 Identity Card / Temporary Family Permit in Form-VI (If any)

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।

Memo No.

3474-F Dt. 11/05/2009 Finance Department, Audit Branch, Medical Cell

। WBHS, 08

Sl.

No.

Form required for

Govt. employee

Form required for Govt.

pensioner

1 A I Application for enrolment

2 B II Certificate of enrolment

3 C III Application for settlement of claims for reimbursement

4 (a) D1 IV1

OPD - essentiality certificate cum statement of expenditure

certificate by treating specialist and counter signed by

administrative officer / medical superintendent of the empanelled

/ recognized hospital

4 (b) D2 IV2

Indoor / Day care and related OPD - essentiality certificate cum

statement of expenditure certified by treating specialist and

counter signed by administrative officer / medical superintendent

of the empanelled / recognized hospital

4 (c) D3 IV3

Non-recognized Pvt. Hospital - essentiality certificate cum

statement of expenditure certified by treating specialist and

counter signed by administrative officer / medical superintendent

of the empanelled / recognized hospital

5 E V Checklist for medical claims / sanction of advance

6 F VI Temporary Family Permit

7 NIL VII Prayer for change of sanctioning authority in connection with

medical facilities under the WBHS, 08

। WBHS Category

Category

Category of Employee /

Pensioner

Basic Pay (Band Pay

including Grade Pay) / Basic

Pension

Type of accommodation Colour of WBHS identity

card

I Above Rs.27000/- p.m. /

Rs.13500/- p.m. Private ward Yellow

II

Rs.18000/- p.m. and above

but below Rs.27000/- /

Rs.9000 – Rs.13500 p.m.

Semi-private ward Pink

III Below Rs.18000 p.m. /

Rs.9000 p.m. General ward White

। major procedure minor procedure WBHS

major procedure minor procedure major procedure

minor procedure approved rate

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। West Bengal Health Scheme authority

permission

Notification No. 3731-F (Med) Dt. 10/05/2013 Finance Department, Audit Branch, Medical Cell

WBHS, 08

WBHS authority- permission WBHS

। ‘Digital Hearing Aid’ West Bengal Health Scheme Authority permission

Notification No. 3733-F (Med) Dt. 10/05/2013 Finance Department Audit Branch Medical Cell

Digital Hearing Aid’ West Bengal Health Scheme Authority

permission

WBHS Code No. 03003003 30,000 Digital Hearing Aid

Digital Hearing Aid

Audiometry Report

। OPD

OPD B-Thalassemia, Hepatitis C Carcinoma

Including Multiple Myeloma

adjust

[Memo No. 7168-F (Med) dt. 6th

September’2013 of Finance Department, Audit Branch]

WBHS, 2008

www.wbfin.nic.in (link) WB Health Scheme, 2008