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  • West Bengal Cashless Medical Treatment Scheme

    The West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, notified in 2014 is a comprehensive health scheme which aims to provide cashless medical facilities to employees, officers and pensioners of state government (not excepting family pensioners) All India Service (AIS) officers and their family members across empanelled hospitals in West Bengal. The WBHS 2008 has been merged with the Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014 from September 15th, 2014.

    It is important to note that the cashless facility is available on the approved package rates under this scheme. Beneficiaries under this scheme can avail of cashless medical treatment for up to Rs.1 lakh. In case the treatment costs exceed the ceiling amount, the beneficiary has to pay the remaining balance amount to the HCO (Health Care Organisation). Furthermore, cardholders of West Bengal Health Scheme (2008) should apply for online enrollment at http://wbfin.nic.in by using their GPF account number as login id. Post registration, the print outs of the registration forms should be taken which along with stamp size photographs should be submitted to DDOs. State government pensioners should also follow the same procedures.

    In other words, a beneficiary under this scheme has to submit an enrolment certificate before a HCO for availing cashless medical treatment. However, no prior authorization is required for availing cashless indoor medical facilities. At the time of discharge of a beneficiary, his or her bill will consist of details regarding treatment charges and code number.

    Forms for State Government Employees:

    The table below shows the different types of forms for State Government Employees

    Type of forms Particulars
    Form-A Enrolment application
    Form-D1 Essentiality Certificate (OPD treatment)
    Form-C Claim settlement for reimbursement
    Form-E Checklist
    Form-D2 Essentiality Certificate (Indoor treatment and OPD treatment
    Form-D3 Essentiality Certificate (non-recognised HCOs)

    Forms for State Government Pensioners:

    The table below shows the different types of forms for State Government Pensioners

    Type of forms Particulars
    Form-I Enrolment application (West Bengal Health Scheme, 2008)
    Form-III Claim settlement for reimbursement
    Form-II Enrolment certificate
    FORM IV2 Essentiality certificate-cum-statement of expenditure (duly certified by a specialist for Indoor and OPD treatment)
    FORM IV1 Essentiality certificate-cum-statement of expenditure (duly certified by any OPD Treatment specialist)
    Form-V Checklist for medical claims reimbursement
    FORM IV3 Essentiality certificate-cum-statement of expenditure (duly certified by a specialist from any non-recognised private nursing home under WB Health Scheme)
    Form-VI Family Permit (Temporary)

    Implementation of West Bengal Health Scheme 2008:

    The finance department of the government of West Bengal along with the department of health and family welfare issue guidelines for operations and clarifications for the smooth functioning of the scheme. The West Bengal Health Scheme 2008 is implemented in the following ways:

    • The finance department prepares the respective policy, rules and regulations which need to be applied under the West Bengal Health Scheme 2008
    • The rates for various medical treatment procedures are fixed by the finance department
    • Various private HCOs along with diagnostic centres are empanelled in consultation with the health and family welfare department
    • Various regulations are laid down for government departments to approve reimbursement proposals
    • Ensure proper monitoring of HCOs for proper treatment of beneficiaries under this scheme
    • Grant permission for the following:
      • Treatment in specialty hospitals out of West Bengal which are recognized under WBHS
      • Implantation of medical implants
      • Organ transplantation
      • Cochlear surgery

    Benefits of West Bengal Health Scheme 2008 extended to IAS, IFS and IPS officers:

    IAS officers:

    The benefits of the West Bengal Health Scheme, 2008 was extended to the members of Indian Administrative Service (IAS) and their family members, subject to the following conditions:

    • Enrolment under the WBHS 2008 scheme is optional for IAS officers
    • The Personnel and Administrative Reforms Department is the concerned administrative department for IAS officers under the West Bengal Health Scheme, 2008
    • IAS officers and their families can avail of facilities under the West Bengal Health Scheme, 2008 besides facilities under the All India Services (Medical Attendance) Rules, 1954
    • IAS Officers enrolled under the central government health scheme cannot avail of the West Bengal Health Scheme, 2008

    IPS officers:

    The benefits of the West Bengal Health Scheme, 2008, have been extended to members of the Indian Police Service (IPS) and their families, subject to the following conditions:

    • Enrolment under the West Bengal Health Scheme, 2008 scheme is optional for IPS officers
    • The Home Department, Police Service Cell, is the concerned administrative department for IPS officers under the West Bengal Health Scheme, 2008
    • IPS officers and their families can avail of facilities as per the All India Services (Medical Attendance) Rules, 1954 in addition to those under West Bengal Health Scheme, 2008
    • IPS officers enrolled under the health scheme of the central government cannot avail West Bengal Health Scheme, 2008

    IFS officers:

    The benefits of the West Bengal Health Scheme, 2008, have been extended to members of Indian Forest Service (IFS) and their families, subject to the following conditions:

    • Enrolment for IFS officers under the West Bengal Health Scheme, 2008 is optional
    • The Department of Forests is the concerned administrative Department for IFS officers under the West Bengal Health Scheme, 2008
    • IFS officers and their families can avail of facilities under All India Services (Medical Attendance) Rules, 1954 in addition to those under West Bengal Health Scheme, 2008
    • IFS officers enrolled under the health scheme of the central government cannot avail of West Bengal Health Scheme, 2008

    Empanelled hospitals in Kolkata, West Bengal:

    The following is the list of empanelled hospitals in the state of West Bengal and NCR

    1. The Calcutta Medical Research Institute
    2. Desun Hospitals and Heart Institute
    3. Nightingale Hospitals
    4. R N Tagore International Institute of Cardiac Sciences
    5. Apollo Gelneagles
    6. Ruby general hospital
    7. BM Birla Heart research centre
    8. Medica Superspecialty Hospital
    9. Rotary Narayana Nethralaya
    10. Silverline Eye Hospital
    11. B.P Poddar Hospital
    12. Mission of Mercy Hospital
    13. Dr.Nihar Munshi Eye Foundation
    14. Eye care and Research Centre
    15. D.M Hospital Pvt. Ltd
    16. Susrut Eye Foundation
    17. Bhattacharya Orthopedics
    18. Institute of Neuroscience
    19. Amri Hospitals
    20. Barrackpore Medicare
    21. Disha Eye Hospitals
    22. Belle Vue Clinic
    23. Fortis Hospital
    24. Kothari Medical Centre
    25. Peerless Hospitax Hospital
    26. Apex Institute of Medical Sciences
    27. Dafodil Hospitals
    28. Kothari Medical Centre
    29. Ekbalpur Nursing Home
    30. R.G Stone Urology and Laproscopy Hospital
    31. Nabajiban Hospital
    32. KPC Medical College
    33. Implant’s Better Sight Centre
    34. Eskag Sanjeevani
    35. Divine Nursing Home

    Revised Rate list:

    The following table shows some rates* under the West Bengal Health for all Employees and Pensioners Cashless Medical Treatment Scheme, 2014, Finance Department, Government of West Bengal

    Description Rate Package or non-package
    Consultation by super specialists (indoor) (two visits per day) Rs.250 Non-package
    Consultation by specialists (Indoor - two visits) Rs.200 Non-package
    Consultation by super specialists (OPD) Rs.250 Non-package
    Consultation by Medical Officer (OPD) Rs.150 Non-package
    Excision of moles Rs.600 Package
    Excision of Corns Rs.550 Package
    Excision of Molluscum Contagiosum Rs.600 Package
    Excision of Warts Rs.600 Package
    Excision of Venerel Warts Rs.600 Package
    Cyst under LA Rs.300 Non-package
    Flap operation per tooth Rs.500 Non-package
    Extraction of Tooth including LA Rs.120 Non-package
    Gingivectomy per tooth Rs.300 Non-package
    Complicated extraction per tooth including LA Rs.250 Non-package
    Retrobular Injection (both eyes) Rs.300 Non-package
    Lacrimal sac for one eye Rs.200 Non-package
    Subconjunctival Injection -one

    eye

    Rs.200 Non-package
    Subconjunctival Injection -both eyes Rs.300 Non-package

    *List is not exhaustive. Rates vary according to the medical procedure

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