West Bengal Health Scheme: Frequently Asked Questions | FAQ on WBHS

A: Prior permission of WBHS Authority will be required for Human Organ Transplantation, Cochlear Implant Surgery, Implantation of Dual Chamber Pacemaker, more than two Stents, more than one Drug eluting Stents, AICD, CRT with AICD, Neuro Implants viz. Deep Brain stimulator Implants, Intra-thecal Pumps, Spinal Cord stimulators and for Treatment in a Specialty hospital outside the State. { Ref: Memo No 797-F(MED) Dt 31/01/2011} In case of Non Package treatment , prior permission of the West Bengal Health Scheme Authority is required when the treatment cost exceeds Rs 2,50,000/-. Moreover, in case of package treatment, permission of the West Bengal Health Scheme Authority is required for performing more than two packages at the same time. { Ref: Memo No 11253-F(MED) Dt 16/12/2011 Read with Memo No 7578-F(MED) Dt 04/09/2012} In case of treatment within the state in empanelled hospital permission will be sought by the treating hospital. However, in case of treatment in specialty Hospital outside the State permission will be sought by the incumbent or his beneficiary attaching necessary documents.

A: Yes. As per Clause 14 of the West Bengal Health Scheme, Secretary of a Department may allow a Govt. employee / Govt. Pensioner or family pensioner to receive medical treatment in a specialty hospital outside the state as recognized under notification number 3473-F Dt 11/05/2009. But such permission may be given where treatment in such hospital is essential and referred by a recognized hospital. To determine essentiality of the treatment outside the State, the West Bengal Health Scheme Authority should be consulted. { Ref: Memo No 9205-F(MED) Dt 05/10/2009} { Ref: Memo No 11254-F(MED) Dt 16/12/2011} However, prior permission of the West Bengal Health Scheme Authority and referral from the recognized Health Care Organization will no longer be required where medical treatment facilities has been obtained from Tata Memorial Hospital, Mumbai for treatment of Cancer disease. Prior approval of the Secretary of the Department will have to be obtained in such cases. { Ref: Memo No 3731-F(MED) Dt 10/05/2013} Similar relaxations have also been provided for obtaining medical treatment facilities at AIIMS, New Delhi and NIMHANS, Bengaluru. Prior approval of the Secretary in charge of the concerned Administrative Department will have to be obtained in such cases. { Ref: Memo No 74-F(MED) Dt 21/08/2018}

 A: In case of cashless indoor treatment in empanelled Private Health Care Organizations (HCOs) the employee / pensioner / family pensioner is entitled to get Cashless treatment facilities upto Rupees One Lakh. They have to pay the balance amount over Rupees One Lakh directly to the HCOs, if the cost of treatment exceeds Rupees One Lakh. The HCO then submits all the bills, whether upto Rupees One Lakh or more than One Lakh, with required document in original to the Medical Cell, Finance Department for payment. Medical Cell, Finance Department in turn process all the bills, whether upto Rupees One Lakh or more than One Lakh, and fixes admissibility. Admissible amount of HCO’s claim upto Rupees one lakh on every bill of the HCO is paid from the Medical Cell, Finance Department. At the same time, to enable reimbursement in respect of the claim of the employee/ pensioner/ family pensioner for the balance amount over Rupees One Lakh, which they have paid directly to the empanelled HCO, a Cashless Admissible Reimbursement Certificate (CARC) is generated from the system at DDOs end in respect of admissible amount to be reimbursed to the employee/ pensioner / family pensioner. The employee/ pensioner/ family pensioner can claim indoor related OPD treatment cost in addition to CARC mentioned amount. However, no reimbursement will be allowed relating to indoor period in excess of the CARC mentioned amount. It is noted that no CARC is generated for any cashless treatment bill upto Rupees One Lakh. The employee/ pensioner/ family pensioner can claim only indoor related OPD treatment cost in respect of cashless treatment bill upto Rupees One Lakh. {Ref: Memo No 811-F(MED) Dt 16/07/2015 and Memo No 51-F(MED) Dt 07/06/2018}

A: Yes, Sanction Order as usual required as per Memo No 483-F(MED)WB Dt 26/05/2016.

A: As per Memo No 51-F(MED)WB Dt 07/06/2018 CARC is to be generated from DDO’s login through the following path- DDO’s Login> CARC Certificate> Download CARC. After issuance of Memo No 51-F(MED)WB Dt 07/06/2018 no CARC will be issued from Medical Cell, Finance Department.

A: Yes. Only DDO will sign with Official Seal and Date. No signature from the Medical Cell is required.

A: (i) Husband or Wife, as the case may be; (ii) Parents whose monthly income does not exceed rupees three thousand five hundred; (iii) Children including Step-children, legally adopted children and unmarried daughters (iv) Dependent widowed/ divorced daughters; (v) Minor brothers, minor sisters; (vi) Dependent unmarried / widowed/ divorced sisters

A: Yes. But, if he or any of his beneficiaries has enjoyed any benefit under WBHS, he will not be allowed to opt out of the Scheme within five years from the month following the month in which he enjoyed the benefit.

A: Yes. Form VII is to be filled up by the Pensioner / family pensioner and submit the same to the original PSA. The PSA will transfer the requisite document to the district office under the same Department as mentioned in Form VII. { Ref 10795-F(MED) Dt 22/11/2010, Ref 8246-F(MED) Dt 28/09/2012} Again in Memo 102-F(MED) Dt 12/10/18 a pensioner residing at a distant place from the office of the PSA can choose to prefer his claim to the nearest Sub Divisional Level office under the same Deptt., where he was working before retirement and if there is no such office then to the office of the District Magistrate of the District or SDO of the Sub- Division where the pensioner resides . In case of pensioner or family pensioner residing at Kolkata after retirement and whose PSA’ s office situated at a distant place may choose to prefer claim for reimbursement to the concerned Directorate Office in Kolkata.

A: Yes. Ref : Memo No 884-F(MED) Dt 31/07/2015

A: Yes, such pensioner may contact the concerned Pension sanctioning Authority for enrolment under the Scheme. Enrolment Certificates in those cases should be send to the A.G (A &E), West Bengal, Treasury Building for taking necessary action towards discontinuation of monthly medical relief w.e.f. the date mentioned in the enrolment certificate. {Ref: 9205-F(MED) Dt 05/10/2009}

A: Yes. {Ref: 9205-F(MED) Dt 05/10/2009}

A: Yes. Ref: Memo No 9205-F(MED) Dt 05/10/2009

A: Parents of the pensioner can be included as beneficiary under the Scheme provided their monthly income from all source does not exceed rupees three thousand five hundred. In case the parent is a pensioner, income from all sources including pension before commutation is to be taken as income. However, dearness relief on pension is not to be considered as income. {Ref: 10734-F(MED) Dt 18/11/2010}

A: No. Son is considered to be dependent till he starts earning (minimum rupees one thousand five hundred) or attains the age of 25 years whichever is earlier. However, son suffering from permanent disabilities either physically or mentally will be considered dependent without age limit.

A: Every surgical case should be done on package rate. Where there is no package rate for a particular surgical procedure, hospital shall intimate the matter the matter is to claim is to be made on the basis of identical procedure package rate. Permission of the West Bengal Health Scheme Authority under Finance Department is to be obtained if any surgery is not possible following the above guidelines. Identical code is to be sought by the treating Hospital from the Medical Cell, Finance Department through WBHS Portal. {Ref: Memo No 796-F(MED) Dt 31/01/2011}

A: Yes. A pensioner and his beneficiary shall be entitled to the facilities under the WBHS 2008 in addition to the West Bengal Services (Medical Benefits) Rules 1998, as subsequently amended

A: Yes, as per clause 14 of the West Bengal Health Scheme actual cost of treatment in those enlisted hospitals will be reimbursable irrespective of Code and Approved Rate of West Bengal Health Scheme.

A: Yes. Reimbursement for indoor treatment is to be claimed within 3 months from the date of discharge. Whereas, reimbursement in respect of outdoor treatment is be to be claimed within 3 months from each OPD. Otherwise delay is to be condoned by the appropriate authority in terms of 1040-F(MED) Dt 01/12/2016 and 72-F(MED) Dt 14/08/2018. When medicines are to be taken for indefinite period, advance purchase for more than 3 months will not be entertained and 3 months for preferring claim is to be counted from the date of purchase of medicines in such cases. { Ref: Memo No 2618-F(MED) Dt 05/04/2011} As per Memo No 2857-F(MED) Dt 08/04/2013 advance purchase of medicine for maximum period upto six months may be allowed when medicines are prescribed for indefinite period by specialty hospitals outside the State and claim for reimbursement in such cases may be allowed upto six months from the date of purchase of such medicines.

A: If reimbursement (i) in respect of indoor treatment -is not claimed within 3 months from the date of discharge, (ii) in respect of outdoor treatment- is not claimed within 3 months from each OPD or within 3 months from the date of purchase of medicine where medicines is prescribed for indefinite period (within 6 months from the date of purchase of medicine where medicines is prescribed for indefinite period by Specialty Hospitals outside the State) the claim may be sent to the Head of the Administrative department to condone the delay beyond three months but within one year. For condonation of any delay beyond one year from the date of discharge(for indoor treatment), or from the date of OPD or date of purchase of medicines (for outdoor treatment), file may be sent to the West Bengal Health Scheme Authority in Medical Cell, under Finance Department through the concerned Administrative Department. { Ref: Memo No 1040-F(MED) Dt 01/12/2016} { Ref: Memo No 72-F(MED) Dt 14/08/2018}

A: For major illness like Bypass Surgery, implantation of Pacemaker, Coronary angioplasty with Stenting, Kidney transplantation, etc. medical advance may be sanctioned and it shall only be sanctioned to an eligible Govt. pensioner if medical attendance and treatment of his or her or his or her family member are done in a Government Hospital. The sanctioning authority for reimbursement of the costs of medical attendance and treatment may grant 80 percent of the estimated cost including implants as advance directly to the Govt. hospitals. The Sanctioning Authority shall take necessary steps for adjustment of the advance after obtaining Utilization Certificate from the hospital.

A: Prior permission of WBHS Authority will be required for Human Organ Transplantation, Cochlear Implant Surgery, Implantation of Dual Chamber Pacemaker, more than two Stents, more than one Drug eluting Stents, AICD, CRT with AICD, Neuro Implants viz. Deep Brain stimulator Implants, Intra-thecal Pumps, Spinal Cord stimulators and for Treatment in a Specialty hospital outside the State. { Ref: Memo No 797-F(MED) Dt 31/01/2011} In case of Non Package treatment , prior permission of the West Bengal Health Scheme Authority is required when the treatment cost exceeds Rs 2,50,000/-. Moreover, in case of package treatment, permission of the West Bengal Health Scheme Authority is required for performing more than two packages at the same time. { Ref: Memo No 11253-F(MED) Dt 16/12/2011 Read with Memo No 7578-F(MED) Dt 04/09/2012} In case of treatment within the state in empanelled hospital permission will be sought by the treating hospital. However, in case of treatment in specialty Hospital outside the State permission will be sought by the incumbent or his beneficiary attaching necessary documents.

A: Yes. As per Clause 14 of the West Bengal Health Scheme, Secretary of a Department may allow a Govt. employee / Govt. Pensioner or family pensioner to receive medical treatment in a specialty hospital outside the state as recognized under notification number 3473-F Dt 11/05/2009. But such permission may be given where treatment in such hospital is essential and referred by a recognized hospital. To determine essentiality of the treatment outside the State, the West Bengal Health Scheme Authority should be consulted. { Ref: Memo No 9205-F(MED) Dt 05/10/2009} { Ref: Memo No 11254-F(MED) Dt 16/12/2011} However, prior permission of the West Bengal Health Scheme Authority and referral from the recognized Health Care Organization will no longer be required where medical treatment facilities has been obtained from Tata Memorial Hospital, Mumbai for treatment of Cancer disease. Prior approval of the Secretary of the Department will have to be obtained in such cases. { Ref: Memo No 3731-F(MED) Dt 10/05/2013} Similar relaxations have also been provided for obtaining medical treatment facilities at AIIMS, New Delhi and NIMHANS, Bengaluru. Prior approval of the Secretary in charge of the concerned Administrative Department will have to be obtained in such cases. { Ref: Memo No 74-F(MED) Dt 21/08/2018}

A: In case of cashless indoor treatment in empanelled Private Health Care Organizations (HCOs) the employee / pensioner / family pensioner is entitled to get Cashless treatment facilities upto Rupees One Lakh. They have to pay the balance amount over Rupees One Lakh directly to the HCOs, if the cost of treatment exceeds Rupees One Lakh. The HCO then submits all the bills, whether upto Rupees One Lakh or more than One Lakh, with required document in original to the Medical Cell, Finance Department for payment. Medical Cell, Finance Department in turn process all the bills, whether upto Rupees One Lakh or more than One Lakh, and fixes admissibility. Admissible amount of HCO’s claim upto Rupees one lakh on every bill of the HCO is paid from the Medical Cell, Finance Department. At the same time, to enable reimbursement in respect of the claim of the employee/ pensioner/ family pensioner for the balance amount over Rupees One Lakh, which they have paid directly to the empanelled HCO, a Cashless Admissible Reimbursement Certificate (CARC) is generated from the system at DDOs end in respect of admissible amount to be reimbursed to the employee/ pensioner / family pensioner. The employee/ pensioner/ family pensioner can claim indoor related OPD treatment cost in addition to CARC mentioned amount. However, no reimbursement will be allowed relating to indoor period in excess of the CARC mentioned amount. It is noted that no CARC is generated for any cashless treatment bill upto Rupees One Lakh. The employee/ pensioner/ family pensioner can claim only indoor related OPD treatment cost in respect of cashless treatment bill upto Rupees One Lakh. {Ref: Memo No 811-F(MED) Dt 16/07/2015 and Memo No 51-F(MED) Dt 07/06/2018}

A: Yes, Sanction Order as usual required as per Memo No 483-F(MED)WB Dt 26/05/2016.

A: As per Memo No 51-F(MED)WB Dt 07/06/2018 CARC is to be generated from DDO’s login through the following path- DDO’s Login> CARC Certificate> Download CARC. After issuance of Memo No 51-F(MED)WB Dt 07/06/2018 no CARC will be issued from Medical Cell, Finance Department.

A: Yes. Only DDO will sign with Official Seal and Date. No signature from the Medical Cell is required.

A: Yes. But, if he or any of his beneficiaries has enjoyed any benefit under WBHS, he will not be allowed to opt out of the Scheme within five years from the month following the month in which he enjoyed the benefit

A: Yes. Form VII is to be filled up by the Pensioner / family pensioner and submit the same to the original PSA. The PSA will transfer the requisite document to the district office under the same Department as mentioned in Form VII. { Ref 10795-F(MED) Dt 22/11/2010, Ref 8246-F(MED) Dt 28/09/2012} Again in Memo 102-F(MED) Dt 12/10/18 a pensioner residing at a distant place from the office of the PSA can choose to prefer his claim to the nearest Sub Divisional Level office under the same Deptt., where he was working before retirement and if there is no such office then to the office of the District Magistrate of the District or SDO of the Sub- Division where the pensioner resides . In case of pensioner or family pensioner residing at Kolkata after retirement and whose PSA’ s office situated at a distant place may choose to prefer claim for reimbursement to the concerned Directorate Office in Kolkata.

A: Yes. Ref : Memo No 884-F(MED) Dt 31/07/2015

A: (i) Husband or Wife, as the case may be; (ii) Parents whose monthly income does not exceed rupees three thousand five hundred; (iii) Children including Step-children, legally adopted children and unmarried daughters (iv) Dependent widowed/ divorced daughters; (v) Minor brothers, minor sisters; (vi) Dependent unmarried / widowed/ divorced sisters

A: Parents of the employee/pensioner can be included as beneficiary under the Scheme provided their monthly income from all source does not exceed rupees three thousand five hundred. In case, the parent is a pensioner, income from all sources including pension before commutation is to be taken as income. However, dearness relief on pension is not to be considered as income. Parents can live away from employee in another station with other members of the family, however, considered as dependent member of the family of an employee provided the above income criteria is fulfilled. {Ref: Memo No 10531-F(MED) Dt: 10/11/2010and 10734-F(MED) Dt 18/11/2010}

A: For availing the medical facilities under the West Bengal Health Scheme, children, minor brothers, unmarried/ widowed/ divorced daughters, unmarried/ widowed/ divorced sisters shall be deemed to be dependent on the Govt. employee if they are normally residing with him/ her and their income from all source does not exceed Rs. 1500/- per month. { Ref: Memo No 9205-F(MED) Dt 05/10/2009}

A: No. Son is considered to be dependent till he starts earning (minimum rupees one thousand five hundred) or attains the age of 25 years whichever is earlier. However, son suffering from permanent disabilities either physically or mentally will be considered dependent without age limit.

A: Yes. {Ref: Memo No 9205-F(MED) Dt 05/10/2009}

A: Yes. Ref: Memo No 9205-F(MED) Dt 05/10/2009

A: Yes, however, medical facility can be availed at one place only. Therefore, if spouse wants to get the benefits under the West Bengal health scheme, an official certificate from his / her employer is to be obtained first regarding relinquishment of medical allowance and medical benefits available from his /her employer. {Ref: Memo No 9205-F(MED) Dt 05/10/2009}

A: Yes, such pensioner may contact the concerned Pension sanctioning Authority for enrolment under the Scheme. Enrolment Certificates in those cases should be send to the A.G (A &E), West Bengal, Treasury Building for taking necessary action towards discontinuation of monthly medical relief w.e.f. the date mentioned in the enrolment certificate. {Ref: 9205-F(MED) Dt 05/10/2009}

A: Yes. {Ref: 9205-F(MED) Dt 05/10/2009}

A: Every surgical case is to be done on package rate. Where there is no Package Rate for a particular surgical procedure, claim is to be made on the basis of identical procedure package rate. It is the responsibility of the treating Hospital to obtain Identical code from the Medical Cell, Finance Department. {Ref: Memo No 796-F(MED) Dt 31/01/2011}

A: Yes. An employee and his beneficiary shall be entitled to the facilities under the WBHS 2008 in addition to the West Bengal Services (Medical Attendance) Rules 1964, as subsequently amended

A: Yes. A pensioner and his beneficiary shall be entitled to the facilities under the WBHS 2008 in addition to the West Bengal Services (Medical Benefits) Rules 1998, as subsequently amended.

A: Yes, as per clause 14 of the West Bengal Health Scheme actual cost of treatment in those enlisted hospitals will be reimbursable irrespective of Code and Approved Rate of West Bengal Health Scheme

A: Yes. Reimbursement for indoor treatment is to be claimed within 3 months from the date of discharge. Whereas, reimbursement in respect of outdoor treatment is be to be claimed within 3 months from each OPD. Otherwise delay is to be condoned by the appropriate authority in terms of 1040-F(MED) Dt 01/12/2016 and 72-F(MED) Dt 14/08/2018. When medicines are to be taken for indefinite period, advance purchase for more than 3 months will not be entertained and 3 months for preferring claim is to be counted from the date of purchase of medicines in such cases. { Ref: Memo No 2618-F(MED) Dt 05/04/2011} As per Memo No 2857-F(MED) Dt 08/04/2013 advance purchase of medicine for maximum period upto six months may be allowed when medicines are prescribed for indefinite period by specialty hospitals outside the State and claim for reimbursement in such cases may be allowed upto six months from the date of purchase of such medicines.

A: If reimbursement (iii) in respect of indoor treatment -is not claimed within 3 months from the date of discharge, (iv) in respect of outdoor treatment- is not claimed within 3 months from each OPD or within 3 months from the date of purchase of medicine where medicines is prescribed for indefinite period (within 6 months from the date of purchase of medicine where medicines is prescribed for indefinite period by Specialty Hospitals outside the State) the claim may be sent to the Head of the Administrative department to condone the delay beyond three months but within one year. For condonation of any delay beyond one year from the date of discharge(for indoor treatment), or from the date of OPD or date of purchase of medicines (for outdoor treatment), file may be sent to the West Bengal Health Scheme Authority in Medical Cell, under Finance Department through the concerned Administrative Department. { Ref: Memo No 1040-F(MED) Dt 01/12/2016} { Ref: Memo No 72-F(MED) Dt 14/08/2018}

A: The sanctioning authority can grant medical advance to an employee for indoor treatment of him or for his beneficiary in empanelled hospital under West Bengal Health Scheme on submission of a certificate of estimate from the hospital, where the medical attendance or treatment is going to be received. (vi) Advance is available only for indoor treatment including day care treatment. No advance can be sanctioned for OPD treatment. (vii) Advance may be sanctioned for treatment in empanelled hospitals only. No advance is available for treatment in non empanelled hospitals. (viii) The advance shall not exceed 80 per cent of the estimated cost of medical attendance and treatment. (ix) The medical advance shall be adjusted against the admissible cost of medical attendance and treatment, excess if any shall be refunded by the employee. If medical attendance or treatment not received within 60 days of receipt of medical advance, the entire advance shall be refunded by the employee on the expiry of this period. The term “estimate” is defined in point 16 of Order No 796-F(Med) Dt 31/01/2011.

A: For major illness like Bypass Surgery, implantation of Pacemaker, Coronary angioplasty with Stenting, Kidney transplantation, etc. medical advance may be sanctioned and it shall only be sanctioned to an eligible Govt. pensioner if medical attendance and treatment of his or her or his or her family member are done in a Government Hospital. The sanctioning authority for reimbursement of the costs of medical attendance and treatment may grant 80 percent of the estimated cost including implants as advance directly to the Govt. hospitals. The Sanctioning Authority shall take necessary steps for adjustment of the advance after obtaining Utilization Certificate from the hospital.

A: Prior permission of WBHS Authority will be required for Human Organ Transplantation, Cochlear Implant Surgery, Implantation of Dual Chamber Pacemaker, more than two Stents, more than one Drug eluting Stents, AICD, CRT with AICD, Neuro Implants viz. Deep Brain stimulator Implants, Intra-thecal Pumps, Spinal Cord stimulators and for Treatment in a Specialty hospital outside the State. { Ref: Memo No 797-F(MED) Dt 31/01/2011} In case of Non Package treatment , prior permission of the West Bengal Health Scheme Authority is required when the treatment cost exceeds Rs 2,50,000/-. Moreover, in case of package treatment, permission of the West Bengal Health Scheme Authority is required for performing more than two packages at the same time. { Ref: Memo No 11253-F(MED) Dt 16/12/2011 Read with Memo No 7578-F(MED) Dt 04/09/2012} In case of treatment within the state in empanelled hospital permission will be sought by the treating hospital. However, in case of treatment in specialty Hospital outside the State permission will be sought by the incumbent or his beneficiary attaching necessary documents.

A: Yes. As per Clause 14 of the West Bengal Health Scheme, Secretary of a Department may allow a Govt. employee / Govt. Pensioner or family pensioner to receive medical treatment in a specialty hospital outside the state as recognized under notification number 3473-F Dt 11/05/2009. But such permission may be given where treatment in such hospital is essential and referred by a recognized hospital. To determine essentiality of the treatment outside the State, the West Bengal Health Scheme Authority should be consulted. { Ref: Memo No 9205-F(MED) Dt 05/10/2009} { Ref: Memo No 11254-F(MED) Dt 16/12/2011} However, prior permission of the West Bengal Health Scheme Authority and referral from the recognized Health Care Organization will no longer be required where medical treatment facilities has been obtained from Tata Memorial Hospital, Mumbai for treatment of Cancer disease. Prior approval of the Secretary of the Department will have to be obtained in such cases. { Ref: Memo No 3731-F(MED) Dt 10/05/2013} Similar relaxations have also been provided for obtaining medical treatment facilities at AIIMS, New Delhi and NIMHANS, Bengaluru. Prior approval of the Secretary in charge of the concerned Administrative Department will have to be obtained in such cases. { Ref: Memo No 74-F(MED) Dt 21/08/2018}

A: In case of cashless indoor treatment in empanelled Private Health Care Organizations (HCOs) the employee / pensioner / family pensioner is entitled to get Cashless treatment facilities upto Rupees One Lakh. They have to pay the balance amount over Rupees One Lakh directly to the HCOs, if the cost of treatment exceeds Rupees One Lakh. The HCO then submits all the bills, whether upto Rupees One Lakh or more than One Lakh, with required document in original to the Medical Cell, Finance Department for payment. Medical Cell, Finance Department in turn process all the bills, whether upto Rupees One Lakh or more than One Lakh, and fixes admissibility. Admissible amount of HCO’s claim upto Rupees one lakh on every bill of the HCO is paid from the Medical Cell, Finance Department. At the same time, to enable reimbursement in respect of the claim of the employee/ pensioner/ family pensioner for the balance amount over Rupees One Lakh, which they have paid directly to the empanelled HCO, a Cashless Admissible Reimbursement Certificate (CARC) is generated from the system at DDOs end in respect of admissible amount to be reimbursed to the employee/ pensioner / family pensioner. The employee/ pensioner/ family pensioner can claim indoor related OPD treatment cost in addition to CARC mentioned amount. However, no reimbursement will be allowed relating to indoor period in excess of the CARC mentioned amount. It is noted that no CARC is generated for any cashless treatment bill upto Rupees One Lakh. The employee/ pensioner/ family pensioner can claim only indoor related OPD treatment cost in respect of cashless treatment bill upto Rupees One Lakh. {Ref: Memo No 811-F(MED) Dt 16/07/2015 and Memo No 51-F(MED) Dt 07/06/2018}

A: Yes, Sanction Order as usual required as per Memo No 483-F(MED)WB Dt 26/05/2016.

A: As per Memo No 51-F(MED)WB Dt 07/06/2018 CARC is to be generated from DDO’s login through the following path- DDO’s Login> CARC Certificate> Download CARC. After issuance of Memo No 51-F(MED)WB Dt 07/06/2018 no CARC will be issued from Medical Cell, Finance Department.

A: Yes. Only DDO will sign with Official Seal and Date. No signature from the Medical Cell is required.

A: Yes. Ref : Memo No 884-F(MED) Dt 31/07/2015

A: Every surgical case is to be done on package rate. Where there is no Package Rate for a particular surgical procedure, claim is to be made on the basis of identical procedure package rate. Permission of the West Bengal Health Scheme Authority under Finance Department is to be obtained if any surgery is not possible following the above guidelines. {Ref: Memo No 796-F(MED) Dt 31/01/2011}

A: Yes. An employee and his beneficiary shall be entitled to the facilities under the WBHS 2008 in addition to the West Bengal Services (Medical Attendance) Rules 1964, as subsequently amended.

A: Yes. A pensioner and his beneficiary shall be entitled to the facilities under the WBHS 2008 in addition to the West Bengal Services (Medical Benefits) Rules 1998, as subsequently amended.

A: Yes, as per clause 14 of the West Bengal Health Scheme actual cost of treatment in those enlisted hospitals will be reimbursable irrespective of Code and Approved Rate of West Bengal Health Scheme.

A: Yes. Reimbursement for indoor treatment is to be claimed within 3 months from the date of discharge. Whereas, reimbursement in respect of outdoor treatment is be to be claimed within 3 months from each OPD. Otherwise delay is to be condoned by the appropriate authority in terms of 1040-F(MED) Dt 01/12/2016 and 72-F(MED) Dt 14/08/2018. When medicines are to be taken for indefinite period, advance purchase for more than 3 months will not be entertained and 3 months for preferring claim is to be counted from the date of purchase of medicines in such cases. { Ref: Memo No 2618-F(MED) Dt 05/04/2011} As per Memo No 2857-F(MED) Dt 08/04/2013 advance purchase of medicine for maximum period upto six months may be allowed when medicines are prescribed for indefinite period by specialty hospitals outside the State and claim for reimbursement in such cases may be allowed upto six months from the date of purchase of such medicines.

A: If reimbursement (v) in respect of indoor treatment -is not claimed within 3 months from the date of discharge, (vi) in respect of outdoor treatment- is not claimed within 3 months from each OPD or within 3 months from the date of purchase of medicine where medicines is prescribed for indefinite period (within 6 months from the date of purchase of medicine where medicines is prescribed for indefinite period by Specialty Hospitals outside the State) the claim may be sent to the Head of the Administrative department to condone the delay beyond three months but within one year. For condonation of any delay beyond one year from the date of discharge(for indoor treatment), or from the date of OPD or date of purchase of medicines (for outdoor treatment), file may be sent to the West Bengal Health Scheme Authority in Medical Cell, under Finance Department through the concerned Administrative Department. { Ref: Memo No 1040-F(MED) Dt 01/12/2016} { Ref: Memo No 72-F(MED) Dt 14/08/2018}

A: The sanctioning authority can grant medical advance to an employee for indoor treatment of him or for his beneficiary in empanelled hospital under West Bengal Health Scheme on submission of a certificate of estimate from the hospital, where the medical attendance or treatment is going to be received. (x) Advance is available only for indoor treatment including day care treatment. No advance can be sanctioned for OPD treatment. (xi) Advance may be sanctioned for treatment in empanelled hospitals only. No advance is available for treatment in non empanelled hospitals. (xii) The advance shall not exceed 80 per cent of the estimated cost of medical attendance and treatment. (xiii) The medical advance shall be adjusted against the admissible cost of medical attendance and treatment, excess if any shall be refunded by the employee. If medical attendance or treatment not received within 60 days of receipt of medical advance, the entire advance shall be refunded by the employee on the expiry of this period. The term “estimate” is defined in point 16 of Order No 796-F(Med) Dt 31/01/2011.

A: For major illness like Bypass Surgery, implantation of Pacemaker, Coronary angioplasty with Stenting, Kidney transplantation, etc. medical advance may be sanctioned and it shall only be sanctioned to an eligible Govt. pensioner if medical attendance and treatment of his or her or his or her family member are done in a Government Hospital. The sanctioning authority for reimbursement of the costs of medical attendance and treatment may grant 80 percent of the estimated cost including implants as advance directly to the Govt. hospitals. The Sanctioning Authority shall take necessary steps for adjustment of the advance after obtaining Utilization Certificate from the hospital.

A: Prior permission of WBHS Authority will be required for Human Organ Transplantation, Cochlear Implant Surgery, Implantation of Dual Chamber Pacemaker, more than two Stents, more than one Drug eluting Stents, AICD, CRT with AICD, Neuro Implants viz. Deep Brain stimulator Implants, Intra-thecal Pumps, Spinal Cord stimulators and for Treatment in a Specialty hospital outside the State. { Ref: Memo No 797-F(MED) Dt 31/01/2011} In case of Non Package treatment , prior permission of the West Bengal Health Scheme Authority is required when the treatment cost exceeds Rs 2,50,000/-. Moreover, in case of package treatment, permission of the West Bengal Health Scheme Authority is required for performing more than two packages at the same time. { Ref: Memo No 11253-F(MED) Dt 16/12/2011 Read with Memo No 7578-F(MED) Dt 04/09/2012} In case of treatment within the state in empanelled hospital permission will be sought by the treating hospital. However, in case of treatment in specialty Hospital outside the State permission will be sought by the incumbent or his beneficiary attaching necessary documents.

A: Yes. As per Clause 14 of the West Bengal Health Scheme, Secretary of a Department may allow a Govt. employee / Govt. Pensioner or family pensioner to receive medical treatment in a specialty hospital outside the state as recognized under notification number 3473-F Dt 11/05/2009. But such permission may be given where treatment in such hospital is essential and referred by a recognized hospital. To determine essentiality of the treatment outside the State, the West Bengal Health Scheme Authority should be consulted. { Ref: Memo No 9205-F(MED) Dt 05/10/2009} { Ref: Memo No 11254-F(MED) Dt 16/12/2011} However, prior permission of the West Bengal Health Scheme Authority and referral from the recognized Health Care Organization will no longer be required where medical treatment facilities has been obtained from Tata Memorial Hospital, Mumbai for treatment of Cancer disease. Prior approval of the Secretary of the Department will have to be obtained in such cases. { Ref: Memo No 3731-F(MED) Dt 10/05/2013} Similar relaxations have also been provided for obtaining medical treatment facilities at AIIMS, New Delhi and NIMHANS, Bengaluru. Prior approval of the Secretary in charge of the concerned Administrative Department will have to be obtained in such cases. { Ref: Memo No 74-F(MED) Dt 21/08/2018}

A: In case of cashless indoor treatment in empanelled Private Health Care Organizations (HCOs) the employee / pensioner / family pensioner is entitled to get Cashless treatment facilities upto Rupees One Lakh. They have to pay the balance amount over Rupees One Lakh directly to the HCOs, if the cost of treatment exceeds Rupees One Lakh. The HCO then submits all the bills, whether upto Rupees One Lakh or more than One Lakh, with required document in original to the Medical Cell, Finance Department for payment. Medical Cell, Finance Department in turn process all the bills, whether upto Rupees One Lakh or more than One Lakh, and fixes admissibility. Admissible amount of HCO’s claim upto Rupees one lakh on every bill of the HCO is paid from the Medical Cell, Finance Department. At the same time, to enable reimbursement in respect of the claim of the employee/ pensioner/ family pensioner for the balance amount over Rupees One Lakh, which they have paid directly to the empanelled HCO, a Cashless Admissible Reimbursement Certificate (CARC) is generated from the system at DDOs end in respect of admissible amount to be reimbursed to the employee/ pensioner / family pensioner. The employee/ pensioner/ family pensioner can claim indoor related OPD treatment cost in addition to CARC mentioned amount. However, no reimbursement will be allowed relating to indoor period in excess of the CARC mentioned amount. It is noted that no CARC is generated for any cashless treatment bill upto Rupees One Lakh. The employee/ pensioner/ family pensioner can claim only indoor related OPD treatment cost in respect of cashless treatment bill upto Rupees One Lakh. {Ref: Memo No 811-F(MED) Dt 16/07/2015 and Memo No 51-F(MED) Dt 07/06/2018}

A: Yes, Sanction Order as usual required as per Memo No 483-F(MED)WB Dt 26/05/2016.

A: As per Memo No 51-F(MED)WB Dt 07/06/2018 CARC is to be generated from DDO’s login through the following path- DDO’s Login> CARC Certificate> Download CARC. After issuance of Memo No 51-F(MED)WB Dt 07/06/2018 no CARC will be issued from Medical Cell, Finance Department.

A: Yes. Only DDO will sign with Official Seal and Date. No signature from the Medical Cell is required.