WBHS OPD Rules: Big relief for state government employees in medical treatment! Finance Department changes OPD bill rules, know the details
WBHS OPD Rules: The Finance Department of the Government of West Bengal has brought extremely relieving news for state government employees and pensioners. The process of claiming reimbursement for OPD treatment bills under the West Bengal Health Scheme (WBHS) has been simplified, especially for those undergoing treatment for chronic illnesses. According to Memo No. 187-F(Med) WB issued by the Medical Cell of the Finance Department, the complications regarding the submission of multiple prescriptions for medical needs have now been resolved.
Why This New Decision?
Until now, the rule was that under Clause 7(1) or 7(2) of the West Bengal Health Scheme, if a patient suffered from listed critical diseases like cancer, heart disease, renal failure, or thalassemia, the government would also bear the cost of treating any co-morbidities. However, problems arose during the submission of bills.
Under the previous regulation, there was a condition that medicines for the primary disease and medicines for co-morbidities had to be written on a single prescription by the Primary Treating Doctor. In reality, this is not always feasible in medical science. A cardiologist often refers a patient to another specialist for diabetes or other issues. This naturally results in separate prescriptions. Previously, due to these ‘separate prescriptions,’ many employees’ OPD bills were rejected, or they could not claim reimbursement.
Benefits of the New Directive
Following the Governor’s order and the recent notification from the Finance Department, significant changes have been made to this rule. From now on, the ‘multi-disciplinary’ approach in treatment has been recognized.
- Referral Benefit: If your primary doctor refers you to another specialist or super-specialist for the treatment of a co-morbidity, that referral will be accepted.
- Acceptance of Separate Prescriptions: If the referred specialist prescribes medicines or tests on a separate prescription, that separate prescription will now be considered valid for OPD claims.
- Reimbursement: Even with separate prescriptions, there will be no further hurdles in receiving reimbursement for those bills.
Rule Change at a Glance
See the table below to understand the matter more clearly:
| Subject | Old Rule | New Rule (From 26.12.2025) |
|---|---|---|
| Prescription | All medicines had to be on one prescription. | Separate prescription from referred doctor is accepted. |
| Referral | Separate referrals had less importance. | Referral from the primary doctor is mandatory. |
| Bill Claim | Bills were rejected if prescriptions were separate. | Bills for both prescriptions can be claimed. |
What Applicants Need to Do
If you wish to avail of this benefit, keep a few things in mind while submitting bills:
- Ensure that the referral to another doctor is clearly mentioned in the primary doctor’s prescription.
- Carefully preserve the prescription and bills of the referred specialist separately.
- When submitting the bill or claim at the office or portal, submit both the primary doctor’s advice note and the new doctor’s prescription together.
The notification states that this new rule has come into effect immediately from December 26, 2025. It is expected that thousands of ailing employees and pensioners, who are burdened with huge medical expenses, will find significant relief through this measure.
