West Bengal Health Scheme Form Download

Last Updated on November 6, 2019 by WBPAY

Here are all required WB Health Scheme Form for West Bengal Govt Employees, Pensioners, DDO/HOO and empaneled Hospitals.

Click here to view the new revised form (Updated on 22/10/2019)

WB Health Scheme Form for Employees:

DescriptionForm NoDownload Link
Application for enrolmentForm-ADownload WB Health Scheme Form
Application Form for settlement of claim for reimbursementForm-CDownload WB Health Scheme Form
Checklist For Reimbursement of Medical ClaimsForm-EDownload WB Health Scheme Form
Essentiality Certificate for Indoor/Day Care treatment & related OPD treatmentForm-D2Download WB Health Scheme Form
Essentiality Certificate for treatment in Health Scheme non-recognised H.C.O.sForm-D3Download WB Health Scheme Form

WB Health Scheme Form for Pensioners:

DescriptionForm NoDownload Link
Application for enrolmentForm-IDownload WB Health Scheme Form
Application Form for settlement of claim for reimbursementForm-IIIDownload WB Health Scheme Form
Certificate of enrolment (Government pensioner/ family pensioner)Form-IIDownload WB Health Scheme Form
Checklist For Reimbursement of Medical ClaimsForm-VDownload WB Health Scheme Form
Essentiality Certificate for Indoor/Day Care treatment & related OPD treatmentForm-IV2Download WB Health Scheme Form
Essentiality Certificate for OPD treatmentForm-IV1Download WB Health Scheme Form
Essentiality Certificate for treatment in Health Scheme non-recognised H.C.O.sForm-IV3Download WB Health Scheme Form
Prayer for Changing Sanctioning Authority in Connection with WBHS 2008Form-VIIDownload WB Health Scheme Form

WB Health Scheme Forms for DDO/HOO:

Forms for Hospitals:

DescriptionForm NoDownload Link
Generation of CARC from Health Portal51-F(MED)WBDownload WB Health Scheme Form
Treasury form requires for submission of Health Scheme claim at Treasury/PAOT.R. Form No. 68Download WB Health Scheme Form
DescriptionForm NoDownload Link
Application Form of Empanellment under WBHSApplicationDownload WB Health Scheme Form
Essentiality Cum Expenditure Statement for Cashless Indoor Medical Treatment.Form-D4Download WB Health Scheme Form
Information Sheet for Cashless Indoor Medical TreatmentForm-HDownload WB Health Scheme Form
Memorandum of Agreement (MOA)141-F (Med)Download WB Health Scheme Form
Procedure and guidelines for online functionaries of Health PortalOnline BillingDownload WB Health Scheme Form
Rate ChartsRate Charts
Download WB Health Scheme Form

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