Government of West Bengal
No. 6953-F (MED)
In the process of implementation of the West Bengal Health Scheme, 2008 the Government from some time past was considering for amendment of Forms regarding enrolment under the Health Scheme and settlement of claims. Accordingly, the Governor is pleased to publish the following amended Forms under the West Bengal Health Scheme, 2008 and guidelines for settlement of claims.
2. Under Clause-7 (1) of the West Bengal Health Scheme, 2008, costs of OPD treatment of tell listed diseases are reimbursable. Reimbursement of the cost of medical treatment of such diseases may be allowed when the attending physician of recognized hospital clearly certifies that the beneficiary was/ has been suffering from any of the listed diseases of Clausc-7(l) of the Health Schemc. Essentiality Certificate for treatment under Clausc-7 (1) of the Health Scheme should be furnished in Form-D1’/Form-IV1’.
Cases relating to Clause-6, Clause-7 (2) or Clause-9 of the Health Scheme may be settled following provisions of those Clauses. Essentiality Certificates for those cases should be furnished in Form-D2’/ Form-IV2’.
3. Revised terms and conditions for rendering services under the Health Scheme and revised rate list have been published under the notification no. 796-F (MED), dated 31-01-2011. Guidelines for settlement of claims along with list of inadmissible items have also been published under the memo nos. 797-F (MED), dated 31-01-2011 and 6586-F (MED), dated 29-06-2011 respectively.
Accordingly, all claims should be settled strictly following the provisions of the Health Scheme, guidelines and rate list.
4. For enrolment and settlement of claims under the Health Scheme, henceforth, revised Forms shall be used (attached herewith).
5. Health Scheme with amendments, revised rate list, list of empanelled and recognized Health Care Organisations, Forms, Guidelines and related Government Orders, Memorandum of Agreement with the Health Care Organisations may be available in the official website of the Finance Department www.wbfin.nic.in -West Bengal Health Scheme, 2008.
Officer on Special Duty and
Ex-officio Special Secretary
to the Government of West Bengal
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