Government Deptt.

of Health

of

West & Family Salt

Bengal Welfare City,

Swasthya

Bhavan, Kolkata-700

Lake

091.

No.
CIRCULAR

Government Health Scheme,

of 2008

West for the

Bengal State from

has recently Government lst June,

launched Employees

the

West

Bengal

& Pensioners.

The scheme

has been effective

2009.

It themselves allowance

is an optional into the of Rs. 300.00.

of the

scheme by

and

the

willing the

employees

can enroll medical

scheme

foregoing

regular

monthly

A Booklet of Office

scheme under the

has recently Health

been

forwarded

to every

Head

and Director

& F. W. Department.

In order provisions

to implement

and operationalise

the said scheme every Head

of the scheme. of Health for Services, West Bengal is, however, issuing the

The Director following

Process

broad guidelines
of Enrolment:

this puropose:

(I)

The willing Form-'A' After D,D.O.,

employees a week, the

may be requested option, the

to submit

their

option

in

within of

(2)

examining requesting

Head of the drawing of

Office from

will issue a to the next 2009, can also cards of the

certificate

enrolment

in Form-'B',

endorsing M,A"

a copy

him to stop of Form-'A'

month of submission

3)

We want to operationalise However, as this opt for it and enroll

the scheme w.e.f, scheme, will the

lst September, employees identity of the

is a continuous at any time. Office, according identity

(4)

The Head of the different colours for The requisition

therefore, to the

issue

categories

employees. to the DHS

cards shall be forwarded

through the next period (5) All the however, employee

CMOH immediately it is not possible 'family fail. Permit' This without particulars

after

the issuance of form-'B', scheme from the next cards remain this identity must

so that If , the the a

employees month,

can avail of the

month. within to

to issue the in form-'f' form-'f',

be issued

however, under

valid for scheme

of six months only. of enrolled computer employees shall in the and a hard copy as well as a soft CMOH will submit monthly card. months till all Head of the is done. as Head of enrolment medical blockwise ensure compilation. that

be documented

copy shall be forwarded (6) (7) The This the (8) Office should (9) Head process willing of the will,

to the CMOH. In turn, shall continue

the same to the DHS for proper Office before however, allowance is stopped employees

the issue of the identity in subsequent Accordingly, this the

are enrolled. of CMOH for

will repeat

the same process as and when enrolment himself, process the employees the under his control

In the establishment be undertaken the staff of the Office (i) Likewise, submit District, forms their (ii) The staff and any other to their take necessary

under the provisions under option form

of the Scheme. Sub-centre, PHC, BPHC should Superintendent TB, Leprosy, submit their of BMOH for processing. DfWO option

to the respective General, hospitals Head of the

under the control State decentralized respective actions. is optional

of the ACMOH, Mental, should Office,

Sub-division,

who will similarly can opt out of the

(10)

Although scheme within Scheme.

the scheme at any time, five years,

and employees

he / she is not allowed once he / she has taken

to leave the any benefit

scheme of the

Procedure

for Under

re-imbursement: this Health and Pvt. treatment several Scheme, treatment Hospitals have disease have basic 2008, an employee at any Govt. / 1 institutions been made can avail all medical hospital Diagnostic for Scheme. as well as 1 centres For

(1

attendance authorized nursing outdoor treatment, The

homes, as enlisted

in the Scheme. Provisions in the profile as enumerated into getting and they

indoor and OPD

in clause- 7 of categories pay of Rs. to

the scheme are also admissible (2) employees to their been according 270001-

for MR claim. classified three basic

pay. Employees

and above belong to category-I

are entitled

get

"Pvt.

Ward" are

accommodation ( having to \\Semi

at

the

hospital Ward" and

or

institutions. to Rs. of

Category-II 27000/-) Category-III to \'General 1,11 & III respectively.

employees entitled ( with Ward"

basic Pvt.

pay of

Rs. 18000/-

employees of

basic pay below Rs. 18000/accommodation.

p.m.) are entitled Category colour photo at in of

The employees

shall have identity Each employee members receives Health

cards of yellow, pink and white has to submit of the family. medical of . payment of the the attendance shall submit Office 2 copies of colour

for every enrolled When an employee any

and treatment an intimation 3 days within

hospital/institution, to the the of treatment employee

he /she

writing Initially, treatment medical purpose

commencement

shall make direct cases Kidney a

cost of apply for

to the hospital/institution. advance with he is in certain stenting, to submit

He may, however, like Bypass Surgery, transplantation certified so granted, estimate etc.

Pacemaker, For from this the 80io

Angioplasty

hospital/institution. of the estimated from

The advance, cost. If treatment

shall not exceed within

is not received the employee the original

60 days the and

the date of advance, the entire medical form reimbursement, with will, all

amount shall be refunded. shall submit Head of the office prescriptions within

(5)

For regular duly filled-up three

"C', 'D' & \Et to the

months,

along Office

vouchers.

(6)

The Head of the in annexure

thereafter, under 3473-F the

examine rates dated

and scrutinize 11-5-09 ( p.p. 23 as well as institutions II to & III should their to get will

the bill with reference of the scheme).

to the prescribed

/ packages as given

'Bt of notification of claims, keep under medical Class-I rates

(7)

For this the have service realize

settlement should classified cost of

Head of the Office that the medical as Class-I, only provider class-II service according

employee been the

in mind

3 categories treatment service while

providers.

Each of these

class of service

providers is entitled

earmarked

category. prescribed

100io of the

service providers

provider

get 80io of the rates of the prescribed

and class -III

will get 70io properly, the "12-

rates. Reimbursement himself claim is examined the admissible the detailed will sanction amount and

(8)

After

the Medical

Head of the Office the expenditure

will be met from

head of account

Medical 2008", the Moreover,

Reimbursement subordinate of the

under

the

West

Bengal

Health

Scheme

to respective Office employee must

salary head. the claim above Rs. 30,0001the detailed which with Head of this and under available he or she is him for mention

at the time of forwarding of the salary concerned of fund

Head

Accounts drawing

and provision

purpose. The Head of the Office pass be M.R. Bills forwarded to with the 300001-

up to the level of CMOH will process extent comments of Rs. 30001through for that to M.R. bills exceeding CMOH the bills

OPD and Rs. limit should the Addl. them

for IPD treatment.

DHS(Admn.). Addl. DHS (Admn.) approved

(11)

in turn

will examine . this

and get for

by the DHS up to an amount of Rs. 50001for IPD treatment cases with his limit, the

OPD and

Rs. 500001When the relevant

the amount of the bill exceeds remarks that

DHS will forward Department for

to

(12)

settlement. It has further under process the

been decided

only the

Dte. of Drug Control the for enrolment OPD and Dte. of ,

Department

will independently prescribed limit

deal with

of the employees

into the scheme as well as dispose of the of Rs. 50001of Medical complete

M.R. claims up to the Rs. 500001All other of enrolment applicable CCL, Director Ayurveda, Directorates, Dte. of including in the

for IPD cases. viz. Directorate Homeopathy Director, Institute,. With will Education, the process

distribution

of identity Central Jt. regard

cards. This will also be Blood Bank, Director Nutrition, Jt. it has to and settlement of the cases on be forwarded Director

case of Pasteur

Director

& CHO, KMUHO. that

to receipt

of M.R. claims of the employees been decided behalf For the settlement of this Dte I Office smooth ocerseeing

under these

Dtes I Offices,

DHS will process

and sanction

the cases accordingly the process of

the Addl. D.H.S. (Admn.) enrolment : as well as of M.R. Claims a central (GA) -Tel. nodal agency has been formed officers

at the Swasthya (1) Jt. Secretary

Bhavan with the following No.23330508 23330328

(2) Addl. D.H.S. (dmn.) -23330209 (3) Addl. D.H.S. (A A & V.

All

necessary

correspondence

may be

made and clarification officers. of

may be sought from (15) At the district the following (1) C.M.O.H. (2) Dy. C.M.O.H.-I (3) Accounts ( 4) A.C.M.O.H. Necessary staff Officer (M.A.). Officers

anyone of the above noted :

level, CMOH should form

an M.R. Cell comprising

of the office

of the C.M.O.H.

may also be tagged to this and settle

cell of the employees referred D.H.S. (Admn.) under with

This cell will examine the office of the offices CMOH / remarks. subordinate

all the claims to the

as well as examine those

all the Addl.

cases from

and forward

recommendations

This has the approval & F.W., Govt. of West Bengal.

of the Addl. Chief

Secretary,

Deptt.

of Health

Director E.O. Secretyary

nD~ ,g~ of Health Govt .of

Services

&

I Deptt.

of Health West

& F. w. Bengal.

No. A- 5oog
~

Copy forwarded
1. 2.

for officer

information of Health

to the

: --district. / Director / Director C.C.L. / I Pagteur F .w.

Chief Director Institute Training

Medical Central

Jt. DHS(Nutrition)

/ Jt. DHS & CHO, KMUHO Blood Bank / Dy. DHS(E&S)

/ Director I Ayush / Director, Centre./~+,PHS L-r-,r~&.J-J f.f..9.~...'?.c;:,.1, N.~.Bf

Homeopathy .

/ Principal, ~

3.

i~

M...$

A Director E.O. Secretyary, ~&\~ of Deptt.

~~ \se~viies Health West & F.W. Bengal. &

Govt .of

WEST -

BENGAL

HEAL

TH

SCHEME-2008

M ain F eatures: I. This dated 2. This (vide scheme scheme clause has been effective applies 2(1) & employees of their to State from 1.6.2009 (vide 3474-F

11.5.2009) Government clause clause 3) and Employees the retired ) as well 3474-F, (vide families.

Government 3. Enrolment can join Medical

16 & 3475-F

as the members

under this scheme is optional and employees this scheme in lieu of the existing monthly Allowance of Rs. 3001- [ vide clause 2(2 & 3) ] any Government Private Hospitals necessary Hospital I Nursing as well Home this are A, I

4. Employees can attend as authorized enlisted IDiagnostic scheme 5. For [vide every Centre disease for clause 6].

treatment test

under there under treatment

I surgery

I diagnostic

certain approved B & C categories 6. There

medical institutions classified [ vide 3473-F , annexure A ]. rate I package for every

is an approved

test [vide 3473-F annexure B]. If an employee receives treatment category, approved it, while the a 'C' said institution cost; a 'B' employee (clause institution will 4-note)]. paid will

at an institution charge will can charge accordingly 100% charge

of' A , of the 80% of

medical The

category

category

up to 70% get medical (2), note

of the same. reimbursement

for the amount

[vide 3473-F

a, b, c and 3474-F,

7. An may

employee

has

to

initially up

pay

the

cost of the

of

medical cases he estimated

treatment

to the hospital/institution. Advance to 80%

In certain

get Medical

expenditure [vide clause 15 & 3474-F (II)]. 8. If the employee / beneficiary ( i.e. a member as defined Patient entitled under the scheme) is admitted prior Department to Medical of the hospital/Institution, Reimbursement

of his family in the In of he Ishe is to 30 days

admission as well as up to 30 days after discharge [vide clause 8]. An employee must inform r.is I her Head of Office in writing within 3 days of the commencement of the said treatment. [Vide clause II]. 9. Medical Reimbursement is also admissible for Out Patient Department (OPD) treatment in respect of 10 profiles [vide clause 7]. 10. The category I employees under this scheme (with Pay above Rs. 27,000/-) are entitled to Private disease a Basic Ward

accommodation in a hospital I institution, category 2 employees under this scheme (with a Basic Pay between Rs. 18,000/- and Rs. 27,000/-) are entitled to Semi-Private Ward accommodation in a hospital/institution while the category 3 employees under this scheme (with a Basic Pay below Rs. 18,000/-) are entitled to General Ward accommodation in a hospital I institution. [Vide 3473-F (3)]. II. Although enrolment and exit under one cannot received leave within the next five [vide Clause 2 (proviso to 5)]. this scheme years if any is optional, benefit is

1. The willing about his/her 2. The Head

employee has to fill family and submit [Vide the Clause office of will

in the required information the option form' A ' to the then issue an enrolment of the Clause

Head of the office. certificate enrolled

4(1)] containing the names of the family.[Vide. certificate drawing shall the

in form 'B', also members ("beneficiary") of this enrolment who will stop

4(3)] 3. One copy to the

also be endorsed monthly Medical

D.D.O.

Allowance (M.A,) from the next month. [Vide. Clause 4(4)} 4. The Head of the office will also issue the specified identity caril This to the card employee is according and to his/her shall be entitled shown category. to the important

hospital/institution where the employee/beneficiary attends for treatment. [Vide.Clause 10(7 a,b,c) read with clause of 3474-F] 5. An enrolled can attend any State Govt Hospital or any authorized treatment 6. Initially, treatment However, advance certificate private medical institution [Vide. Clause 6 and 7]. the employee has to bear for and indoor/ pay the outdoor cost of

to the medical institution where in certain cases, the employee may to the maximum for which extent from the of 80% advising

he/she receive has

attends medical cost, a to be

of the estimated doctor

produced well in advance before But, in case no treatment is received the entire 7. For filled-in amount 'C', 'D', has to be refunded. of M.R. and 'E' bills, forms, regular claim vouchers Rule 12].

the sanctioning within a period [Vide. Rule the employee together

authority. of 60 days, shall submit original of the

15(3)] with

prescription, office. [Vide.

and other

documents

to the Head

The claim

C.M.O.H. up to

or Rs.

his 3000

subordinate for OPD

H/O and

can Rs.

sanction 30000 for

M.R. IPD

treatment.[ vide Rule 13( 4) ]. If the claim exceeds that limit, the bill shall be forwarded to the D.H.S. through the C.M.O.H. The D.H.S. The bill can sanction for M.R. M.R. claim and upto [vide other Rs. 5000/Rule documents within for O.P .D. should be and Rs. 50000/submitted for I.P .D. treatment. claims 13(3) ]. 3 months of the

to the Head

of the Office

treatment. [vide 9. If the employee Medical Insurance

rule 12(2) ). has a separate Policy,

"Mediclaim" should first

or any other submit the

he /she

original papers to the concerned Insurer. If the medical benefit thus received, falls short of the M.R. admissible approved rate, he/she should Head submit M.R. claim for the balance amount to the [vide of the Office with photocopies ailments have the of all the documents. an employee/ institution so far prior [vide

3474-F(9) (vii) ]. 10.In certain cases of serious can also attain the state. for wise such M.R. this purpose. 8 such But, claims treatment institutions

beneficiary out side of for permission .Other 3473-F(I)(v) of M.R. is

at some reputed the employee from will not

medical been

earmarked

has to obtain Departmental

Secretary

be entertained. as well

read with 3474-F(10) ). 11. The process of enrolment claims similar. to the in respect However, Pension of the retired in this Sanctioning

as the settlement

State Government Authority

Employees

case application 3475-F).

has to be submitted (P .S.A. ) instead of the

Head of the Office.[vide

**

All

the above

relevant

G.O.

of

the 3475-F

Finance dated

Department 11.5.2009)

as are

quoted included

( 3473,3474,

in the booklet

of the Scheme

at page 17,49,55.

~~

~ ~

'""
b'"O%

'C~

~) ~~'Jf1 m~ m)
~

JIm

r..f1~

~~

\:!iI1\8~

9fr'8m

<!1r.<f I

(~

b-

'"ilW~ ~) ~)

':>':>

I
~~

m~ 'J 0)
~~

~ I.Q~

~\'3 mr:~
)

9fr\'3m ~
~

I ,

(.<1 ~-'1~<r-

~~/m~~~ -'ijJ<

'~' fii~

\8~,

~~

~~

'Jb"ooo iF5'8

~ m~~

~ ~~

(. <1\!)~~~ ) 9fm

~~

\9

R~

~,

~,

~]
~

~, ~'~

~]

****************************************************

f<t:
~~

E:
'J'JI

8q(c,

({I

~OO~