Under the West Bengal Health Scheme (WBHS), employees, pensioners, and their beneficiaries are already entitled to reimbursement for the cost of outpatient (OPD) treatment for specific diseases listed in Clause 7(1).
List of Diseases under OPD Treatment in WBHS:
These following diseases are included for WBHS OPD Treatment:
- Malignant Diseases
- Tuberculosis
- Hepatitis B/C and other Liver Diseases
- Type-1 Insulin-Dependent Diabetes
- Heart Diseases
- Neurological Disorders / Cerebrovascular Disorders
- Malignant Malaria
- Renal Failure
- Thalassaemia / Bleeding Disorders / Platelet Disorders
- Injuries Caused by Accidents (including Animal Bite)
- Rheumatoid Arthritis
- Systematic Lupus Erythematosus (LUPUS)
- Crohn’s Disease
- Endodontic Treatment (Root Canal Treatment)
- Chronic Obstructive Pulmonary Disease (COPD)
- Ankylosing Spondylitis
- COVID-19
The new order clarifies that:
- Additional Disease Coverage: If a beneficiary has any of the diseases listed in Clause 7(1) or (2), they are also entitled to reimbursement for the treatment of any other related diseases.
- Prescription Requirements: To get the reimbursement, all the medicines, including supplements like vitamins and calcium, must be prescribed by the treating specialist in one prescription.
- Effective Date: The new rules apply from the date the order is issued.
Also Read: WBHS Cashless Hospital List
Reimbursement Claim Forms Under WBHS:
Introduction of revised physical Application Forms and also introduce online reimbursement claim forms of each category of the following:
- Form-C1 [Reimbursement for cost of Out-Door Patient (OPD) treatment in Empanelled /Enlisted Hospital].
- Form-C2 [Reimbursement for cost of In-Patient Department (IPD) treatment in Non-Empanelled Hospital].
- Form-C3 [Reimbursement for cost of Cashless In-Patient Department (IPD) treatment in Empanelled Hospital].
- Form-C4 [Reimbursement for cost of Non-Cashless In-Patient Department (IPD) treatment in Empanelled/Enlisted Hospital].
Download The Forms- Click Here
An Employees / Pensioner / Family Pensioner have to now submit the claim for reimbursement of expenditure incurred for treatment under WBHS in these revised forms only.
Official Order
Government of West Bengal
Finance Department
Medical Cell
No. 164-F(Med)WB Date: 06.11.2023
NOTIFICATION
Sub: Clarification on OPD treatment under West Bengal Health Scheme (WBHS)
At present, an employee/pensioner or his/her beneficiary is entitled to reimbursement of the cost of medical attendance and treatment as an OPD patient in a hospital/institution in the following cases vide Clause 7(1) of West Bengal Health Scheme:
Here is the information presented in a table format:
| Sl. No. | Name of the Disease | Sl. No. | Name of the Disease |
|---|---|---|---|
| 1 | Malignant Diseases | 10 | Injuries Caused by Accidents (including Animal Bite) |
| 2 | Tuberculosis | 11 | Rheumatoid Arthritis |
| 3 | Hepatitis B/C and other Liver Diseases | 12 | Systematic Lupus Erythematosus (LUPUS) |
| 4 | Type-1 Insulin-Dependent Diabetes | 13 | Crohn’s Disease |
| 5 | Heart Diseases | 14 | Endodontic Treatment (Root Canal Treatment) |
| 6 | Neurological Disorders / Cerebrovascular Disorders | 15 | Chronic Obstructive Pulmonary Disease (COPD) |
| 7 | Malignant Malaria | 16 | Ankylosing Spondylitis |
| 8 | Renal Failure | 17 | COVID-19 |
| 9 | Thalassaemia / Bleeding Disorders / Platelet Disorders |
Various requests have been received by Medical Cell of this department from stakeholders for clarifications regarding treatment of OPD listed diseases as well as diseases /treatment/medical condition which are often co morbid or co terminus with the above listed OPD diseases.
After careful consideration of the matter, the Governor is pleased to clarify the following for improvement & betterment of medical management of OPD treatment under the WBHS:
If a beneficiary is detected with any of the diseases listed under Clause 7(1) & (2) of WBHS then he/she will also be entitled to reimbursement of the cost of medical attendance & treatment for any other disease(s), which may be required for better medical management and improving life expectancy of the said beneficiary. The beneficiary will get reimbursement of the entire cost of the OPD treatment for the disease(s) on the strength of diagnosis & admissibility being made under Clause 7(1) & (2) of WBHS provided that all the medicines (including Vitamins,Calcium etc.) are prescribed by the treating specialist in a single prescription.
This will take effect from the date of issuance of this order
By Order of the Governor,
sd/-
(KA. Anwar, IAS)
Senior Special Secretary to the
Government of West Bengal
Official Source: Click Here