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SETTLEMENT OF CLAIMS

The application made under Para-11 for reimbursement of the costs shall be processed by the concerned department, the Directorate or the office, as the case may be, under which the pensioner last worked. Provisions of the Clause-13 of the West Bengal Health Scheme, 2008 shall be applicable for the pensioners. The expenditure shall be met from the head "2071- Pension and other Retirement Benefits- 01- 800- NP-002- 12- Medical Reimbursement under the West Bengal Health Scheme, 2008" under the Demand No-18.

While settling a claim following guidelines may be followed:-

(i) For treatment within the State in Government hospital/ Govt. aided hospital or recognized Private hospitals/ Institutions, etc as (as mentioned at Annexure-A of the Notification No. 3473 F dt. 11.05.09.) cost of treatment may be reimbursed on the basis of approved rates given in Annexure-B of the Notification No. 3473 F dt. 11.05.09. or the actual cost whichever is less. Class of the Service Provider (Hospitals/ diagnostic centres, etc.) shall be taken into account for reimbursement of the costs.

If the rates quoted by the hospitals/diagnostic centres are lower than the ceiling rates given in Annexure- B the reimbursement may be allowed on that lower rates.

(ii) No reimbursement shall be allowed for treatment taken from unrecognized Private hospitals/ diagnostic centres.

(iii) Costs of medicines are reimbursable in full except preparations classified as food, tonic, vitamin, disinfectant, toiletry, cosmetic items and telephone charges. Charges for pathological and radiological investigations are also reimbursible if not included in package rate. Cost of devices, implants, etc. are also reimbursible.

(iv) Special Nursing/ Aya/ Attendant charges are reimbursible in full.

(v) Blood transfusion charges are reimbursible in full but cost of blood is to be reimbursed as per State Govt. Hospital rates.