Revised Reimbursement Claim Form of West Bengal Health Scheme
The West Bengal Health Scheme has recently introduced revised “Reimbursement Claim Forms” for its beneficiaries. These updated forms are designed to streamline the reimbursement process and make it easier for beneficiaries to claim reimbursement for their medical expenses.
The revised forms include new fields and instructions that are intended to help beneficiaries provide all necessary information and documentation in a clear and organized manner. This is expected to help the West Bengal Health Scheme review and process reimbursement claims more efficiently, reducing the time and effort required for beneficiaries to get the reimbursement they are entitled to.
The introduction of the revised “Reimbursement Claim Forms” is a welcome step for beneficiaries of the West Bengal Health Scheme, as it is expected to make the reimbursement process more convenient and hassle-free. It is important for beneficiaries to familiarize themselves with the revised forms and ensure that they provide all necessary information and documentation to avoid delays in the reimbursement process.
Government of West Bengal
Finance Department,
Medical Cell
No.: 78-F(MED)WB
Dated : 22/10/2019
MEMORANDUM
Sub : Introduction of revised “Reimbursement Claim Forms” of West Bengal Health Scheme
Employees / Pensioners / Family Pensioners submit their reimbursement claim under West Bengal Health Scheme in the specified forms circulated vide order no. 6953-F(MED), dated; 11.07.2011 attaching essential documents required for such reimbursement.
West Bengal Health Scheme Portal has been upgraded and various services and process have been made online. Now various applications by employees / pensioners and family pensioners can be made online and Heads of Offices and DDOs can perform various functions, processing and approval online.
“Application Form” have been modified to make them simpler and compatible with online mode.
After careful observation, the Governor is pleased to abolish all the existing forms and introduce revised physical Application Forms and also introduce online reimbursement claim forms of each category of the following:
i. Form-C1 [Reimbursement for cost of Out-Door Patient (OPD) treatment in Empanelled /Enlisted Hospital].
ii. Form-C2 [Reimbursement for cost of In-Patient Department (IPD) treatment in Non-Empanelled Hospital].
iii. Form-C3 [Reimbursement for cost of Cashless In-Patient Department (IPD) treatment in Empanelled Hospital].
iv. Form-C4 [Reimbursement for cost of Non-Cashless In-Patient Department (IPD) treatment in Empanelled/Enlisted Hospital].
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.
This order shall come into effect from the date of issue of this order.
Enclosures : As stated
(Parwez Ahmad Siddiqui)
Secretary
Finance Department
Manual/ Offline Reimbursement Application Form PDF Download
Simply fill out the form, attach any necessary documentation, and submit it to the appropriate department. Streamline your reimbursement process and save time by downloading our manual/offline application form.
Form-C1
Form-C2
Form-C3
Form-C4
Online Reimbursement Claim Form PDF Download
Get your reimbursement claim processed quickly and efficiently with our Online Reimbursement Claim Form PDF Download. Simply fill out the form and submit it online to get your reimbursement request processed in no time. This convenient and easy-to-use form is available for free download, so you can get started right away.
Form-C1
Form-C2
Form-C3
Form-C4
Annexure I
Annexure II