Kolkata, Cashless medical treatment facility has been extended beyond the existing limit of ₹2 lakh for pensioners under the West Bengal Health Scheme , an official said on Monday.
The decision came in the view of instances where treatment costs in critical and complex cases exceed the stipulated cashless ceiling, placing an additional financial burden on pensioners, he said.
At present, employees and pensioners enrolled under WBHS are eligible for cashless treatment up to ₹2 lakh for indoor treatment in empanelled private healthcare organisations.
While in-service employees were earlier permitted to avail medical advances beyond this limit, pensioners and family pensioners were not covered under such provisions, he said.
Following consideration of the matter, the state government has now introduced an alternative mechanism to extend the cashless facility for pensioners undergoing IPD treatment in empanelled hospitals.
Under the revised framework, pensioners or their authorised representatives will be required to apply through a prescribed form to the empanelled healthcare organisation seeking extension of the facility when treatment costs exceed ₹2 lakh, the official said.
The hospital concerned will submit an estimate of treatment cost for a period not exceeding 10 days along with a prognosis report to justify the proposed intervention.
The medical cell of the Finance Department will then examine these documents to determine the necessity of treatment and the admissible cost, he said.
The scrutiny process is to be completed within 24 working hours of receipt of complete documentation.
In case no decision is communicated within this period, approval will be deemed granted, and the cashless treatment limit will be automatically enhanced to the permissible extent, capped at 75 per cent of the estimated cost submitted by the hospital, an official memorandum said.
The extension may be availed multiple times during the course of treatment.
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