Psychology Research Unit of the Indian Statistical Institute is going to organize 2-days workshop titled "WORKSHOP ON LIFE CONTINGENCY TABLE FOR ESTIMATING MORTALITY AND MORBIDITY OF PATIENTS SUFFERING FROM MENTAL DISEASES" from 16th to 17th February, 2016. The workshop will try to find answers to the most ingenious and serious questions as How long do the patients suffering from psychiatric disorders live ? Are their life expectancies depend on physical, mental, social, behavioural and financial conditions ? How can their quality of lives be improved through Mental health care insurance ? Our aim is to design the mental health care insurance product in such a manner so that both the insurance company and the insured persons will be benefitted.
We do not currently have any credible information about the nature and extent of mortality from mental diseases, particularly those which can be cured if detected in time and treated properly. This results difficulty to make adequate planning about increase in life expectancy. The World Health Organization defines life expectancy as "the average number of years a person is expected to live on the basis of the current mortality rates and prevalence distribution of health states in a population". Many persons suffering from such mental diseases are denied of any treatment and simply allowed to die, The absence of a Mental Health Insurance Scheme is one among this sorry state of affairs. We need to develop details of a feasible Insurance Scheme
The workshop includes 13 technical sessions. 20 Professors of different disciplines like Psychiatry, Psychology, Economics, Management, Actuarial Sciences, Population studies and Statistics coming from research institutes and universities across different states of India will address at the sessions. Almost 8 rapporteurs of different institutes and universities will prepare the session proceedings. There will be almost 20 senior level participants coming from different parts of India. All the deliberations will focus on two broad objectives - (a) To identify data requirements and data sources on morbidity and mortality from mental diseases in order that a life contingency table can be developed in respect of currently affected individuals, and (b) To develop some data base for costs of treatment in respect of some specified mental diseases viz. Depression, Schizophrenia, Manic Depressive Psychosis and Obsessive Compulsive Disorder. These two will enable calculation of risks and insurance premium in a scheme of Health Insurance in respect of individuals suffering from mental health problems. (Attention should be paid to those who suffered only from mental diseases. Deaths from accidents and physical diseases primarily are to be excluded.). The unit has designed one Mental health Care Insurance Product named ' NIRBHOY'. Final conclusions will be sent to Shri R. Raghavan, CEO of the Insurance Information Bureau of India working under Insurance Regulatory and Development Authority of India.
We do not currently have any credible information about the nature and extent of mortality from mental diseases, particularly those which can be cured if detected in time and treated properly. This results difficulty to make adequate planning about increase in life expectancy. The World Health Organization defines life expectancy as "the average number of years a person is expected to live on the basis of the current mortality rates and prevalence distribution of health states in a population". Many persons suffering from such mental diseases are denied of any treatment and simply allowed to die, The absence of a Mental Health Insurance Scheme is one among this sorry state of affairs. We need to develop details of a feasible Insurance Scheme
The workshop includes 13 technical sessions. 20 Professors of different disciplines like Psychiatry, Psychology, Economics, Management, Actuarial Sciences, Population studies and Statistics coming from research institutes and universities across different states of India will address at the sessions. Almost 8 rapporteurs of different institutes and universities will prepare the session proceedings. There will be almost 20 senior level participants coming from different parts of India. All the deliberations will focus on two broad objectives - (a) To identify data requirements and data sources on morbidity and mortality from mental diseases in order that a life contingency table can be developed in respect of currently affected individuals, and (b) To develop some data base for costs of treatment in respect of some specified mental diseases viz. Depression, Schizophrenia, Manic Depressive Psychosis and Obsessive Compulsive Disorder. These two will enable calculation of risks and insurance premium in a scheme of Health Insurance in respect of individuals suffering from mental health problems. (Attention should be paid to those who suffered only from mental diseases. Deaths from accidents and physical diseases primarily are to be excluded.). The unit has designed one Mental health Care Insurance Product named ' NIRBHOY'. Final conclusions will be sent to Shri R. Raghavan, CEO of the Insurance Information Bureau of India working under Insurance Regulatory and Development Authority of India.
THE PROGRAM SCHEDULE
VENUE: Seminar room,Economic Research Unit,6th floor,S.N.Bose Bhawan
| Date | Time | Event | Resource Person | |
| 16.2.16 | 9-30:10-00 | Registration at Economic Research Unit | ||
| 10-00:10-45 | Inauguration | Invocation Inauguration: Prof.SanghamitraBandyopadhyay, Director, ISI, Prof.Manoranjan Pal, Prof-in-charge, Social Sciences Division,ISI, Kolkata About the Psychology Research Unit: Prof.AmitaMajumdar Head, Psychology Research Unit,ISI, Kolkata Purpose of the Workshop: Dr. Debdulal Dutta Roy, Psychology Research Unit,ISI.,Kolkata KEY NOTE ADDRESS:Professor S.P. Mukherjee, (Centenary Professor of Statistics at the University of Calcutta, Prof P V Sukhatme Awardee for Senior Statisticians and P C Mahalanobis Birth Centenary Awardee, Mentor of the indian association for Productivity, Quality & Reliability. Vote of thanks:Dr. Rumki Gupta, Psychology Research Unit,ISI.,Kolkata | ||
| 10-45:11 | Tea Break | |||
| 11-00:11-15 | Technical Session | The NIRBHAYA: Mental Health Care Insurance Scheme-Debdulal Dutta Roy | ||
| 11-15:11-45 | Technical Session | Chair Person:Professor Divyagopal Mukherjee, HOD, Department of Psychiatry, R G Kar Medical College, Kolkata Title: PRELIMINARY REQUIREMENTS OF MENTAL HEALTH INSURANCE Speaker:Shri Ashok Poddar, Ex-Secretary (Actuarial), Central office,LIC., Mumbai. Rapporteur: Tanusree Moitra,Post-Doc Fellow, Psychology Research Unit,Indian Statistical Institute,Kolkata | ||
| 11-45:12-30 | Technical Session | Chair Person: Prof. Premananda Bharati, Biological Anthropological Unit, Indian Statistical Institute, Kolkata. Title: CAUSE SPECIFIC LIFE CONTINGENCY TABLE Speaker: Prof. Arvind Pandey, Director,National Institute of Medical Statistics, ICMR.New Delhi. Rapporteur:Shri Parth De,Associate Scientist,Poulation Studies Unit,Indian Statistical Institute, Kolkata | ||
| 12-30:1-15 | Technical Session | Chair Person: Professor Pradeep Kumar Saha, HOD,Hon.State Secretary,Indian Medical Council (Academics), Convenor,Preventive Psychiatry, Indian Psychiatric Society, Kolkata Title: ESTIMATION OF LIFE TABLE FUNCTIONS Speaker: Dr. Prasanta Pathak, Associate Professor, Sampling and Official Statistics Unit,Member-Secretary, International Statistical Education Centre,Indian Statistical Institute, Kolkata Rapporteur:Tanusree Moitra,Post-Doc Fellow, Psychology Research Unit,Indian Statistical Institute,Kolkata | ||
| 1-15-2-15 | Lunch | |||
| 2-15:3-00 | Technical Session | Chair person:Prof. Debasis Sengupta,Applied Statistics Unit, ISI.,Kolkata Title:Developing and pricing long term and short term life and general insurance products Speaker: Shri Khushwant Pahwa,Senior Actuary Rapporteur:Smt.Sravanti Ghosh,Sr.Research fellow,Psychology Research Unit,ISI.,Kolkata | ||
| 3-00:3-45 | Technical Session | Chair Person:Prof.Amita Majumdar Head, Psychology Research Unit,ISI, Kolkata Title: CONSTRUCTION OF LIFE CONTINGENCY TABLE FOR PSYCHIATRIC DISORDERS Speaker: Professor Narendra K Sharma, PhD, Retired Professor, IIT Kanpur,Senior Advisor and Consultant business analytics and consulting, Kanpur. Rapporteur:Smt.Murshida Khatoon,Junior Research Fellow | ||
| 3-45:4-00 | Coffee Break | |||
| 4-00:5-00 | Technical Session | Chair person:Prof. Anjali Ghosh, Former Head, Psychology Research Unit,ISI, Kolkata Title: DETERMINANTS OF PSYCHIATRIC MORBIDITY, MORTALITY AND RELAPSE Speaker: Professor Pradeep Kumar Saha, HOD,Hon.State Secretary,Indian Medical Council (Academics), Convenor,Preventive Psychiatry, Indian Psychiatric Society, Kolkata Rapporteur:Dr. Rumki Gupta,Associate Scientist,Psychology Research Unit,ISI, Kolkata. | ||
| 17.2.2016 | 10-00:10-45 | Technical Session | Chair Person: Professor Narendra K Sharma,IIT Kanpur,Senior Advisor and Consultant business analytics and consulting, Kanpur Title: MENTAL HEALTH CARE NEEDS OF PATIENTS WITH SEVERE MENTAL ILLNESS Professor Divyagopal Mukherjee, HOD, Department of Psychiatry, R G Kar Medical College, Kolkata Rapporteur:Smt.Sudipa Basu,Consulting clinical psychologist,Kolkata | |
| 10-45:11-00 | Tea Break | |||
| 11-00:11-45 | Technical Session | Chair Person:Prof. Arvind Pandey, Director,National Institute of Medical Statistics, ICMR.New Delhi Title: DETERMINANTS OF PSYCHIATRIC MORBIDITY, MORTALITY AND RELAPSE IN SCHIZOPHRENIA Speaker: Dr. Uday Shankar Mondal, Asst. Professor, Department of Psychiatry, R G Kar Medical College, Kolkata Rapporteur:Smt.Sumona Datta,Sr.Research fellow | ||
| 11-45:12-45 | Technical Session | Chair Person:Professor Divyagopal Mukherjee, HOD, Department of Psychiatry, R G Kar Medical College, Kolkata Title: DETERMINANTS OF PSYCHIATRIC MORBIDITY, MORTALITY AND RELAPSE IN RECURRENT DEPRESSION Speaker: Dr.Amlan Jana, Asst. Prof.,K.P.C. Medical college, Kolkata Rapporteur:Smt.Murshida Khatoon,Jr.Research Fellow, Psychology Research unit,ISI.,Kolkata/Smt.Sucharita Sushree Shamal,NIMH,Kolkata | ||
| 12-45:1-15 | Resource persons and participant Discussion | Co-ordinator:D. Dutta Roy,Psychology Research Unit | ||
| 1-15:2-00 | Lunch | |||
| 2-00:2-45 | Technical Session | Chair Person:Prof.Anjali Roy,Department of Applied Psychology,University of Calcutta,Kolkata Title: CONSTRUCTION OF LIFE CONTINGENCY TABLES WITH SCANTY DATA Speaker:Prof.Debasis Sengupta,Applied statistics unit,Indian Statistical Institute,Kolkata Rapporteur:Dr.Shivani Santosh,visiting faculty,Department of Applied Psychology,University of Calcutta,Kolkata & Neotia University, Kolkata | ||
| 2-45:3-45 | Technical Session | Chair Person: Shri Ashok Poddar, Ex-Secretary (Actuarial), Central office,LIC., Mumbai. MENTAL HEALTH CARE INSURANCE FROM STAKEHOLDER PERSPECTIVE: INSIGHT FROM LIFE CONTINGENCY TABLE Speaker:Dr Susmita Mukhopadhyay,Assistant Professor, Vinod Gupta School of Management,IIT, Kharagpur. Rapporteur:Smt.Sumona Datta,Sr.Research fellow,Psychology Research Unit | ||
| 3-45:4-00 | Coffee Break | |||
| 4-00:5-00 | Technical Session | Chair person: Professor Divyagopal Mukherjee, HOD, Department of Psychiatry, R G Kar Medical College, Kolkata DETERMINANTS OF PSYCHIATRIC MORBIDITY, MORTALITY AND RELAPSE IN RECURRENT DEPRESSION Speaker: Dr. Nilanjana Pal,Asst. Prof.,Haldia Medical College, Haldia. Rapporteur:Smt.Sravanti Ghosh,Sr.Research fellow,Psychology Research Unit,ISI.,Kolkata | ||
| 5-00:5-30 | Valedictory | Chair Person: Professor Sadhan Dasgupta,Department of Applied Psychology,University of Calcutta,Kolkata Distribution of certificates |
DEFINITIONS
Registered No. WB/SC-247 No. WB(Part-I)/2008/SAR-332 Extraordinary Published by Authority BHADRA 28] FRIDAY, SEPTEMBER 19, 2008 [SAKA 1930 PART I—Orders and Notifications by the Governor of West Bengal, the High Court, Government Treasury, etc. The Kolkata Gazette GOVERNMENT OF WEST BENGAL FINANCE DEPARTMENT AUDIT BRANCH NOTIFICATION No. 7287–F 19-09-2008—The Governor is pleased hereby to make, in addition to the West Bengal Services (Medical Attendance) Rules, 1964, as subsequently amended, the following scheme regulating the medical benefits for the State Government employees and the family members thereto, with a view to providing better medical facilities to such employees and their family members :— Scheme 1. Short title and commencement — (1) This Scheme may be called the West Bengal Health Scheme, 2008. (2) It shall come into force on such date, as the State Government may, by notification in the Official Gazette, appoint. 2. Application— (1) This scheme shall apply to the employee and his beneficiary. (2) The provision of enrolment under this scheme shall be optional. (3) An employee shall not be entitled to draw the regular medical allowance with effect from the date of effect of such enrolment under clause 4. (4) An employee and his beneficiary shall be entitled to the facilities under this scheme in addition to the facilities under the West Bengal Services (Medical Attendance) Rules, 1964, as subsequently amended. 2 THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 [PART I (5) An employee shall have the liberty to opt out of this scheme at any time. Provided that where an employee or his beneficiary has enjoyed any benefit under this scheme, such employee shall not be allowed to opt out the scheme within five years from the month following the month in which he enjoyed the benefit. 3. Definitions — In this Scheme, unless there is anything repugnant in the subject or context– (a) “approved rates” means such rates as may be notified by the Government from time to time for various services, procedures and investigations required in connection with the medical attendance and treatment of a beneficiary; (b) “beneficiary” means a member of the family of an employee; (c) “clause” means a clause of the scheme; (d) “employee” means an employee of the Government of West Bengal enrolled under clause 4; (e) “family”, in relation to an employee, means— (i) children including step-children and unmarried daughters, (ii) minor brothers, (iii) minor sisters, (iv) father or mother whose monthly income does not exceed rupees one thousand five hundred, (v) wife or husband, as the case may be; (f) “Form” means a Form appended to this scheme; (g) “Government” means Government of West Bengal; (h) “hospital or institution” means such hospital or nursing home or institution as may be recognized from time to time by the Government for the purpose of availing benefits of medical attendance and treatment under this scheme; (i) “laboratory” means such laboratory or institution as may be recognized by the Government from time to time for availing of benefits of medical attendance and treatment under this scheme; (j) “medical attendance” means attendance for professional advice and includes pathological, bacteriological, radiological or other methods of investigations for the purpose of diagnosis which are considered necessary by the attending physician and are carried out in a hospital or institution; (k) “specified” means specified by order; (l) “treatment” means the use of medical and surgical facilities and includes– (i) the employment of such pathological, bacteriological, radiological or other methods of investigations as are considered necessary by the attending physician; (ii) the use of such medicines, vaccines, serum or other therapeutic substances as may be considered necessary by the attending physician; (iii) medical and surgical services and procedures; (iv) dental treatment; (v) accommodation according to the entitlement of the employee; PART I] THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 3 (vi) such nursing as is ordinarily provided at the hospital or such special nursing at the hospital as the authorized medical attending physician at the hospital may certify, in writing, to be essential for the recovery or for the prevention of serious deterioration in the condition of the patient, having regard to the nature of the disease. 4. Enrolment – (1) An employee seeking enrolment under the scheme shall exercise his option in Form A, in duplicate, along with an undertaking that upon enrolment under this scheme, such employee shall forgo the regular medical allowance drawn as part of monthly salary. (2) The option referred to in sub-clause (1) shall be submitted– (a) to the Cadre Controlling Department, in case an employee is a member of a constituted State service; and (b) to the Head of Office, in case of any other employee. (3) The Cadre Controlling Authority or the Head of Office, as the case may be, shall, after scrutinization of the option exercised by the employee, issue a certificate of enrolment in Form B in favor of the employee, to be effective from the first day of the month following the month in which the certificate is issued. (4) The Cadre Controlling Authority or the Head of Office, as the case may be, shall send one copy of the certificate to the Drawing and Disbursing Officer in respect of the employee with a direction to discontinue the drawal of regular medical allowance with effect from the first day of the month following the month in which the certificate is issued. 5. Facilities – An employee or a beneficiary of such employee shall be entitled to the following facilities, namely:– (a) medical attendance and treatment as an indoor patient in a hospital or an institution; and (b) medical attendance and treatment at out patient department of a hospital or an institution, or a clinic attached to such hospital or institution for such diseases, and under such circumstances, as may be specified. 6. Medical attendance and treatment as an indoor patient in a hospital – An employee shall be entitled to reimbursement of the cost of his or his beneficiary’s medical attendance and treatment, as an indoor patient in a hospital or an institution. Explanation.– For the purpose of this clause, the expression “cost of medical attendance and treatment” shall include – (a) the amount charged by the hospital or institution in accordance with the approved rates; (b) the cost of medicines purchased from outside on the advice of the attending physician at the hospital or institution; (c) the charges for such pathological, bacteriological, radiological or other methods of investigations as are considered necessary by the attending physician and carried out, on the advice of the attending physician, in a laboratory or institution, other than the hospital or institution in which the patient is treated. 7. Medical attendance and treatment as an OPD (Out-Patient Department) patient in a hospital – (1) An employee shall be entitled to reimbursement of the cost of his or his beneficiary’s medical attendance and treatment as an OPD patient in a hospital or institution in the following cases : – (i) Malignant diseases, (ii) Tuberculosis, 4 THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 [PART I (iii) Hepatitis B/C and other liver diseases, (iv) Insulin-dependent diabetes, (v) Heart diseases, (vi) Neurological disorders/Cerebrovascular disorders, (vii) Malignant malaria, (viii) Renal failure, (ix) Thallasaemia/Bleeding orders/Platelet disorders, (x) Injuries caused by accidents. (2) An employee or his beneficiary shall also be entitled to reimbursement of the cost of follow-up medical attendance and treatment relating to Neuro Surgery, Cardiac Surgery (Including Coronary Angioplasty and implants), Cancer Surgery/Chemotherapy/Radiotherapy, Renal Transplant, Hip/Knee replacement Surgery and Accident cases received as an OPD patient in a hospital or institution. Explanation. – For the purpose of this clause, the expression “cost of medical attendance and treatment” shall include– (a) the amount charged by the hospital or institution in accordance with the approved rates, (b) the cost of medicines purchased from outside on the advice of the attending physician at the hospital or institution. (c) the charges for such pathological, bacteriological, radiological or other methods of investigations as are considered necessary by the attending physician and carried out on the advice of the attending physician in a laboratory or institution, other than the hospital or institution in which the patient is treated. 8. Accommodation– (1) In the case of medical attendance and treatment as an indoor patient in a hospital or an institution, an employee or his beneficiary shall be entitled to such accommodation as mentioned in column (4) of the Table below, of the category of the employee as mentioned in column (2), to be determined on the basis of the basic pay including dearness pay as mentioned in column (3), respectively, against the Sl. No. as mentioned in column (1) of the said Table :– Table Sl. Category of Basic pay including dearness pay Type of No. employee accommodation (1) (2) (3) (4) 1. I Above Rs. 18,000 p.m. Private Ward 2. II Rs. 12,000 p.m. and above but Semi-Private Ward below Rs. 18,000 p.m. 3. III Below Rs. 12,000 p.m. General Ward PART I] THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 5 (2) Where the type of accommodation in a hospital does not correspond to the nomenclature as referred to in column (4) of Table to sub-clause (1) or any similar nomenclature, the Government shall, in consultation with the authorities of the hospital concerned, determine the entitlement of the beneficiary. 9. Tenure – Notwithstanding anything contained in this scheme and without prejudice to the provisions of sub-clause (2) of clause 7, the cost incurred on account of related medical attendance and treatment received in a hospital or an institution during the period upto 30 days prior to hospitalization and 30 days from the date of discharge, shall be reimbursable. 10. Issue of Identity Card to employee and beneficiary – (1) The employee and his beneficiary shall be issued a photo-identity card with a unique identification number under the seal and signature of the issuing authority. (2) The identification number of the employee and his beneficiary shall consist of three numbers, for example x/y/z, where “x” denotes the code number of the employee, “y” denotes the serial number of the beneficiary belonging to the family of the employee (it being 1 in the case of the employee himself) and “z” denotes the total number of cards issued for the family of the employee. Explanation.– For the purpose of this clause, the expression “issuing authority” shall mean– (a) the Cadre Controlling Department, in case an employee is a member of a constituted State service; and (b) the Head of Office, in case of any other employee. (3) The blank identity cards with running serial numbers shall be supplied by the Finance Department on the basis of requisition received from the Cadre Controlling Departments, or the Heads of Offices through the administrative departments concerned, as the case may be. (4) The identity card shall consist of two parts of which the issuing authority shall retain the first part and the second part shall be handed over to the employee concerned. (5) A list of employees to whom identity cards have been issued shall be forwarded to the Drawing and Disbursing Officer and also to the Finance Department. (6) The identity card shall have a standard format and shall contain such particulars as the name, the date of birth and the relationship of the beneficiary with the employee. (7) The colour of the identity card shall be– (a) yellow, in case employee belonging to category I as mentioned in column (2) against Sl. 1 in column (1) of Table to clause 8; (b) pink, in case employees belonging to category II as mentioned in column (2) against Sl. 2 in column (1) of Table to clause 8; and (c) white, in case employees belonging to category III as mentioned in column (2) against Sl. 3 in column (1) of Table to clause 8. (8) For the purpose of availing the benefits under this scheme, the employee or his beneficiary shall show his identity card to the hospital, laboratory or institution where he receives medical attendance and treatment. (9) A temporary family permit in Form F may be issued to an employee enrolled under this scheme by the Head of office for a period as may be specified, pending issue of photo-identity cards and such temporary family permit shall entitle the employee and his beneficiary to all the benefits of this scheme. 6 THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 [PART I (10) The identity cards issued under this scheme shall be surrendered to the Cadre Controlling Department, or the Head of Office, as the case may be, at the time of retirement/resignation/on being relieved from Government service. 11. Intimation of medical attendance and treatment– An employee shall give an intimation to the Head of office within three days of commencement of his or his beneficiary’s medical attendance and treatment : Provided that where an employee himself is undergoing medical attendance or treatment and not in a position to intimate personally, any member of his family may give such intimation. 12. Claims for reimbursement of the cost of medical attendance and treatment – (1) An application for reimbursement of the cost of medical attendance and treatment shall be made by an employee in Form C. (2) The application for settlement of claim under this scheme shall be made within three months of the completion of treatment – (a) to the Secretary of the Department, in case of an employee working in the Secretariat, (b) to the head of the Directorate, in case of an employee working in the headquarters of a Directorate, (c) to the Head of Office, in all other cases. (3) The application referred to in sub-clause (1) shall be accompanied with the following documents :– (a) essentiality Certificates in Form D; (b) photocopy of the identity card issued to the employee, and where the claim relates to a member of the family of the employee, photocopy of the identity card issued to such member of the family of the employee; (c) all original bills verified by the hospital, laboratory or institution; (d) all original vouchers, cash memos and money receipts; (e) detailed lists of all medicines, laboratory tests, investigations, procedures, number of doctors’ visits, etc. with dates, duly countersigned by an authorized person of the hospital where the beneficiary has received medical attendance and treatment, along with a certificate from such authorized person that all charges are as per approved rates. In the bill prepared by the hospital, each service, procedure and investigation for which the beneficiary is charged should be specified, along with this reference number in the approved list; (f) detailed list of all medicines purchased from outside and all laboratory tests, investigations and procedures done in a laboratory, institution or hospital other than the hospital where the patient has received medical attendance and treatment, along with a certificate from an authorized person of the hospital that such medicines had to be purchased or such laboratory tests, investigations and procedures had to be done on the advice of the attending physician of the hospital; (g) photocopy of the intimation given to the Head of the Office of the employee regarding medical attendance and treatment of the employee or the beneficiary member of the family of the employee; (h) Check List in Form E. 13. Settlement of claims– (1) The application made under sub-clause (1) of clause 12 for reimbursement shall be processed by the concerned Department, the Directorate or the Office, as the case may be, under which the employee is presently working and the admissible cost of medical attendance and treatment shall be worked out on the basis of the approved rates. PART I] THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 7 (2) The sanctioning authority for reimbursement of the cost of medical attendance and treatment in the case of an employee working in the Secretariat shall be the Secretary: Provided that the Secretary may delegate this power to a Special Secretary, or a Head of Department not below the rank of Special Secretary to the Government, subject to the limits of – (i) for medical attendance and treatment as an indoor patient in a hospital, Rs. 50,000, (ii) for medical attendance and treatment as an OPD patient in a hospital, Rs. 5,000. (3) The sanctioning authority in the case of an employee working in the headquarters of a Directorate shall be the Head of the Directorate, where the claim does not exceed Rs. 50,000 for indoor treatment and Rs. 5,000 in case of OPD treatment, and the Secretary of the Department where the claim exceeds these limits. (4) The sanctioning authority in case of all other employees shall be the head of Office where the claim does not exceed Rs. 30,000 for indoor treatment and Rs. 3,000 for OPD treatment, the Head of the Directorate where the claim exceeds these limits but does not exceed Rs. 50,000 for indoor treatment and Rs. 5,000 for OPD treatment, and the Secretary of the department in all other cases. 14. Treatment in a hospital or institution outside the State– (1) Notwithstanding anything contained elsewhere in this scheme, the Government may recognize specialized hospitals and institution outside the State for treatment of specific diseases. (2) Prior approval of the Secretary of the department shall be obtained before receiving medical attendance and treatment in these hospitals or institutions. (3) Claim for reimbursement of the cost of medical attendance and treatment in these hospitals or institutions shall be allowed on the basis of the rates of various services provided by and investigations and procedures carried out by these hospitals/institutions in the course of medical attendance and treatment. 15. Medical advance– (1) The sanctioning authority for reimbursement of the cost of medical attendance and treatment may grant medical advance on submission of a certificate estimate from the hospital in which medical attendance and treatment is received as an indoor patient. (2) The Advance shall not exceed 80 per cent of the estimated cost of medical attendance and treatment. (3) The medical advance shall be adjusted against the admissible cost of medical attendance and treatment, excess, if any, shall be refunded by the employee. If medical attendance and treatment is not received within 60 days of receipt of medical advance, the entire advance shall be refunded by the employee on the expiry of this period. 16. Applicability of benefit of Scheme to retired Government employees and their family members– The benefit of the Scheme shall be applicable for the retired State Government employees and their family members, to such extent and on such terms and conditions as may be specified. 17. Operational guidelines, clarifications, etc.– (1) The Finance Department, in consultation with the Health and Family Welfare Department wherever necessary, shall issue operational guidelines, clarifications, etc. for implementation of the scheme. (2) If any difficulty arises in the course of implementation of the scheme, it shall be referred to the Finance Department and the decision of the Finance Department thereon shall be fina
Registered No. WB/SC-247 No. WB(Part-I)/2008/SAR-332 Extraordinary Published by Authority BHADRA 28] FRIDAY, SEPTEMBER 19, 2008 [SAKA 1930 PART I—Orders and Notifications by the Governor of West Bengal, the High Court, Government Treasury, etc. The Kolkata Gazette GOVERNMENT OF WEST BENGAL FINANCE DEPARTMENT AUDIT BRANCH NOTIFICATION No. 7287–F 19-09-2008—The Governor is pleased hereby to make, in addition to the West Bengal Services (Medical Attendance) Rules, 1964, as subsequently amended, the following scheme regulating the medical benefits for the State Government employees and the family members thereto, with a view to providing better medical facilities to such employees and their family members :— Scheme 1. Short title and commencement — (1) This Scheme may be called the West Bengal Health Scheme, 2008. (2) It shall come into force on such date, as the State Government may, by notification in the Official Gazette, appoint. 2. Application— (1) This scheme shall apply to the employee and his beneficiary. (2) The provision of enrolment under this scheme shall be optional. (3) An employee shall not be entitled to draw the regular medical allowance with effect from the date of effect of such enrolment under clause 4. (4) An employee and his beneficiary shall be entitled to the facilities under this scheme in addition to the facilities under the West Bengal Services (Medical Attendance) Rules, 1964, as subsequently amended. 2 THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 [PART I (5) An employee shall have the liberty to opt out of this scheme at any time. Provided that where an employee or his beneficiary has enjoyed any benefit under this scheme, such employee shall not be allowed to opt out the scheme within five years from the month following the month in which he enjoyed the benefit. 3. Definitions — In this Scheme, unless there is anything repugnant in the subject or context– (a) “approved rates” means such rates as may be notified by the Government from time to time for various services, procedures and investigations required in connection with the medical attendance and treatment of a beneficiary; (b) “beneficiary” means a member of the family of an employee; (c) “clause” means a clause of the scheme; (d) “employee” means an employee of the Government of West Bengal enrolled under clause 4; (e) “family”, in relation to an employee, means— (i) children including step-children and unmarried daughters, (ii) minor brothers, (iii) minor sisters, (iv) father or mother whose monthly income does not exceed rupees one thousand five hundred, (v) wife or husband, as the case may be; (f) “Form” means a Form appended to this scheme; (g) “Government” means Government of West Bengal; (h) “hospital or institution” means such hospital or nursing home or institution as may be recognized from time to time by the Government for the purpose of availing benefits of medical attendance and treatment under this scheme; (i) “laboratory” means such laboratory or institution as may be recognized by the Government from time to time for availing of benefits of medical attendance and treatment under this scheme; (j) “medical attendance” means attendance for professional advice and includes pathological, bacteriological, radiological or other methods of investigations for the purpose of diagnosis which are considered necessary by the attending physician and are carried out in a hospital or institution; (k) “specified” means specified by order; (l) “treatment” means the use of medical and surgical facilities and includes– (i) the employment of such pathological, bacteriological, radiological or other methods of investigations as are considered necessary by the attending physician; (ii) the use of such medicines, vaccines, serum or other therapeutic substances as may be considered necessary by the attending physician; (iii) medical and surgical services and procedures; (iv) dental treatment; (v) accommodation according to the entitlement of the employee; PART I] THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 3 (vi) such nursing as is ordinarily provided at the hospital or such special nursing at the hospital as the authorized medical attending physician at the hospital may certify, in writing, to be essential for the recovery or for the prevention of serious deterioration in the condition of the patient, having regard to the nature of the disease. 4. Enrolment – (1) An employee seeking enrolment under the scheme shall exercise his option in Form A, in duplicate, along with an undertaking that upon enrolment under this scheme, such employee shall forgo the regular medical allowance drawn as part of monthly salary. (2) The option referred to in sub-clause (1) shall be submitted– (a) to the Cadre Controlling Department, in case an employee is a member of a constituted State service; and (b) to the Head of Office, in case of any other employee. (3) The Cadre Controlling Authority or the Head of Office, as the case may be, shall, after scrutinization of the option exercised by the employee, issue a certificate of enrolment in Form B in favor of the employee, to be effective from the first day of the month following the month in which the certificate is issued. (4) The Cadre Controlling Authority or the Head of Office, as the case may be, shall send one copy of the certificate to the Drawing and Disbursing Officer in respect of the employee with a direction to discontinue the drawal of regular medical allowance with effect from the first day of the month following the month in which the certificate is issued. 5. Facilities – An employee or a beneficiary of such employee shall be entitled to the following facilities, namely:– (a) medical attendance and treatment as an indoor patient in a hospital or an institution; and (b) medical attendance and treatment at out patient department of a hospital or an institution, or a clinic attached to such hospital or institution for such diseases, and under such circumstances, as may be specified. 6. Medical attendance and treatment as an indoor patient in a hospital – An employee shall be entitled to reimbursement of the cost of his or his beneficiary’s medical attendance and treatment, as an indoor patient in a hospital or an institution. Explanation.– For the purpose of this clause, the expression “cost of medical attendance and treatment” shall include – (a) the amount charged by the hospital or institution in accordance with the approved rates; (b) the cost of medicines purchased from outside on the advice of the attending physician at the hospital or institution; (c) the charges for such pathological, bacteriological, radiological or other methods of investigations as are considered necessary by the attending physician and carried out, on the advice of the attending physician, in a laboratory or institution, other than the hospital or institution in which the patient is treated. 7. Medical attendance and treatment as an OPD (Out-Patient Department) patient in a hospital – (1) An employee shall be entitled to reimbursement of the cost of his or his beneficiary’s medical attendance and treatment as an OPD patient in a hospital or institution in the following cases : – (i) Malignant diseases, (ii) Tuberculosis, 4 THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 [PART I (iii) Hepatitis B/C and other liver diseases, (iv) Insulin-dependent diabetes, (v) Heart diseases, (vi) Neurological disorders/Cerebrovascular disorders, (vii) Malignant malaria, (viii) Renal failure, (ix) Thallasaemia/Bleeding orders/Platelet disorders, (x) Injuries caused by accidents. (2) An employee or his beneficiary shall also be entitled to reimbursement of the cost of follow-up medical attendance and treatment relating to Neuro Surgery, Cardiac Surgery (Including Coronary Angioplasty and implants), Cancer Surgery/Chemotherapy/Radiotherapy, Renal Transplant, Hip/Knee replacement Surgery and Accident cases received as an OPD patient in a hospital or institution. Explanation. – For the purpose of this clause, the expression “cost of medical attendance and treatment” shall include– (a) the amount charged by the hospital or institution in accordance with the approved rates, (b) the cost of medicines purchased from outside on the advice of the attending physician at the hospital or institution. (c) the charges for such pathological, bacteriological, radiological or other methods of investigations as are considered necessary by the attending physician and carried out on the advice of the attending physician in a laboratory or institution, other than the hospital or institution in which the patient is treated. 8. Accommodation– (1) In the case of medical attendance and treatment as an indoor patient in a hospital or an institution, an employee or his beneficiary shall be entitled to such accommodation as mentioned in column (4) of the Table below, of the category of the employee as mentioned in column (2), to be determined on the basis of the basic pay including dearness pay as mentioned in column (3), respectively, against the Sl. No. as mentioned in column (1) of the said Table :– Table Sl. Category of Basic pay including dearness pay Type of No. employee accommodation (1) (2) (3) (4) 1. I Above Rs. 18,000 p.m. Private Ward 2. II Rs. 12,000 p.m. and above but Semi-Private Ward below Rs. 18,000 p.m. 3. III Below Rs. 12,000 p.m. General Ward PART I] THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 5 (2) Where the type of accommodation in a hospital does not correspond to the nomenclature as referred to in column (4) of Table to sub-clause (1) or any similar nomenclature, the Government shall, in consultation with the authorities of the hospital concerned, determine the entitlement of the beneficiary. 9. Tenure – Notwithstanding anything contained in this scheme and without prejudice to the provisions of sub-clause (2) of clause 7, the cost incurred on account of related medical attendance and treatment received in a hospital or an institution during the period upto 30 days prior to hospitalization and 30 days from the date of discharge, shall be reimbursable. 10. Issue of Identity Card to employee and beneficiary – (1) The employee and his beneficiary shall be issued a photo-identity card with a unique identification number under the seal and signature of the issuing authority. (2) The identification number of the employee and his beneficiary shall consist of three numbers, for example x/y/z, where “x” denotes the code number of the employee, “y” denotes the serial number of the beneficiary belonging to the family of the employee (it being 1 in the case of the employee himself) and “z” denotes the total number of cards issued for the family of the employee. Explanation.– For the purpose of this clause, the expression “issuing authority” shall mean– (a) the Cadre Controlling Department, in case an employee is a member of a constituted State service; and (b) the Head of Office, in case of any other employee. (3) The blank identity cards with running serial numbers shall be supplied by the Finance Department on the basis of requisition received from the Cadre Controlling Departments, or the Heads of Offices through the administrative departments concerned, as the case may be. (4) The identity card shall consist of two parts of which the issuing authority shall retain the first part and the second part shall be handed over to the employee concerned. (5) A list of employees to whom identity cards have been issued shall be forwarded to the Drawing and Disbursing Officer and also to the Finance Department. (6) The identity card shall have a standard format and shall contain such particulars as the name, the date of birth and the relationship of the beneficiary with the employee. (7) The colour of the identity card shall be– (a) yellow, in case employee belonging to category I as mentioned in column (2) against Sl. 1 in column (1) of Table to clause 8; (b) pink, in case employees belonging to category II as mentioned in column (2) against Sl. 2 in column (1) of Table to clause 8; and (c) white, in case employees belonging to category III as mentioned in column (2) against Sl. 3 in column (1) of Table to clause 8. (8) For the purpose of availing the benefits under this scheme, the employee or his beneficiary shall show his identity card to the hospital, laboratory or institution where he receives medical attendance and treatment. (9) A temporary family permit in Form F may be issued to an employee enrolled under this scheme by the Head of office for a period as may be specified, pending issue of photo-identity cards and such temporary family permit shall entitle the employee and his beneficiary to all the benefits of this scheme. 6 THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 [PART I (10) The identity cards issued under this scheme shall be surrendered to the Cadre Controlling Department, or the Head of Office, as the case may be, at the time of retirement/resignation/on being relieved from Government service. 11. Intimation of medical attendance and treatment– An employee shall give an intimation to the Head of office within three days of commencement of his or his beneficiary’s medical attendance and treatment : Provided that where an employee himself is undergoing medical attendance or treatment and not in a position to intimate personally, any member of his family may give such intimation. 12. Claims for reimbursement of the cost of medical attendance and treatment – (1) An application for reimbursement of the cost of medical attendance and treatment shall be made by an employee in Form C. (2) The application for settlement of claim under this scheme shall be made within three months of the completion of treatment – (a) to the Secretary of the Department, in case of an employee working in the Secretariat, (b) to the head of the Directorate, in case of an employee working in the headquarters of a Directorate, (c) to the Head of Office, in all other cases. (3) The application referred to in sub-clause (1) shall be accompanied with the following documents :– (a) essentiality Certificates in Form D; (b) photocopy of the identity card issued to the employee, and where the claim relates to a member of the family of the employee, photocopy of the identity card issued to such member of the family of the employee; (c) all original bills verified by the hospital, laboratory or institution; (d) all original vouchers, cash memos and money receipts; (e) detailed lists of all medicines, laboratory tests, investigations, procedures, number of doctors’ visits, etc. with dates, duly countersigned by an authorized person of the hospital where the beneficiary has received medical attendance and treatment, along with a certificate from such authorized person that all charges are as per approved rates. In the bill prepared by the hospital, each service, procedure and investigation for which the beneficiary is charged should be specified, along with this reference number in the approved list; (f) detailed list of all medicines purchased from outside and all laboratory tests, investigations and procedures done in a laboratory, institution or hospital other than the hospital where the patient has received medical attendance and treatment, along with a certificate from an authorized person of the hospital that such medicines had to be purchased or such laboratory tests, investigations and procedures had to be done on the advice of the attending physician of the hospital; (g) photocopy of the intimation given to the Head of the Office of the employee regarding medical attendance and treatment of the employee or the beneficiary member of the family of the employee; (h) Check List in Form E. 13. Settlement of claims– (1) The application made under sub-clause (1) of clause 12 for reimbursement shall be processed by the concerned Department, the Directorate or the Office, as the case may be, under which the employee is presently working and the admissible cost of medical attendance and treatment shall be worked out on the basis of the approved rates. PART I] THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 7 (2) The sanctioning authority for reimbursement of the cost of medical attendance and treatment in the case of an employee working in the Secretariat shall be the Secretary: Provided that the Secretary may delegate this power to a Special Secretary, or a Head of Department not below the rank of Special Secretary to the Government, subject to the limits of – (i) for medical attendance and treatment as an indoor patient in a hospital, Rs. 50,000, (ii) for medical attendance and treatment as an OPD patient in a hospital, Rs. 5,000. (3) The sanctioning authority in the case of an employee working in the headquarters of a Directorate shall be the Head of the Directorate, where the claim does not exceed Rs. 50,000 for indoor treatment and Rs. 5,000 in case of OPD treatment, and the Secretary of the Department where the claim exceeds these limits. (4) The sanctioning authority in case of all other employees shall be the head of Office where the claim does not exceed Rs. 30,000 for indoor treatment and Rs. 3,000 for OPD treatment, the Head of the Directorate where the claim exceeds these limits but does not exceed Rs. 50,000 for indoor treatment and Rs. 5,000 for OPD treatment, and the Secretary of the department in all other cases. 14. Treatment in a hospital or institution outside the State– (1) Notwithstanding anything contained elsewhere in this scheme, the Government may recognize specialized hospitals and institution outside the State for treatment of specific diseases. (2) Prior approval of the Secretary of the department shall be obtained before receiving medical attendance and treatment in these hospitals or institutions. (3) Claim for reimbursement of the cost of medical attendance and treatment in these hospitals or institutions shall be allowed on the basis of the rates of various services provided by and investigations and procedures carried out by these hospitals/institutions in the course of medical attendance and treatment. 15. Medical advance– (1) The sanctioning authority for reimbursement of the cost of medical attendance and treatment may grant medical advance on submission of a certificate estimate from the hospital in which medical attendance and treatment is received as an indoor patient. (2) The Advance shall not exceed 80 per cent of the estimated cost of medical attendance and treatment. (3) The medical advance shall be adjusted against the admissible cost of medical attendance and treatment, excess, if any, shall be refunded by the employee. If medical attendance and treatment is not received within 60 days of receipt of medical advance, the entire advance shall be refunded by the employee on the expiry of this period. 16. Applicability of benefit of Scheme to retired Government employees and their family members– The benefit of the Scheme shall be applicable for the retired State Government employees and their family members, to such extent and on such terms and conditions as may be specified. 17. Operational guidelines, clarifications, etc.– (1) The Finance Department, in consultation with the Health and Family Welfare Department wherever necessary, shall issue operational guidelines, clarifications, etc. for implementation of the scheme. (2) If any difficulty arises in the course of implementation of the scheme, it shall be referred to the Finance Department and the decision of the Finance Department thereon shall be fina
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