Get West Bengal Health Scheme Reimbursement Form For Pensioners
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How to fill out the West Bengal Health Scheme Reimbursement Form For Pensioners online
The West Bengal Health Scheme Reimbursement Form for Pensioners is designed to assist pensioners in claiming reimbursement for outpatient treatment expenses. This guide will provide you with detailed, step-by-step instructions for filling out the form online effectively.
Follow the steps to complete the form accurately.
- Click ‘Get Form’ button to access the reimbursement form and open it in your designated editor.
- Enter the full name of the government pensioner or family pensioner along with their identification number in the indicated fields.
- Provide the name of the office of the ex-government employee or government pensioner and the sanctioning authority in the respective sections.
- Fill in the patient's name, relationship with the ex-government employee, and the identification number.
- Detail the expenditures incurred by completing the sections provided. This includes providing the name and code number of the empanelled or government-recognized hospital and the period of outpatient treatment.
- List the total number of original bills and vouchers submitted for reimbursement.
- Fill out the details of the diagnosed disease, including the amount claimed for outpatient treatment and a description of items such as consultation fees, pathological investigations, radiological investigations, medicines, special devices, and miscellaneous expenses.
- Insert the claimed amount and the allowable amount for official use in the respective fields.
- Ensure to sign the form, print your name in block letters, and provide your address.
- The treating specialist must certify the verified bills/vouchers, confirming the accuracy and necessity of the expenditures listed in the form.
- After completing the form, you can save changes, download, print, or share the document as needed.
Start filling out your reimbursement form online to ensure timely processing and support for your healthcare expenses.
The West Bengal Health Scheme is designed to provide healthcare benefits to government pensioners. It covers various medical expenses, ensuring financial support for their health needs. The scheme aims to assist pensioners in managing healthcare costs effectively, including provisions for reimbursement through the West Bengal Health Scheme Reimbursement Form For Pensioners.
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