Get West Bengal Health Scheme

The West Bengal Health Scheme provides essential health support to government pensioners and their dependents. This guide will assist you in completing the Essentiality Certificate–Cum–Statement of Expenditure form accurately to claim indoor, daycare, and related outpatient treatment costs.

Follow the steps to successfully complete the West Bengal Health Scheme form.

1. Press the 'Get Form' button to access the Essentiality Certificate form online and open it in your editor.
2. Begin filling out the form by entering the name of the government pensioner or family pensioner, including their identification number.
3. Next, provide the name of the office related to the ex-government employee, along with the Pension Sanctioning Authority details.
4. Fill in the patient's name, their relationship with the ex-government employee, and the patient's identification number.
5. In the 'Details of expenditure' section, report on the diagnosed disease and include the name, code number, and class of the empaneled or recognized hospital.
6. Specify the period during which indoor or daycare treatment was received and the total number of original bills and vouchers attached.
7. Detail the amounts claimed for package treatment, including the procedure name, procedure code number, and amount claimed for each relevant procedure.
8. If applicable, complete the section for non-package treatment by providing a description of items and corresponding amounts claimed.
9. Additionally, include costs for related outpatient department treatment, detailing the amounts claimed for consultation fees and any investigations or medicines.
10. Sum all the amounts from package, non-package treatment, and OPD claims to reach a grand total.
11. Complete the claimant's signature and provide your name in block letters and address.
12. Ensure that the treating specialist certifies and signs the relevant sections of the form, confirming the accuracy of expenditures and treatments.
13. Lastly, have the form countersigned by the Medical Superintendent or Administrative Officer of the recognized hospital, along with their official seal.
14. Save the changes, download, print, or share the completed form as necessary.

Complete your West Bengal Health Scheme form online today to ensure you receive the benefits you deserve.