The West Bengal Health Scheme has expanded its treatment network for eligible state government employees, pensioners and their dependants, with five more AIIMS facilities added for treatment without prior permission and new rates notified for specialised surgical oncology at empanelled private hospitals.
The newly recognised AIIMS facilities are located in Patna, Guwahati, Kalyani, Bhubaneswar and Deoghar. AIIMS, New Delhi, was already covered under the scheme. The change gives beneficiaries access to treatment at a wider set of public medical institutions without first obtaining permission under the scheme.
The state government has also fixed rates for specialised surgical oncology procedures performed at private healthcare organisations empanelled under the West Bengal Health Scheme. The notification states that existing rates did not adequately cover several advanced surgical procedures, creating a gap in the scheme’s coverage for complex cancer treatment.
The revised rates will apply only to empanelled facilities with valid National Accreditation Board for Hospitals and Healthcare Providers, or NABH, accreditation for surgical oncology. This condition links reimbursement eligibility to the accreditation status of the hospital and the specific oncology service being provided.
The notification provides for the admissible treatment cost to be calculated under several heads. Consultation fees will continue to be admissible at the existing rates. However, beneficiaries will remain subject to the West Bengal Health Scheme’s existing reimbursement provisions.
The amount payable will also be limited by a lower-of-two-costs rule: the admissible reimbursement will be either the actual amount charged by the institution or the amount permitted under the scheme, whichever is lower. The notification therefore expands the procedures and facilities available to beneficiaries without removing the financial limits built into the scheme.
The new surgical oncology rates do not apply to Tata Medical Center, Chittaranjan National Cancer Institute or the Woodburn ward at IPGMER-SSKM. These institutions are therefore outside the specific rate framework announced for empanelled private healthcare organisations.
The changes highlight the administrative challenge of updating public employee health schemes as specialised medical treatment becomes more complex and available across a wider institutional network. In this case, the state has addressed two separate access issues: the need for a broader list of recognised treatment centres and the absence of adequate rates for advanced cancer procedures.
For beneficiaries, the practical effect will depend on whether the chosen facility is covered under the notification, holds the required NABH accreditation for surgical oncology and charges within the scheme’s admissible limits. The state notification retains the existing reimbursement conditions while adding the five AIIMS facilities and establishing rates for the specified private hospitals.
