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WBHS - West Bengal Health Scheme: Eligibility, Coverage, Benefits

Team AckoFeb 13, 2024

From time-to-time, the Centre and State Governments of India keep bringing out welfare schemes for the public. Sometimes, they are for the underprivileged section of the society and sometimes for other sections. There are dedicated health schemes as well. The West Bengal Health Scheme is one such dedicated health scheme.

Health insurance is a measure to ensure financial security during unfortunate medical emergencies leading to hospitalisation. Welfare schemes that offer health insurance coverage help people to manage medical expenses in a better manner. Read ahead to know more about the West Bengal Health Scheme (WBHS).

Contents

What is the West Bengal Health Scheme?
Features and Benefits of the West Bengal Cashless Medical Treatment Scheme:
- Here are the key features of the WBHS scheme:
Here are the key benefits of the updated WBHS scheme:
What is Not Covered Under the Scheme?
Eligibility for West Bengal Health Scheme:
How to Enrol and Register in West Bengal Health Scheme:
- Here’s how you can enrol as a Government Employee:
How to Download West Bengal Health Scheme Application Form:
How to Claim the West Bengal Health Scheme:
- Here’s the Claim Process:
Empanelled Hospitals Listed Under West Bengal Health Scheme:
West Bengal Health Scheme Helpline Number:
Regulation of the Scheme:
Wrapping up!
Frequently Asked Questions:

What is the West Bengal Health Scheme?

The WBHS is a state-level health insurance welfare scheme. This scheme began in the year 2008. However, in 2014, it underwent a revamp and came to be known as the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme. Both schemes have been merged.

As per this scheme, eligible people can avail cashless treatment in the stated list of hospitals, also known as empanelled hospitals and Health Care Organisations (HCO). Those who are eligible can avail a cashless treatment of Rs. One lakh.

Features and Benefits of the West Bengal Cashless Medical Treatment Scheme:

Here are the key features of the WBHS scheme:

1) Cashless Indoor Treatment

The beneficiary can avail cashless indoor treatment up to Rs. One lakh in an empanelled hospital. If the cost exceeds the limit, the extra amount in the bill shall be settled by the beneficiary. This feature reduces the financial burden during a trying health situation. Cashless access to hospital care ensures patients can focus on recovery rather than worry about large medical bills, allowing critical care when needed.

2) OPD Treatment

You can avail reimbursement for the OPD treatment as per the waiting period and other conditions of the scheme. This provides coverage for regular health expenses and preventative care to maintain wellness. Having OPD treatment covered allows people to stay on top of their health with routine doctor visits, tests, and medication without bearing the entire cost.

Also, read: OPD Cover with Health Insurance

3) Hospital That is Non-empanelled

If treatment is availble in a non-empanelled hospital, a certain percentage of the amount can be reimbursed as per the terms and conditions. This allows some flexibility to receive cash benefits still even if an empanelled hospital is not accessible. Getting partial reimbursement from non-empanelled hospitals gives patients more options in an emergency and expands overall access to healthcare services.

4) Out-of-state Hospitalisation

Expenses can be covered if the treatment is availed in a hospital belonging to a different state, provided it has been listed as an empanelled hospital. This is helpful for people who fall ill while travelling or seek specialised care. Not limiting hospital coverage only within the state allows beneficiaries to access quality care wherever they may require it if hospitalisation occurs while away from home.

Here are the key benefits of the updated WBHS scheme:

More than 1000 medical procedures are covered by the scheme. The following table is about the type of procedure and the extent of the cover.

Benefits	Cover
Specialised surgeries	Up to 12 days
Major surgeries	7 to 8 days
Laparoscopic or endoscopic surgeries, normal deliveries	3 to 4 days
OPD and minor surgeries	1 day

Benefits of West Bengal Health Scheme 2008 extended to IAS, IFS and IPS officers:

In the subsequent years of the 2008 scheme, certain benefits were extended to officers belonging to the Indian Administrative Service (IAS), Indian Forest Service (IFS) and Indian Police Service (IPS).

Benefits for IAS Officers

IAS officers and their family members can avail the benefits of the scheme as per the following conditions:

Being a part of the scheme is optional.
Their concerned administrative department would be the Personnel and Administrative Reforms Department.
Can avail facilities as per All India Services Rules, 1954.
They should not be a part of the Central Government Health Scheme (CGHS).

Benefits for IPS Officers

IPS officers and their family members can benefit from the scheme as per the following conditions:

They have the option to be a part of the scheme.
The administrative department for IPS officers would be The Home Department Police Service Cell.
All India Services Rules, 1954 facilities are also available.
Those officers who are a part of the Central Government Health Scheme (CGHS) cannot be a part of the state scheme.

Benefits for IFS Officers

IFS officers and their family members can be a part of the scheme subject to the following conditions.

Their enrollment is optional.
Their concerned department as far as this scheme is concerned would be the Department of Forests.
All India Services Rules, 1954 facilities can be availed by them.
Those officers who are a part of the Central Government Health Scheme (CGHS) will not be eligible to be a part of this state scheme.

Also, read: Arogya Sanjeevani Policy

List of Diseases and Treatments Covered under West Bengal Health Scheme:

The scheme covers 1014 medical treatments. It also states the maximum approved package rate for each procedure in Indian currency. The details can be viewed here.

OPD Treatment Diseases List:

The scheme covers crucial Out-patient Department diseases. Here’s the West Bengal Health Scheme 2008 OPD treatment list

Rheumatoid Arthritis
Endodontic Treatment (Root Canal Treatment)
Systemic Lupus Erythematosus (LUPUS)
Crohn’s Disease Heart disease
Neurological disorder/Cerebrovascular disorders
Malignant Malaria
COPD (Chronic Obstructive Pulmonary Disease)
Malignant diseases
Tuberculosis
Hepatitis B/C and other liver diseases
Insulin-dependent diabetes (Type-2 Diabetic Melitas is not considered as insulin-dependent diabetes)
Thalassaemia/Bleeding orders/Platelet disorders
Renal failure
Injuries caused by accident (including animal bite)

What is Not Covered Under the Scheme?

The scheme excludes cosmetic surgeries and non-medical treatments. Apart from these, major treatments should be covered in a cashless manner in empanelled hospitals.

There are certain other exclusions as well that beneficiaries should be aware of. Experimental and investigational treatments without established medical usage are typically not covered. Additionally, the insurance may not cover medical care needed due to self-inflicted injuries or substance abuse. High-cost treatments like organ transplants and rehabilitation therapy also tend to be excluded depending on the fine print. While cashless hospitalisation for critical illness is provided in empanelled hospitals, outpatient services for chronic conditions like diabetes or hypertension maintenance may or may not be covered.

Those enrolling should carefully go through the insurance paperwork to clarify what is covered and what is omitted so there are no surprises later on if care is required that ends up being an exclusion rather than a covered benefit. Understanding the scope of the policy ensures beneficiaries have realistic expectations.

Eligibility for West Bengal Health Scheme:

Listed below are the eligibility criteria to be a part of the scheme.

This scheme is directed towards state government employees, government employees who avail pension, and their families.
Those who have opted for this scheme as per Medical Allowance are also eligible for it.
This cover can be availed by All India Services officers and pensioners.
The cover mentioned for the family includes that for the spouse, parents, children who are dependant on the beneficiary and the siblings who are dependant on the beneficiary.

How to Enrol and Register in West Bengal Health Scheme:

You can visit the West Bengal Health Department’s website to begin the enrolment and registration process. From there, you can choose to enrol as a Government employee, Government pensioner, Beneficiaries of Grant-in-Aid College, and Beneficiaries of Grant-in-aid University. It also facilitates the New Hospital Registration.

Here’s how you can enrol as a Government Employee:

Step 1 – Visit the West Bengal Health Scheme Portal
Step 2 – Click on Online Enrolment from the header section and select Government Employee.
Step 3 – In case you have a PRAN/GPF number, then check the Yes box and enter the details. If you don’t have the details, then check the NO box and select Non-GPF.
Step 4 – Mention details like residential district and birth date. Save the information to register in the WB Health Portal and click next for the rest of the process.
Step 5 – Mention personal details like name, address, mobile number, employee number, etc.
Step 6 – Mention office details.
Step 7 – Mention family details.
Step 8 – Upload photograph and signature. Make sure to adhere to the specified rules regarding the dimensions.
Step 9 – Mention details pertaining to the beneficiary.
Step 10 – Mention head office details.
Step 11 – Save the details and print the report for future reference.

How to Download West Bengal Health Scheme Application Form:

Wealth Bengal Health Scheme forms can be downloaded from the official website. Here’s how you can do so for different sections.

The process to Download Forms for State Government Employees

Step 1 – Visit the West Bengal Health Scheme Portal > Downloads section
Step 2 – Select ‘Employees’ from the “Select Category” drop-down menu
Step 3 – Download the relevant form

The process to Download Forms for State Government Pensioners

Step 1 – Visit the West Bengal Health Scheme Portal > Downloads section
Step 2 – Select ‘Pensioner’ from the “Select Category” drop-down menu
Step 3 – Download the relevant form

How to Claim the West Bengal Health Scheme:

The scheme works on a cashless basis. Therefore, if the treatment cost is under the stated package, the beneficiary does not have to settle the hospital bill as the treatment will be covered as per the scheme. If the cost exceeds the limit mentioned in the package allocated for the treatment, the additional expenses of the bill shall be settled by the beneficiary and the hospital, and there shall be no claim for the exceeding amount.

Here’s the Claim Process:

Step 1 – Submit the cashless card while getting admitted for treatment at an empanelled hospital.
Step 2 – Health Care Organisation shall send an authorisation request to the Government Authorised Agency (GAA).
Step 3 – GAA will check the details and approve the request.
Step 4 – Post the treatment, HCO or the hospital will send the bill to the GAA. The bill shall be accompanied by required documents like a medical report, doctor’s certificate, discharge summary, etc.
Step 5 – GAA will verify the sent documents.
Step 6 – GAA will transfer the amount to HCO.

Empanelled Hospitals Listed Under West Bengal Health Scheme:

Here’s the list of empanelled hospitals under West Bengal Health Scheme.

The Calcutta Medical Research Institute
Desun Hospitals and Heart Institute
Nightingale Hospitals
R N Tagore International Institute of Cardiac Sciences
Apollo Gleneagles
Ruby General Hospital
BM Birla Heart Research Centre
Medica Super-specialty Hospital
Mission of Mercy Hospital
Susrut Eye Foundation

Note that some hospitals might not be a part of the scheme any longer, therefore it is better to confirm with the hospital or check on the below-mentioned website.The complete list of West Bengal Health Scheme Cashless Hospitals can be found on the West Bengal Health Scheme’s Portal. The website has information related to Government hospitals, local hospitals, state-aided hospitals, and private hospitals.

Also, read: Corona Kavach Policy

West Bengal Health Scheme Helpline Number:

The following will provide you with the necessary contact details.

Email ID: [email protected]

Contact Number: (033)2254-4123/(033)2254-4034

Regulation of the Scheme:

West Bengal’s Government’s Finance Department has a Medical Cell which administers the WBHS. The Cell along with the state’s Health and Family Welfare department is responsible for monitoring the scheme. The Cell also states operational guidelines.

Wrapping up!

The West Bengal Health Scheme aims to provide accessible and affordable healthcare to state government employees, pensioners, and their families. By covering expenses for hospitalisation, treatments, and certain outpatient care up to Rs 1 lakh in empanelled facilities, this scheme reduces the financial barriers to critical medical care. Though not without some exclusions, the WBHS represents the government's efforts to assure basic health coverage and protection for its workforce against medical expences.

Frequently Asked Questions:

Here’s a list of some of the prominent questions related to the West Bengal Health Scheme.

Is it possible for an employee to opt-out of this scheme?

Yes, an employee can opt-out of the scheme. However, the employee must meet certain requirements for doing so.

Is it possible for the beneficiary or the beneficiary’s family members to benefit from the scheme’s reimbursement facility using the Certificate of Enrolment?

Yes, employees, pensioners and their family members can benefit with the help of a Certificate of Enrolment.

Is it possible for an employee who is a part of the West Bengal Health Scheme to benefit from the West Bengal Services Rules facilities?

Yes, it is possible to benefit from West Bengal Services Rules facilities for an employee who is a part of the West Bengal Health Scheme.

Is the scheme member’s spouse considered as a beneficiary?

Yes, the member’s spouse can be considered as a beneficiary.

Can the cost of treatment for surgery be reimbursed if there is no package rate assigned to it?

Yes, it can be reimbursed. The package cost of a similar surgery shall be taken into consideration.

What is the West Bengal (WB) Health Recruitment Board?

The WB Health Recruitment Board is constituted by the State Government. It recruits candidates as a part of direct recruitment. For example, it recruits nurses and medical officers. The official website of the board is www.wbhrb.in.

How can I access the West Bengal Health Department website?

You can access the Government of West Bengal’s Health and Family Welfare Department by visiting www.wbhealth.gov.in.

What benefits are extended to IAS, IFS, and IPS officers under the WBHS?

Officers and their family members can opt into the scheme, provided they are not part of the Central Government Health Scheme (CGHS) and will avail facilities as per All India Services Rules, 1954.

What diseases and treatments are excluded from the WBHS?

Cosmetic surgeries, non-medical treatments, experimental treatments without established medical usage, self-inflicted injuries, substance abuse, high-cost treatments like organ transplants, and certain chronic conditions may be excluded.

Who regulates the West Bengal Health Scheme?

The Finance Department plays a critical role in managing the financial aspects and policy framework of the scheme, while the Health and Family Welfare Department ensures the medical services and healthcare infrastructure are aligned with the scheme's objectives.