West Bengal Health Scheme

The Central and State Governments of India from time to time launch health welfare schemes for the underprivileged section of society. The West Bengal Health Scheme (WBHS) is an example of this type of health welfare scheme. Health insurance is a way of providing financial protection in case of an unwanted medical condition that requires hospitalization. Health insurance coverage provided by welfare schemes enables people to manage their medical costs better. Read the below section to know more about the West Bengal Health Scheme (WBHS).

What is West Bengal Health Scheme (WBHS)?

West Bengal Health Scheme (WBHS) is a state-level health insurance welfare scheme. It was started in 2008. However, in 2014, it underwent a revamp and became known as West Bengal Health for Cashless Medical Treatment Scheme for all employees and pensioners. The scheme allows eligible individuals to avail of cashless medical treatment at hospitals in a specified list, commonly known as empanelled hospitals and health care organizations (HCOs). Those who are eligible can avail of cashless treatment of INR 1 Lakh.

Features and Benefits of the West Bengal Health Scheme (WBHS)

West Bengal Health Scheme (WBHS) scheme offers various benefits to its policyholders. Below mentioned are the features and benefits of the West Bengal Health Scheme (WBHS) scheme:

Cashless Treatment
OPD Treatment
Hospitalization in non-empanelled hospital
Out-of-State Hospitalization

Cashless Treatment: The beneficiary can avail of cashless treatment in the empanelled hospital up to Rs.1 lakh. If the cost exceeds the cap, the beneficiary is responsible for paying any additional charges on the bill.
OPD Treatment: The policyholder can get reimbursement for the OPD treatments as per the waiting period and the other terms and conditions of the WB health scheme.
Hospitalization in a non-empanelled hospital: If the beneficiary has received medical treatment in a non-empanelled hospital, a fixed amount of the total bill will be reimbursed per the scheme's terms and conditions.
Out-of-State Hospitalization: If the treatment is received in a hospital located in any other state, the expenses can be paid as long as the hospital is designated as an empanelled hospital.

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Key Benefits of the Updated West Bengal Health Scheme (WBHS)

There are more than 1000 medical procedures covered under the West Bengal Health Scheme (WBHS). The table given below is about the type of procedure offered under the scheme and the extent of cover.

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

Benefits of West Bengal Health Scheme Offered to IAS, IFS and IPS officers

The Indian Administrative Service (IAS), Indian Forest Service (IFS), and Indian Police Service (IPS) officers received certain benefits under the West Bengal Health Scheme (WBHS):

Benefits for IAS Officers

IAS officers and their families can be a part of this scheme, but it is optional.
They should not be a part of any CGHS (central government health scheme).
They can avail of facilities per the all India service rule act, 1954.

Benefits for IPS Officers

They can be a part of this scheme, but it is optional for them.
They can avail of facilities per the all India service rule act, 1954.
Officers who are already a part of any CGHS (central government health scheme) cannot be part of this scheme.

Benefits for IFS Officers

They can be a part of this scheme, but it is optional for them.
They can avail of facilities per the all India service rule act, 1954.
Officers who are already a part of any CGHS (central government health scheme) cannot be part of this scheme.

List of Diseases Covered Under the West Bengal Health Scheme

The WB health scheme covers 1014 medical treatments. You can check the complete list of covered diseases under the WB health scheme by clicking here.

OPD Treatment Diseases List

The WB health scheme covers various OPD treatments. The West Bengal Health Scheme OPD treatment list is available here. Below mentioned is the list of OPD treatments covered under the West Bengal health scheme:

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

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West Bengal Health Scheme Exclusions

WB Health Scheme does not cover you for the following expenses:

Non-medical treatments
Cosmetic surgeries

Eligibility Criteria For West Bengal Health Scheme

The eligibility criteria for joining the west bengal health scheme are listed below.

The West Bengal health scheme is aimed towards state government employees, retired government personnel, and their families.
People who chose to participate in this WB Health Scheme under the Medical Allowance are also eligible.
All India Services officers and pensioners are eligible for this scheme.
The family members covered under the West Bengal Health Scheme include the beneficiary's spouse, parents, dependent children, and dependent siblings.

West Bengal Health Scheme (WBHS) Enrollment Process

The process of enrollment and registration can be started by visiting the website of West Bengal Health Department. From there, you can choose to enroll as a government employee, government pensioner, grant-aided college or university beneficiary, or grant-aided college employee. Below mentioned are the steps to enroll yourself into the West Bengal Health Scheme (WBHS):

Visit the official website of West Bengal Health Scheme.
Click on the “Online Enrollment” section and select government employees.
Check the Yes box if you have a PRAN/GPF number, and then enter the details. If you do not have the details, check the NO box and choose Non-GPF.
Enter details like birth date, and residential district. Save the information needed to register in the WB Health Portal, then click the next button to continue.
Enter details like name, mobile number, address, employee number, office details, family details.
Upload photograph and signature.
Enter details of the beneficiary and head office.
Save the details and make a print out of the report.

How to Download WB Health Scheme (WBHS) Application Form?

Application forms for the Wealth Bengal Health Scheme (WBHS) are available for download on the official website.

For Govt. Employees

Visit the West Bengal Health Scheme official website
Go to the “Download” section
Select ‘Employees’ from the “Select Category”
Download the required form

For the State Govt. Pensioners

Visit the West Bengal Health Scheme official website
Go to the “Download” section
Select “Pensioner” from the “Select Category”
Download the required form

West Bengal Health Scheme (WBHS) Empanelled Hospitals

Below mentioned is the complete list of West Bengal Health Scheme (WBHS) Empanelled Hospitals:

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

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West Bengal Health Scheme (WBHS) Claim Process

West Bengal Health Scheme (WBHS) provides cashless treatment. Hence, if the cost of the treatment is less than the specified package then the beneficiary need not pay the hospital bill as the treatment will be covered as per the scheme. If the cost exceeds the cap specified in the allocated treatment package, the beneficiary and the hospital will be responsible for paying the additional costs billed; There can be no claim for coverage. Below mentioned is the claim process for West Bengal Health Scheme (WBHS):

Submit your west bengal health scheme cashless card at the time of admission at the hospital.
The hospital will send an authorisation request to the Government Authorized Agency (GAA).
GAA will verify the details and approve the request.
The hospital will send the treatment bill to the GAA after the treatment along with the required documents such as doctor’s certificate, medical report, discharge summary, etc.
GAA will verify the sent documents and transfer the amount to HCO.