West Bengal Health Scheme
05
Feb 2025

Introduction

The West Bengal Health Scheme (WBHS) is a state-initiated health insurance program designed to provide comprehensive medical coverage to government employees, pensioners, and their dependents. Launched in 2008 and revamped in 2014 as the “West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme,” WBHS aims to alleviate the financial burden of medical expenses by offering cashless treatment facilities and reimbursement options.

Also Read: CMCHIS

Key Features of the West Bengal Health Scheme

The WBHS offers several notable features to its beneficiaries:

  1. Cashless Indoor Treatment: Beneficiaries can avail of cashless indoor treatment up to ₹2,00,000 per admission in empanelled private hospitals. If the treatment cost exceeds this limit, the additional amount must be settled by the beneficiary.
  2. Reimbursement of Indoor Treatment Costs Beyond ₹2,00,000: For treatment costs exceeding ₹2,00,000, beneficiaries can submit claims for reimbursement to the Drawing and Disbursing Officer (DDO) or Pension Sanctioning Authority (PSA).
  3. Reimbursement of Related OPD Treatment Costs: Expenses incurred for outpatient department (OPD) treatments related to indoor treatment are reimbursable for up to 30 days prior to admission and 30 days post-discharge.
  4. Reimbursement of OPD Treatment Costs for Specified Diseases: OPD treatment costs for certain specified diseases are reimbursable when treatment is received at recognized hospitals.
  5. Reimbursement for Treatment in Non-Empanelled Hospitals: If treatment is obtained in non-empanelled hospitals within the state, 60% (or 80% if the hospital has more than 80 beds) of the approved cost or the actual amount paid, whichever is less, is reimbursable, provided the hospital had a valid license under the West Bengal Clinical Establishment Act and Rules at the time of treatment.
  6. Coverage for Specific Investigations: Certain investigations are reimbursable based on OPD prescriptions from doctors consulted in recognized hospitals, provided the investigations are conducted in empanelled hospitals or diagnostic centers.
  7. Treatment in Specialty Hospitals Outside the State: Reimbursement is available for treatment in specified specialty hospitals outside West Bengal, subject to prior approval and adherence to guidelines.

Also Read: Bangla Shasya Bima

Benefits of the West Bengal Health Scheme

Below are some of the benefits of West Bengal Health Scheme:

  1. Comprehensive Medical Coverage

  • Covers both indoor and outpatient treatments for various medical conditions.
  • Reimbursement is available for specific chronic diseases even without hospitalization.
  1. Financial Security for Medical Expenses

  • Reduces out-of-pocket expenses by providing cashless treatment at empanelled hospitals.
  • Reimbursement for treatments exceeding the ₹2,00,000 cashless limit ensures financial security.
  1. Access to Top-Tier Medical Facilities

  • Beneficiaries can seek treatment in high-quality empanelled hospitals.
  • The scheme includes provisions for specialized treatments outside West Bengal.
  1. OPD and Diagnostic Reimbursements

  • OPD expenses related to hospitalization and specific diseases are covered.
  • Reimbursement for necessary diagnostic tests prescribed by recognized doctors.
  1. Coverage for Pensioners and Dependents

  • Ensures retired employees and their families continue to receive healthcare benefits.
  • Dependents, including spouses and children, are also covered.
  1. Flexible Treatment Options

  • Even if treatment is sought in non-empanelled hospitals, partial reimbursement is provided.
  • Beneficiaries can seek approval for treatment in specialized hospitals outside the state.

These benefits make the West Bengal Health Scheme a crucial healthcare initiative, ensuring affordable and accessible medical treatment for government employees, pensioners, and their families.

Also Read: Ayushman Bharat Yojana

Eligibility Criteria of West Bengal Health Scheme

The WBHS is primarily designed for:

  • Government employees of West Bengal.
  • Pensioners who have retired from government service in West Bengal.
  • Beneficiaries of Grant-in-Aid Colleges and Universities.
  • Employees and pensioners of Panchayati Raj (PR) Bodies in West Bengal.

Dependents of the aforementioned categories are also eligible for the scheme’s benefits.

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Diseases and Treatments Covered Under the West Bengal Health Scheme

The West Bengal Health Scheme (WBHS) provides coverage for 1,014 medical procedures, each with a predefined maximum package rate in Indian currency. The complete list of covered treatments and their respective rates can be accessed on the official WBHS portal.

List of OPD Treatments Covered Under West Bengal Health Scheme

The scheme also includes coverage for critical Out-Patient Department (OPD) diseases. Below is a list of conditions eligible for OPD treatment under the West Bengal Health Scheme 2008:

  • Rheumatoid Arthritis
  • Root Canal Treatment (Endodontic Treatment)
  • Systemic Lupus Erythematosus (LUPUS)
  • Crohn’s Disease
  • Heart Diseases
  • Neurological and Cerebrovascular Disorders
  • Severe Malaria (Malignant Malaria)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Cancer (Malignant Diseases)
  • Tuberculosis (TB)
  • Hepatitis B, Hepatitis C, and Other Liver Diseases
  • Insulin-Dependent Diabetes (Note: Type-2 Diabetes Mellitus is not considered insulin-dependent)
  • Thalassemia, Bleeding Disorders, and Platelet Disorders
  • Kidney Failure (Renal Failure)
  • Injuries Due to Accidents, Including Animal Bites

This scheme ensures that beneficiaries receive necessary medical care for both inpatient and outpatient treatments, helping them manage critical health conditions effectively. For a detailed breakdown of all covered procedures and approved package rates, beneficiaries can refer to the official WBHS website.

Also Read: NREGA Job Card

Enrollment Process of WB Health Scheme

Enrollment in the WBHS is a structured process:

  1. For Government Employees:

    • Access the online enrollment portal designated for government employees.
    • Fill out the required details, including personal information, employment details, and dependent information.
    • Submit the application through the portal.
    • Upon approval, an enrollment certificate or identity card will be issued, confirming coverage under the scheme.
  2. For Pensioners:

    • Visit the online enrollment portal specifically for government pensioners.
    • Complete the application form with personal and pension-related details.
    • Submit the form electronically.
    • After verification, an enrollment certificate or identity card will be provided, indicating inclusion in the scheme.
  3. For Beneficiaries of Grant-in-Aid Institutions and PR Bodies:

    • Separate enrollment portals are available for beneficiaries of Grant-in-Aid Colleges, Universities, and PR Bodies.
    • Applicants should select the appropriate portal and follow the specified enrollment procedures.

Detailed instructions and access to the enrollment portals can be found on the official WBHS website.

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Claim Process of West Bengal Health Scheme

The WBHS provides a streamlined process for claiming medical expenses:

  • Cashless Treatment:

      • Available at empanelled hospitals for indoor treatments up to ₹2,00,000.
      • Beneficiaries must present their WBHS identity card at the time of admission.
      • The hospital will coordinate directly with the scheme authorities for payment up to the specified limit.
  • Reimbursement Claims:

    • For Indoor Treatment Costs Exceeding ₹2,00,000:

      • Submit a claim to the DDO or PSA with all relevant medical bills and documents.
    • For OPD Treatments Related to Indoor Treatment:

      • Claims for expenses incurred 30 days before admission and 30 days after discharge can be submitted for reimbursement.
    • For Specified OPD Treatments:

      • Claims for treatments of specified diseases received at recognized hospitals can be submitted as per guidelines.

All claims should be accompanied by necessary documentation, including medical bills, prescriptions, and relevant certificates. Detailed guidelines and claim forms are available on the WBHS portal.

Required Documents for WB Health Scheme Claims

Below is the list of required documents for WB health scheme claims:

  • WBHS identity card or enrollment certificate
  • Original hospital bills and invoices
  • Prescription from an authorized doctor
  • Diagnostic test reports (if applicable)
  • Discharge summary from the hospital
  • Bank details for reimbursement
  • Any additional documents as required by WBHS

Empanelled Hospitals Within West Bengal Health Scheme

As of the latest updates, WBHS has empanelled numerous private hospitals across various districts in West Bengal. These hospitals offer a range of medical specialties and diagnostic services. For a detailed and updated list of empanelled hospitals within the state, beneficiaries are advised to visit the official WBHS portal:

  • Empanelled Private Hospitals

    : https://wbhealthscheme.gov.in/Home/hospital_list.aspx

This link provides a comprehensive list of empanelled hospitals, including their addresses and contact details.

Specialty Hospitals Outside West Bengal

For treatments that may require specialized care not available within the state, WBHS has also empanelled several renowned hospitals across India. Beneficiaries can seek treatment in these institutions, subject to prior approval and adherence to scheme guidelines. The list of specialty hospitals outside West Bengal includes:

  1. All India Institute of Medical Sciences (AIIMS), New Delhi
  2. Post Graduate Institute of Medical Education and Research, Chandigarh
  3. Tata Memorial Hospital, Mumbai
  4. National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore
  5. Christian Medical College (CMC), Vellore, Tamil Nadu
  6. Apollo Hospital, Chennai, Tamil Nadu

For the complete and updated list of specialty hospitals outside the state, beneficiaries can refer to:

Important Considerations

  • Verification: Before availing of medical services, beneficiaries should verify the current empanelment status of the hospital or diagnostic center, as the list is subject to periodic updates.
  • Prior Approval: For treatments in specialty hospitals outside West Bengal, obtaining prior approval from the relevant authorities is mandatory to ensure coverage under the scheme.
  • Documentation: Beneficiaries are advised to maintain all necessary documentation, including referral letters, medical records, and approval letters, to facilitate smooth processing of claims.

By utilizing the services of these empanelled hospitals and adhering to the guidelines of the West Bengal Health Scheme, beneficiaries can access quality healthcare services with financial support from the government.

How to Check West Bengal Health Scheme Status?

To check the status of your claim under the West Bengal Health Scheme (WBHS), follow these steps:

  • Access the Official WBHS Portal:

  • Log in to Your Account:

      • Click on the “Login” option.
      • Enter your User ID and Password.
      • Complete the CAPTCHA verification.
      • If you haven’t registered yet, you’ll need to create an account by selecting the appropriate option (e.g., Government Employee, Pensioner) and providing the required details.
  • Navigate to Claim Status:

    • Once logged in, go to the “My Claim” section.
    • Select “Claim Status” to view the current status of your submitted claims.

Please note that the WBHS portal will be undergoing maintenance from February 7, 2025, 10:00 AM to February 10, 2025, 12:00 PM. During this period, the portal will be unavailable. After the maintenance, the new portal will be accessible at https://healthscheme.wb.gov.in.

For detailed instructions and further assistance, you can refer to the official WBHS portal.

West Bengal Health Scheme Helpline Number

Below, we have mentioned the necessary contact details of WBHS:

Email ID: support.wbmedicalcell@nic.in

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

Conclusion

The West Bengal Health Scheme (WBHS) is a vital initiative that ensures quality healthcare access for government employees, pensioners, and their dependents. By offering cashless hospitalization, reimbursements for treatments, and financial coverage for specialized care, WBHS significantly reduces the financial burden of medical expenses.

With a vast network of empanelled hospitals across West Bengal and select specialty hospitals outside the state, beneficiaries can avail of top-tier medical facilities. Additionally, the hassle-free claim process and online tracking system make it convenient for users to manage their healthcare benefits efficiently.

For the latest updates, eligibility details, and hospital lists, beneficiaries should regularly visit the official WBHS portal (wbhealthscheme.gov.in). Staying informed about the scheme’s benefits and processes ensures that government employees and pensioners can make the most of their healthcare entitlements.

By leveraging the West Bengal Health Scheme, individuals can access quality medical care without financial stress, reinforcing the state’s commitment to affordable and accessible healthcare.

Categories: Government Schemes

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