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A financial safety net is provided by health insurance in the event of unlucky medical situations requiring hospitalisation. Welfare programmes that provide health insurance coverage assist consumers in better controlling their medical costs.

 

Indian state and federal governments frequently introduce social programmes for the general public. They are occasionally for the less fortunate members of society and occasionally for other groups. There are also specific health-related programmes. One such specialised health programme is the West Bengal Health Scheme.

What is the West Bengal Health Scheme?

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The West Bengal Health Scheme is a state-level health insurance welfare programme that was introduced by the West Bengal government in 2008 and distributed through its Finance Department.

 

This programme intends to give state government employees improved medical facilities. The WB government has periodically updated its health programme to cover a wider range of society. A beneficiary of this programme is eligible to receive reimbursement for medical expenses incurred at a limited number of hospitals in this state. Additionally, this programme covers the costs of OPD treatment for 15 disorders (conditions apply).

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Features of the West Bengal Health Scheme

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There are several features of the west Bengal health insurance scheme, such as:

 

Cashless Indoor Medical Care

The West Bengal Health Scheme's cashless indoor treatment facility is one of its defining features. It covers medical expenses up to Rs. 1 lakh in hospitals with accreditation. However, the relevant individuals are required to pay the remaining costs to the healthcare organisation if the overall cost of the indoor treatment exceeds the predetermined limit (HCO).

 

Off-State Hospitalisation Facility

Treatment is extended by the West Bengal Health Scheme to hospitals outside the state. However, it must be an empanelled one in order to use the medical amenities in these hospitals.

 

Treatment Coverage in Facilities that are not on the Panel

WBHS application also covers payment for medical expenses incurred in facilities that are not panelled. In situations like this, beneficiaries may be eligible to receive reimbursement for a portion of the cost of the treatment in accordance with the plan's standards.

Benefits of West Bengal Health Scheme

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These are some of the advantages of the West Bengal Health Scheme.

 

The West Bengal Health Scheme was initially only available to West Bengal Government retirees and family pensioners. The revised programme, however, aims to offer medical facilities to IAS, IFS, IPS, and retired AIS officials as well as to personnel of the Indian Administrative Services (IAS), Indian Forest Services (IFS), and Indian Police Services (IPS).

 

For IPS personnel

IPS personnel and their families are eligible for the West Bengal Health Scheme, 2008, with some restrictions. These include

 

  • Enrollment in the WBHS 2008 is optional for IPS officers.
  • The Home Department Police Service Cell is the IPS officers' primary administrative department under WBHS 2008.
  • In accordance with the WBHS 2008 and the All India Services (Medical Attendance) Rules, 1954, IPS officers are eligible for healthcare benefits.
  • Benefits under this WB government-sponsored programme are not available to IPS officers who are enrolled in the Central Government Health Scheme (CGHS).

 

For IFS personnel

 

  • Under WBHS 2008, IFS personnel and their families are permitted to enter healthcare institutions under the following restrictions.
  • For IFS officers, participation in the West Bengal Health Scheme, 2008 is optional.
  • The Forest Department is the administrative division that IFS officers are most interested in.
  • In addition to the services offered by the All India Services (Medical Attendance) Rules, 1954, IFS officers and their families may use the medical facilities of WBHS 2008.
  • IFS officers are prohibited from signing up for WBHS 2008 while receiving healthcare benefits under the Central Government Health Scheme (CGHS).

 

IAS officials

IAS officers are eligible for healthcare benefits under the West Bengal Health Scheme if certain requirements are met. These consist of:

 

  • Enrollment in the WBHS, 2008 is optional for IAS officers.

  • The Personnel and Administrative Reforms Department is the administrative division responsible for IAS officers under this plan.
  • IAS officers and their families are eligible for WBHS 2008 benefits and All India Services (Medical Attendance) Rules, 1954-compliant services.
  • IAS officers who now use healthcare services provided by the Central Government Health Scheme (CGHS) are not eligible to use those same services under WBHS 2008.

Exclusions of the West Bengal Health Scheme

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The cashless medical care programme pays for all of the medical costs listed under the hospitals with accreditation. However, the programme does not pay for any non-medical operations or aesthetic treatments. Consider the features below.

 

  • An employee is free to choose whether or not to participate in the West Bengal Health Scheme, but if his beneficiaries have already benefited from it, he will not be able to do so until five years after the scheme's implementation.
  • The female worker is not permitted to designate her dependent parents as beneficiaries of the programme. But if her dependent parents meet the income requirements, she can join separately and name them as beneficiaries. The advantage of enrolling with either parent is granted to children.

Eligibility for the Scheme

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The requirements for joining the programme are listed below.

 

  • This programme is aimed towards state government employees, retired government personnel, and their families.
  • Additionally eligible for it are those who choose this programme in accordance with Medical Allowance.
  • Pensioners and officials of All India Services are eligible for this coverage.
  • The family coverage indicated covers coverage for the spouse, parents, dependent children, dependent siblings, and dependent grandparents.

How to Join the West Bengal Health Scheme and Register?

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To start the enrollment and registration process, go to the West Bengal Health Departments, i.e. WBHS website. Here are the steps you need to follow for the successful registration.

 

  • Check out the West Bengal Health Scheme Portal.
  • Select Government Employee under Online Enrolment in the header section.
  • Check the Yes box if you have a PRAN/GPF number, and then enter the information. If you are missing the information, check the NO box and choose Non-GPF.
  • Mention specifics like your birthdate and neighbourhood. Save the data necessary to register for the WB Health Portal, then click the next button to continue.
  • Mention your name, address, phone number, employee number, and any identifying information. Along with a picture and signature, include any relevant professional information. Ensure that you follow the guidelines for the proportions.
  • Save the information and print the report for later use.

How to Download the Application Form for the West Bengal Health Scheme

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To download the WBHS application form from the official WBHS website, follow these instructions:

 
  • Step 1: Visit the download area of the WBHS portal at https://wbhealthscheme.gov.in/Home/wbhs download. aspx.
  • Step 2: On this page, select the appropriate category by clicking the drop-down menu labelled "Select Category."
  • Step 3: Download the WBHS health scheme application form from the list of forms that appears.
  • Step 4: Be careful to print out the document and save a soft copy to your computer for future use.

Forms for State Government Employees & Pensioners

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State government employees must complete and submit a specific form for the type of treatment they wish to receive in order to be eligible for the benefits of the West Bengal Health Scheme for all employees and pensioners cashless medical treatment scheme. These forms consist of the following:

 

  • Form A: This is the enrollment application for the West Bengal health system.
  • Form D1: This document serves as a statement of expenses for outpatient (OPD) therapy as well as an essentiality certificate. A medical expert who treats patients must certify it.
  • Form D2: Contains a summary of expenses for both IPD and OPD care, as well as an essentiality certificate signed by a licensed medical professional.
  • Form D3: Contains a statement of expenses for medical care received in non-panelled hospitals as well as an essentiality certificate.

Diseases & Treatments Covered Under WBHS

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The programme offers 1014 surgical treatments.  The West Bengal Health Scheme 2008 OPD treatment list is provided below.

 

  • The endodontic procedure (Root Canal Treatment)
  • Rheumatoid Arthritis
  • Systemic Lupus Erythematosus  (LUPUS)
  • Crohn's illness Heart condition
  • Cerebrovascular diseases and neurological conditions
  • Invasive Malaria
  • COPD (Chronic Obstructive Pulmonary Disease) (Chronic Obstructive Pulmonary Disease)
  • Malignant Conditions
  • Tuberculosis
  • B/C hepatitis and other liver conditions
  • Diabetes that is insulin-dependent
  • Bleeding disorders, platelet disorders, or thalassemia
  • Kidney Failure
  • Accidentally inflicted injuries (including animal bite)

Hospitals Empaneled Under WBHS

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The West Bengal Health Scheme's list of accredited hospitals is available here.

 

  • The Calcutta Medical Research Institute
  • Desun Hospitals and Heart Institute
  • Nightingale Hospitals
  • R N Tagore International Institute of Cardiac Sciences

 

It is best to confirm with the hospital or check the website of WBHS since some hospitals may no longer be a member of the programme.  On the portal for the West Bengal Health Scheme, you may find a list of all the hospitals that accept cash payments. The website provides details on public hospitals, neighbourhood hospitals, state-funded hospitals, and for-profit hospitals.

How to Claim the West Bengal Health Scheme?

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The programme operates without the use of money. As a result, the beneficiary does not need to pay the hospital bill if the cost of the treatment falls within the range of the stated package because the treatment will be paid for in accordance with the system. If the cost exceeds the cap specified in the treatment package allocated, the beneficiary and the hospital are responsible for paying the additional costs of the bill; there may be no claims for the overage. Here is how to submit a WBHS benefit claim.

 

  • First, when being admitted to a hospital with an empanelled status, present the cashless card issued by the Government Authorised Agency (GAA).
  • A GAA authorisation is required for an HCO.
  • Before granting the request, GAA will confirm the information.
  • After the course of treatment is complete, HCO or the relevant hospital will send the bills and other necessary medical records to the GAA.
  • The GAA will next examine and validate such documents.
  • After verification, GAA will wire HCO the agreed-upon sum.

Helpline Numbers for West Bengal Health Scheme

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In case of an emergency, make a note of the West Bengal Health Scheme helpline information.

 

  • Email: support.WBMedicalCell@nic.in
  • Contact No: (033) 2254-4123 or (033) 2254-4034

Regulation of the Scheme

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The WBHS is managed by the Medical Cell of the Finance Department of the West Bengal government. The Cell is in charge of overseeing the programme, along with the state's Department of Health and Family Welfare. Additionally, the Cell provides operational standards.

Frequently Asked Questions

Is West Bengal Health Scheme cashless?

How do I submit a reimbursement request to WBHS?

Where can I find a WBHS certificate?

What does West Bengal's health ID mean?

Is West Bengal Health Scheme cashless? - +

Pensioners, officers, and workers for the West Bengal state government can receive cashless medical treatments up to Rs. 1 lakh through the West Bengal Cashless Medical Treatment Scheme. This programme also covers the families of AIS officers.

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