West Bengal Health Insurance Scheme

The West Bengal Cashless Medical Treatment Scheme provides cashless healthcare services up to Rs.1 lakh to pensioners, officers, and employees of the West Bengal state government. AIS officers and their families are also covered under this scheme.

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West Bengal Health Scheme (WBHS) is a state-level insurance welfare policy introduced by the state government and issued by its finance department in 2008. Under this health scheme, beneficiaries can avail of OPD treatment for 15 diseases, a cashless medical facility of up to Rs.15 lakh, and reimbursement of treatment costs in selected hospitals. Read on to learn more about this scheme.

Treatments Covered under West Bengal Health Scheme:

Given below is the list of 1014OPD treatment list that comes under West Bengal Health Scheme: 

  1. Cerebrovascular disorders/ Neurological disorders 
  1. COPD (Chronic obstructive pulmonary disease) 
  2. Crohn’s Disease 
  3. Endodontic treatment (root canal treatment) 
  4. Hepatitis B/C and other liver diseases 
  5. Injuries caused by accident (including animal bite) 
  1. Insulin-dependent diabetes (does not includes Type-2 Diabetes mellitus) 
  2. Malignant diseases 
  3. Malignant malaria 
  4. Renal failure 
  5. Rheumatoid arthritis 
  1. Systemic Lupus Erythematosus (LUPUS) 
  2. Thalassaemia (Platelet or bleeding disorder) 
  3. Tuberculosis 

The following is the list of the days covered under West Bengal Health Scheme for specific treatment: 

Surgeries 

Days Covered 

OPD and Minor surgeries 

One day 

Natural childbirth and Endoscopic or Laparoscopic surgeries 

Three to four days 

Major surgeries 

Seven to eight days 

Specialised Surgeries 

Up to 12 days 

Steps to Register for West Bengal Health Scheme

Here are the steps to enroll and register under WBHS:

  1. Visit the WBHS official website (https://wbhealthscheme.gov.in/)
  2. Click on ‘Online Enrolment’
WBHS registration
  1. Select ‘Government Employee’ from drop-down list
  2. Enter the ‘Date of entry into the Govt. Service’
  3. Tick ‘Yes’ and enter PRAN/GPF number (if not available tick ‘NO’)
wbhs Registration Details
  1. Mention residential detail and date of birth
  2. Save and select next
  1. Mention personal, office, and family details
  2. Upload required documents, photographs, and signature
  3. Enter beneficiary detail and head office details
  4. Save and print the report

Steps to Download West Bengal Health Scheme Application Form

Steps for downloading the WBHS application form for employees and pensioners are simple and easy. Here is how to do it:

  1. Visit the official website
  2. Select ‘Employees’ or ‘Pensioner’ from ‘Select Category’ drop down menu
  3. Download the required form

How to Claim the West Bengal Health Scheme

Here is the claim process under WBHS:

  1. While getting admission at an empanelled hospital submit the cashless card
  2. Authorisation requests will be sent to the Government Authorised Agency (GAA) by the Health Care Organisation (HCO)
  3. After verification of details, GAA will approve the request
  1. The bill along with the doctor’s certificate, medical report, discharge summary, and others will be sent to GAA by HCO
  2. After verification of the documents, GAA will transfer the amount to HCO

Eligibility Criteria

The eligibility criteria to avail the facilities under West Bengal Health Scheme are:

  1. Employees, pensioners and family pensioners of the State Government
  2. All India Service officers and pensioners can avail this scheme
  3. Dependent family members of the beneficiary such as spouse, parent, children, sibling, widowed, or divorced daughter, and unmarried, divorced, or widowed sister
  4. Beneficiary who opted for this scheme as medical allowance

Empanelled Hospitals Listed Under West Bengal Health Scheme

The list of empanelled hospitals under WBHS are as follows:

  1. AMRI Hospitals
  1. Apex Institute of Medical Sciences
  2. Apollo Gleneagles
  3. Barrackpore Medicare
  4. Belle Vue Clinic
  5. Bhattacharyya Orthopaedics& Related Research Centre (P) Ltd.
  1. BM. Birla Heart Research Centre
  2. BP. Poddar Hospital
  3. Daffodil Hospitals
  4. Desun Hospitals and Heart Institute
  5. Disha Eye Hospitals
  1. Divine Nursing Home
  2. DM Hospital Pvt. Ltd
  3. Dr Nihar Munshi Eye Foundation
  4. Ekbalpur Nursing Home
  5. Eskag Sanjeevani
  1. Eye Care and Research Centre
  2. Fortis Hospital
  3. Implants Better Sight Centre
  4. Institute of Neuroscience
  5. Kothari Medical Centre
  1. KPC Medical College
  2. Medica Superspecialty Hospital
  3. Nabajiban Hospital
  4. Nightingale Hospitals
  5. Peerless Hospital
  1. RG Stone Urology & Laparoscopy Hospital
  2. RN Tagore International Institute of Cardiac Sciences
  3. Rotary Narayana Nethralaya
  4. Ruby General Hospital
  5. Silverline Eye Hospital
  1. Susrut Eye Foundation
  2. The Calcutta Medical Research Institute
  3. The Mission of Mercy Hospital & Research Centre

Note: Individuals must cross check the list on the WBHS portal as some hospitals may no longer be a part of the scheme.

List of Nine Empanelled off State Hospitals

  1. AIIMS, New Delhi
  2. Apollo Hospitals, Chennai  
  3. Asian Institute of Gastroenterology, Hyderabad  
  4. Christian Medical College, Vellore  
  5. L.V. Prasad Eye Hospital, Hyderabad  
  1. Metro Hospital & Cancer Institute, New Delhi 
  2. NIMHANS, Bangalore 
  3. PGIMER, Chandigarh 
  4. Sankara Netralaya, Chennai  
  5. Tata Memorial Hospital, Mumbai 

West Bengal Health Scheme Helpline Number 

Important contact details of West Bengal Health Scheme. Here are the help line numbers that you must keep a note of: 

Email

Contact Number

support.wbmedicalcell@nic.in 

(033)2254-4123/ (033)2254-4034 

For technical help 

Email

Contact Number

support.hshed-wb@nic.in 

18001028014 

Features of West Bengal Health Scheme

Below is the list of key features of the West Bengal Health Scheme: 

  1. Cashless indoor treatment up to Rs.1 lakh   
  2. Offers OPD treatment based on the waiting period and related conditions of the scheme  
  3. Off-state hospitalisation facility in nine empanelled hospitals  
  4. Reimbursement of treatment cost on non-empanelled hospitals as per scheme guidelines 

Benefits of West Bengal Health Scheme

The updated scheme covers Indian Forest Services (IFS), Indian Administrative Services (IAS), Indian Police Services (IPS), and the retired AIS officers.  

Here are the benefits of the scheme for IFS, IAS, and IPS officers: 

  1. Enrolment under this scheme is optional. 
  2. The concerned department would be the Forest Department for IFS; the Personnel and Administrative Reforms Department for IPS; and The Home Department Police Service Cell for IPS. 
  1. Facilities under the All India Services (Medical Attendance) Rules, 1954 can also be availed. 
  2. Eligible for WBHS 2008 if not enrolled under the Central Government Health Scheme

FAQs on West Bengal Health Insurance Scheme

  • What if the specific limit for cashless indoor treatment exceeds?

    If the specific limit exceeds then individuals have to pay the balance amount to HCO.

  • Does the scheme offer full reimbursement for non-empanelled hospitals?

    No, the scheme offers reimbursement of a certain percentage of treatment cost in non-empanelled hospitals.

  • Can a beneficiary opt-out of WBHS?

    Yes, any West Bengal Government employee and pensioner or IAS officers and pensioners can opt-out of the scheme anytime.

  • Is treatment cost of surgery reimbursable without any package rate?

    Yes, this is reimbursable considering the package cost of similar surgery.

  • Is Swasthya Sathi and WBHS the same?

    No, both are different health schemes. Swasthya Sathi has an upper limit and is specially designed for unorganised sectors. It does not cover OPD treatment cost unlike WBHS.

  • Does WBHS facilitate the dependent step-parents of the beneficiary?

    Dependent parents are eligible for WBHS, but for more specific information call the helpline number or send them an email to their official e-mail address.

  • How much will be reimbursed if treatment is done in non-empanelled hospitals?

    Reimbursement for treatment done in non-empanelled hospitals would be the actual amount paid or 60% of the approved cost, whichever is the lesser.

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