West Bengal Health Scheme: Eligibility, Benefits, Hospital List, Helpline Number, Cashless Limit

The West Bengal Government launched the West Bengal Health Scheme (WBHS) in 2008, which is a health insurance scheme. It provides a cashless medical treatment facility to state government employees, All India Services (AIS) officers and pensioners. It is a state-level health insurance welfare policy. 

Continue reading to know more about the West Bengal Health Scheme (WBHS), its benefits, eligibility, registration process and diseases covered under the scheme.

What is West Bengal Health Scheme (WBHS)?

The WBHS aims to provide enhanced medical facilities to state government employees and employees of Indian Administrative Services (IAS), Indian Forest Services (IFS), Indian Police Services (IPS) and deputed the affairs of West Bengal. 

Under this scheme, the eligible beneficiaries can get reimbursement for indoor treatment costs in empanelled hospitals in West Bengal and certain empanelled hospitals outside the state. They can also claim reimbursement costs of OPD treatment for specified diseases. 

A medical cell formed under the Finance Department of the Government of West Bengal administers this scheme. The medical cell regulates and monitors this scheme in collaboration with the Health and Family Welfare Department. It also issues the operational guidelines for the scheme’s implementation.

In the year 2014, the Government of West Bengal notified changes to the name of the WBHS scheme. The scheme was renamed as West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme 2014. It also introduced cashless medical facilities up to Rs. 1,50,000 per treatment.

West Bengal Health Scheme Eligibility

• All state government employees and their dependents
• All state government pensioners and their families
• All India Services (AIS) officers and pensioners of West Bengal
• Indian Administrative Service (IAS) officers and their families who fulfil the following conditions are eligible: 
  • They have voluntarily enrolled for the WBHS
  • They should not receive healthcare benefits under the Central Government Health Scheme (CGHS)
• Indian Police Services (IPS) officers and their families who fulfil the following conditions are eligible: 
  • They have voluntarily enrolled for the WBHS
  • They should not receive healthcare benefits under the Central Government Health Scheme (CGHS)
• Indian Forest Services (IFS) officers and their families who fulfil the following conditions are eligible: 
  • They have voluntarily enrolled for the WBHS
  • They should not receive healthcare benefits under the Central Government Health Scheme (CGHS)

West Bengal Health Scheme Benefits

Cashless treatment facility up to Rs.2,00,000:

A cashless treatment facility of up to Rs.2,00,000 per indoor treatment is provided when the treatment is done in empanelled hospitals. Beneficiaries can also claim the reimbursement of indoor treatment costs beyond Rs.2,00,000 when the claim is submitted and approved by the Drawing and Disbursing Officer (DDO) or Public Sector Administration (PSA).

Reimbursement of treatment costs after discharge:

The beneficiaries can get reimbursement of costs of OPD treatment relating to indoor treatment incurred thirty days before admission and also costs incurred thirty days after discharge.

Reimbursement of OPD treatment costs:

Beneficiaries can get reimbursement of the OPD treatment costs for the treatment of 17 specified diseases done in empanelled hospitals.

Reimbursement of the follow-up medical treatment costs:

Beneficiaries can claim reimbursement of follow-up medical treatment costs for certain specified diseases where the treatment is done in empanelled hospitals.

Reimbursement of treatment costs in non-empanelled hospitals:

Beneficiaries can get 60% (80% where there are more than 80 beds) of the approved cost or actual amount paid, whichever is less when treatment is done in non-empanelled hospitals in West Bengal State. However, such hospitals must have a valid license under the West Bengal Clinical Establishment Act and Rules on the treatment date.

Reimbursement of investigation costs:

Beneficiaries can claim reimbursement of certain investigation costs based on the OPD prescriptions of doctors consulted in recognised hospitals concerning any diseases. However, such investigations must be done in empanelled hospitals or diagnostic centres.

Reimbursement of treatment costs in certain hospitals outside West Bengal:

Beneficiaries can claim reimbursement of the actual treatment costs, including the journey cost with one attendant for treatment done in certain specified speciality hospitals outside the state of West Bengal.

West Bengal Health Scheme Hospital List

The list of empanelled hospitals under the WBHS is as follows:

• All hospitals, laboratories, clinics and diagnostic centres under the management of the West Bengal Government and other state governments.
• All hospitals, diagnostic centres and clinics managed by the municipalities or municipal corporations and the other local bodies within the West Bengal State.
• State-aided hospitals:
  • Ramakrishna Mission Seva Pratishthan, Kolkata
  • Islamia Hospital, Kolkata
  • Marwari Relief Society Hospital, Kolkata
  • Institute of Child Health, Kolkata
  • Balananda Brahmachari Hospital, Kolkata
  • Chittaranjan Cancer Hospital, Kolkata
  • Ramakrishna Sarada Mission Matribhavan, Kolkata
  • Dr. M. N. Chatterjee Memorial Eye Hospital, Kolkata
  • J.N. Roy Sishu Seva Bhavan, Kolkata
  • Kalimpong Leprosy Hospital, Kalimpong, Darjeeling
  • Chartoris Hospital, Kalimpong, Darjeeling
  • Sri Balaram Seva Mandir, Khardah
  • Ramkrishna Matri Mangal Pratisthan and B.C. Roy Sishu Sadan, Ariadaha
• Empanelled private hospitals, diagnostic centres and nursing homes within West Bengal State

The list of speciality hospitals under the WBHS outside the state is as follows:

• All India Institute of Medical Sciences, New Delhi
• NIMHANS, Bangalore
• Tata Memorial Hospital, Mumbai
• Christian Medical College, Vellore, Tamil Nadu
• Sankara Netralaya, Chennai, Tamil Nadu
• Apollo Hospital, Chennai, Tamil Nadu
• L.V. Prasad Eye Hospital, Hyderabad, Andhra Pradesh
• Metro Hospital & Cancer Institute, New Delhi
• Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh
• Post Graduate Institute of Medical Education and Research, Chandigarh
• Primus Superspeciality Hospital, New Delhi

Diseases Covered Under West Bengal Health Scheme

Under this scheme, the OPD treatment costs are reimbursable for the following specified diseases:

• Malignant diseases
• Hepatitis B/C and other liver diseases
• Tuberculosis
• Type-1 insulin-dependent diabetes
• Neurological disorders or cerebrovascular disorders
• Heart diseases
• Renal failure
• Malignant malaria
• Thallasaemia, bleeding orders or platelet disorders
• Injuries caused by accident (including animal bites)
• Systematic Lupus Erythematous (LUPUS)
• Rheumatoid arthritis
• Crohn’s disease
• Chronic Obstructive Pulmonary Disease (COPD)
• Endodontic treatment (Root canal treatment)
• Covid
• Ankylosing spondylitis

The follow-up medical treatment is reimbursable for the following specified diseases:

• Neurosurgery
• Renal transplant
• Cancer surgery, chemotherapy or radiotherapy
• Cardiac surgery (Including coronary angioplasty and implants)
• Accident cases
• Hip or knee replacement surgery

The costs of the following specific investigations are reimbursable based on OPD prescriptions from recognised hospitals:

• Sigmoidoscopy
• CT Scan
• Ultrasonography
• Colonoscopy
• Endoscopy
• Endoscopic Retrograde CholangioPancreatography (ERCP)
• Magnetic Resonance Imaging (MRI)

West Bengal Health Scheme Registration Process

Following are the steps to register for the West Bengal Health Scheme:

Step 1: Visit the West Bengal Health Scheme official website.

Step 2: Click the ‘Online Enrolment’ tab and select the appropriate option from the list.

Step 3: Enter the ‘Date of entry into Govt. Service’ or ‘Date of Retirement from Govt. Service’ and the ‘PRAN/GPF’ or ‘PPO’ number or the ‘HRMS ID Number’ or the ‘IOSMS ID’ number.

Step 4: Enter the required details, such as the residential address, date of birth, contact number, district, employee number, etc., and click ‘Continue’. 

Step 5: Upload the photograph and signature in the specified dimension and click ‘Save’.

Step 6: Take a printout of the online form for future reference.

Download West Bengal Health Scheme Application Form

Following are the steps to download West Bengal Health Scheme application form:

Step 1: Visit the West Bengal Health Scheme official website.

Step 2: Click on the ‘Download’ option.

Step 3: Select the category from the drop-down box.

Step 4: Download the West Bengal Health Scheme application form from the list of forms.

Step 5: Once the form is downloaded, take a printout of it.

West Bengal Health Scheme Reimbursement Procedure

The West Bengal Health Scheme is completely cashless; thus, beneficiaries do not have to pay hospital bills. The insurers will directly settle the hospital bills. However, if the bill exceeds the maximum coverage amount, the beneficiaries must pay for the extra expenses. Below are the steps to claim reimbursement of the insured amount under the WBHS:

Step 1: Submit the WBHS certificate to the empanelled hospital during admission or OPD treatment.

Step 2: The empanelled hospital will send bills to the medical cell. 

Step 3: The medical cell will process the bills and pay the bill amount up to Rs.1,50,000 to the hospital. 

West Bengal Health Scheme (WBHS) Helpline Number

WBHS contact number: (033)2254-4123, (033)2254-4034

Email address: support.wbmedicalcell@nic.in

Contact number for GIA colleges and universities: 18001028014

Email address for GIA colleges and universities: support.hshed-wb@nic.in

Benefits of West Bengal Health Scheme (WBHS)

• WBHS provides comprehensive medical coverage, including hospitalization, surgeries, and treatments.
• Beneficiaries can avail cashless medical treatment at empanelled hospitals and medical facilities.
• The scheme offers access to specialist doctors and consultations for various medical conditions.

The West Bengal Health Scheme (WBHS) is an efficent health insurance scheme for the government employees of West Bengal. This scheme provides treatment cost for a variety of diseases and settles the hospital bills. Thus, it secures the medical costs of government employees in the state and their families or dependents.