West Bengal Health Scheme (WBHS): Eligibility, Coverage, Benefits & Registration Process

Launched with the vision to provide end-to-end healthcare benefits, WBHS has become a lifeline for employees and pensioners of the state government and their families. Imagine a scheme that takes care of your hospital bills when life throws up an uncalled-for twist or when your health requires regular visits to the doctor or critical surgery. This is one scheme that is much more about insurance- it's a question of making a choice between health and financial security.

But how does this scheme work? What makes this different, perhaps, from any other health program? And above all, how can you or your loved ones fully exploit its benefit? In this article, we will unwind all the information that will help you run through the labyrinth of WBHS with ease and confidence.

Let's dive in!
 

What Is The West Bengal Health Scheme?

West Bengal Health Scheme is a state-level health insurance scheme that was initiated in 2008. Later, in 2014, it was restructured and renamed as the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme. This updated version of WBHS has merged the original one into its revised provisions, increasing the benefits and accessibility of this scheme to its beneficiaries.

Under the scheme, cashless medical treatment up to Rs. 1 lakh is provided at designated hospitals, commonly known as empanelled hospitals or Health Care Organizations(HCOs).

Wondering what this scheme has to offer? Let’s delve into the various aspects it serves!

Features And Benefits Of The West Bengal Cashless Medical Treatment Scheme:

Key Features:

Let’s have a closer look at the key features of the West Bengal Health Scheme-

• Indoor Cashless Treatment: One of the distinctive features of WBHS is the indoor, cashless treatment facility at empanelled hospitals. The cost for treatment, as covered by the scheme, is up to Rs. 1 lakh. Expenditures exceeding this amount need to be shouldered by the beneficiary. This provision is a great relief during emergencies, ensuring that financial constraints do not impede access to needed medical care.
   
• OPD Treatment: WBHS also provides compensation for OPD treatment. This feature enables beneficiaries to get reimbursement for frequent doctor consultations, tests, and medications, thereby making routine healthcare maintenance more affordable.
   
• Treatment In Non-Empanelled Hospitals: What if a beneficiary chooses to go for treatment in a non-empanelled hospital? Even for that, there is a provision under the scheme. A certain percentage of the expenses incurred at non-empanelled hospitals can be compensated under the scheme's terms, thereby allowing flexibility in the choice of healthcare provider. This ensures some sort of financial aid even when empanelled hospitals are not accessible.
   
• Out-of-State Hospitalisation: The WBHS extends coverage to beneficiaries in empanelled hospitals outside West Bengal in case they require specialised care. This feature is quite handy for beneficiaries who travel out of the station for work or might fall sick in another state and require quality treatment.

Key Benefits:

The updated scheme of WBHS covers more than 1,000 medical procedures. Following is the coverage summary of different types of procedures:

• Specialised Surgical Operations: Cover for a maximum of 12 days.
• Major Surgeries: Cover for 7 to 8 days.
• Laparoscopic or Endoscopic surgeries, Normal Deliveries: Cover for 3 to 4 days.
• OPD and Minor Surgeries: The coverage will be for a day.

Let’s move on to understand what diseases are covered by the WBHS!

List of Diseases and Treatments Covered Under West Bengal Health Scheme:

West Bengal Health Scheme has a long and comprehensive list of different medical ailments and their associated treatments covered under it. Some major areas which have found inclusion in the scheme are as follows:

• Endodontic Procedure (Root Canal Treatment): It covers root canal treatments.
• Rheumatoid Arthritis: This is an autoimmune condition for which the treatment is covered.
• Systemic Lupus Erythematosus: The chronic autoimmune disease also comes under the ambit of this scheme.
• Crohn's Disease: Treatment related to this inflammatory bowel disease also falls under the category.
• Heart Conditions: All types of cardiovascular illnesses that fall under this bracket can be claimed under this policy.
• Cerebrovascular Diseases and Neurological Conditions: The policy covers diseases related to the brain and nervous system.
• Invasive Malaria: Even the most serious types of malaria can be covered.
• COPD, or Chronic Obstructive Pulmonary Disease: Even a chronic respiratory system illness is covered.
• Malignant Conditions: Cancer and other benign diseases are covered under this scheme
• Tuberculosis: This is a serious bacterial infection which the scheme provides coverage for.
• Hepatitis B/C and Other Liver Conditions: Coverage for treatment of diseases of the liver and hepatitis.
• Insulin-Dependent Diabetes: Diabetes requiring a dependent use of insulin is covered by the scheme.
• Bleeding Disorders, Platelet Disorders, or Thalassemia: The treatment that may arise from bleeding disorders, platelet disorders, or thalassemia can also be covered under this scheme.
• Renal Failure: The renal failure treatment and the treatments concerning the same are covered.
• Accidental Injuries: Accidental injuries and animal bites are also covered.

Further, we dive deeper to know what the WBHS comprises and under what circumstances it won’t cover your treatments.
 

Inclusion And Exclusion Of West Bengal Health Scheme

Inclusion:

WBHS offers full medical cover that includes hospitalisation, surgeries, and treatments. The beneficiaries are entitled to cashless medical treatment from the empanelled hospitals and medical facilities. It offers a network of specialist doctors and different consultations for most kinds of medical conditions.

Exclusions:

Although the West Bengal Health Scheme covers a wide range of medical expenses arising at accredited hospitals, there are certain exclusions that do arise.

• Non-medical and aesthetic treatments: The scheme does not cover the cost of non-medical procedures or aesthetic treatments. In other words, it is quite simple that all cosmetic or non-essential treatments or surgeries are excluded under this cover.
• Participation and beneficiary rules:
  • Employee Participation: The West Bengal Health Scheme provides membership facilities to all employees. If a member or any one of his or her beneficiaries has already availed of the benefits under the scheme, re-subscription to the scheme would be possible only after five years.
  • Dependent Parents: Female employees cannot cover dependent parents as beneficiaries under the scheme. The only condition for enrolling dependent parents is that they meet the income criteria, after which they will be enrolled separately under the scheme. The children who meet the eligibility criteria shall be covered under the Scheme.

Wondering if you can benefit from the WBHS? Let’s decode whether you are eligible or not!
 

Who Are Eligible For West Bengal Health Scheme

The beneficiaries falling under the ambit of the West Bengal Health Scheme include:

• State Government Employees And Pensioners: Serving and retired employees of the state government positions.
• Recipients Of Medical Allowance: Such employees who have selected the scheme through their Medical Allowance extended to them are also the recipients.
• Officers And Pensioners Of All India Services: The scheme applies to serving/retired officers and pensioners of All India Services.
• Family Members: The scheme covers the eligible beneficiary's spouse, dependent parents, children, and siblings.
   

How To Join The West Bengal Health Scheme And Register?

Enrollment in the West Bengal Health Scheme is done as follows:

• Log In To The Official Website Of The West Bengal Health Department: You must log in to the official website and start the registration process.
• Enrollment Type: On the website, select the appropriate category for enrollment- Government Employee, Government Pensioner, Beneficiary of Grant-in-Aid College, Beneficiary of Grant-in-Aid University, or New Hospital Registration.

Now, if you are a government employee, the procedure changes as follows:

• Reach The Enrollment Portal: Approach the West Bengal Health Scheme Portal.
• Click Online Enrollment: In the header section, click "Online Enrollment and click "Government Employee."
• PRAN/GPF Number: Further, if you have a PRAN or GPF number, click "Yes," after which you specify all details. Otherwise, click "No," selecting "Non-GPF."
• Give Your Personal Information: This includes your district of residence and date of birth. Click "Save" to continue to the next step.
• Personal Details: The name, address, mobile number, employee number, etc., are to be filled in.
• Office Details: The office details are to be filled here.
• Family Details: The members to be covered under this scheme are to be listed here.
• Photograph And Signature Upload: Upload the photograph and signature here as per the given dimensions and guidelines.
• Beneficiary Information Detail Beneficiary: The beneficiaries of the said scheme are to be detailed here.
• Provide Head Office Detail: Give in head office details.
• Save And Print: Save your details and print your confirmation report for reference purposes.
   

How To Download The Application Form For The West Bengal Health Scheme

To download the application forms for the West Bengal Health Scheme, follow the underlying process for your category in the following manner:

• For State Government Employees:
  • Access The West Bengal Health Scheme Portal: Visit the official website.
  • Downloads Section: Search and click on "Downloads" in the menu.
  • Select Your Category: In the dropdown "Select Category", select 'Employees'.
  • Download The Form: Search and download the applicable form for employees.
     
• For State Government Pensioners:
  • West Bengal Health Scheme Portal: Check the official website.
  • Download Section: Click on the "Downloads" section.
  • Category: Within the drop-down menu option, select "Pensioner".
  • Download The Form: Go and download the relevant form applicable to pensioners.
     

Still confused about how to avail the benefits of the West Bengal Health Scheme? We are here to help you out!
 

How To Claim The West Bengal Health Scheme?

West Bengal Health Scheme is cashless in nature, meaning that if the cost of treatment is covered under and within the package limit, the beneficiary does not have to pay hospital bills. Beyond this limit, the excess has to be settled by the beneficiary directly with the hospital, and no claim for this excess amount can be allowed.

Let’s look at the procedure to be followed to claim the scheme-

• Introduce Cashless Card: Present your cashless card at the time of admission in an empanelled hospital for the treatment.
• Authorisation Request: The HCO shall raise an authorisation request to the Government Authorised Agency(GAA).
• Approval By GAA: The GAA shall scrutinise and approve the request for authorisation.
• Bill Submission Post-Treatment: The HCO or hospital will forward the bill, along with required documents such as a medical report, doctor's certificate, and discharge summary, to the GAA.
• Document Verification: The submitted documents will be verified by the GAA.
• Payment Transfer: The GAA will transfer the approved amount directly to the HCO.
   

Hospitals Empaneled Under WBHS

Following are some of the empanelled hospitals under West Bengal Health Scheme:

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

Please Note: The status of some of the hospitals is likely to change. It is always advisable to check the current status from the hospital itself about the empanelment status or the latest available information in the West Bengal Health Scheme Portal. The website provides a detailed list of all the empanelled hospitals, whether government, local, state-aided, or private.
 

Helpline Numbers For West Bengal Health Scheme

To get any help with the WBHS, the below-mentioned contact details can be used:

• Email: support.wbmedicalcell@nic.in
• Contact Numbers: (033) 2254-4123 / (033) 2254-4034
   

Regulation Of The Scheme

The West Bengal Health Scheme (WBHS) is managed by the Medical Cell under the Finance Department, which oversees its implementation. It is supposed to keep a constant watch over the scheme, and operational guidelines have to be laid down in close coordination with the State Health and Family Welfare Department.
 

Wrapping It Up!

The West Bengal Health Scheme is not only an insurance scheme; it is a lifeline for thousands of employees and pensioners in service and their families serving the state. Comprehensive coverage with cashless treatment facilities, coupled with an easy claim procedure under WBHS, ensures that health care remains within reach and at affordable costs. Whether you want to get enrolled or know the benefits better, this guide will walk you through everything important that you should know about the scheme. In a time when medical expenditures can seem so overwhelming, the WBHS stands as proof of how much the state cares for its employees.

For more information on health insurance and other related discussions, visit our Health Insurance section.
 

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