West Bengal Government Health Scheme

The WBHS is a state-level health insurance welfare scheme that began in 2008 and was revamped in 2014 to include government pensioners. Since then, it has been referred to as the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme.

Eligible policyholders can receive cashless treatments in state-run hospitals, also known as empanelled hospitals and Health Care Organisations(HCOs). They can receive up to ₹1 lakh in cashless treatments. They can also claim reimbursement for OPD treatment costs for specified diseases.

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• The state government pensioners + their dependents.
• The state government employees + their dependents.
• All India Services(AIS) officers + pensioners of the state of West Bengal.
• IAS, IPS, and IFS officers and their immediate families who are eligible under the following criteria:
• They have voluntarily enrolled on the WBHS program.
• They are not already insured under any Central Government Health Scheme (CGHS).

Here are the West Bengal Health Scheme benefits:

Cashless Treatment

The eligible person can avail of the West Bengal health scheme cashless limit of ₹1 lakh at one of the empanelled hospitals. If the bill is more than ₹1, the scheme beneficiary will settle the outstanding amount. The scheme must be approved by the Drawing and Disbursing Officer (DDO) or Public Sector Administration (PSA).

OPD Treatment

The reimbursement of the OPD treatment can also be availed depending on the West Bengal health scheme rules and regulations.

Non-empanelled Hospitals

If you get treated at one of the non-empanelled hospitals, you can get reimbursement up to a certain amount as mentioned under the West Bengal health scheme rules. You can expect up to 60% of the approved amount or the actual amount you have paid, whichever is lower when treatments are conducted in non-state-run hospitals in West Bengal. Note that 80% of your total treatment cost should be from hospitals with more than 80 beds.

In order to receive your reimbursement, these non-empanelled hospitals need to be registered under the West Bengal Clinical Establishment Acts and Rules on the treatment date.

Hospitalisation Outside State

Medical expenses can be covered if treatment is undertaken at an empanelled hospital in another state.

Extent of coverage

Over 1000 medical procedures are covered under the scheme. The extent of the coverage provided is mentioned below:

Reimbursement of Treatment Costs After Discharge

You are eligible to receive reimbursement for any OPD treatment costs incurred by them and within 30 days before and after the hospitalisation period.

Reimbursement of the Follow-up Medical Treatment Costs

In the case of certain medical treatments, you are also entitled to be reimbursed for follow-up treatments as long as they are being conducted in one of the empanelled hospitals.

Reimbursement of Investigation Costs

Beneficiaries can also file for reimbursements for investigation costs based on their OPD prescriptions. However, reimbursements are only available for investigations conducted in state-enrolled hospitals or diagnostic centres.

The WB health insurance scheme covers over 1000 treatments and procedures. Here is the OPD treatment list for your reference:

• Root Canal Treatment(Endodontic Treatment)
• Rheumatoid Arthritis
• Crohn’s Disease
• Injuries due to an accident (including animal bite)
• Hepatitis B or Hepatitis C, or any other liver disease
• LUPUS (Systemic Lupus Erythematosus)
• Malignant Malaria
• Tuberculosis
• Bleeding orders/Thalassaemia/Platelet disorders
• Cerebrovascular disorders/Neurological disorder
• Insulin-dependent diabetes (Type-2 Diabetic Melitas does not come into consideration as insulin-dependent diabetes)
• Chronic Obstructive Pulmonary Disease(COPD)
• Malignant diseases
• Renal failure

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

You are also eligible to get reimbursed for the below-mentioned investigation as per your OPD prescriptions from empanelled hospitals:

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

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

The West Bengal government and other state governments manage all hospitals, laboratories, clinics, and diagnostic centres.

Municipalities, corporations, and other local bodies manage all hospitals, diagnostic centres, and clinics in West Bengal State.

State-aided Hospitals

• Dr. M. N. Chatterjee Memorial Eye Hospital, Kolkata
• Ramakrishna Mission Seva Pratishthan, Kolkata
• Ramakrishna Sarada Mission Matribhavan, Kolkata
• Balananda Brahmachari Hospital, Kolkata
• Islamia Hospital, Kolkata
• Institute of Child Health, Kolkata
• Marwari Relief Society Hospital, Kolkata
• J.N. Roy Sishu Seva Bhavan, Kolkata
• Chittaranjan Cancer Hospital, Kolkata
• Chartoris Hospital, Kalimpong, Darjeeling
• Kalimpong Leprosy Hospital, Kalimpong, Darjeeling
• Ramkrishna Matri Mangal Pratisthan and B.C. Roy Sishu Sadan, Ariadaha
• Sri Balaram Seva Mandir, Khardah

Hospitals Outside West Bengal

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

To enrol in the scheme, you can go to the Health Department of the West Bengal Government website. On the website, you can select the option under which you wish to enrol in the scheme. You can enrol as a government employee or pensioner, etc.

For your reference, here are the steps that you need to take if you are a government employee:

• Go to the West Bengal Health Scheme portal.
• Click on the tab for Online Enrolment. Choose “Government Employee”.
• If you have the GPF/PRAN number, tick the box for Yes and add all the details. If you do not have these details, tick No and choose the non-GPF number option.
• Mention all the details like birth date and residential address. Save all this information for registration.
• Now click on Next to proceed ahead.
• Add in all the details like your name, mobile number, address, employee details, etc.
• Add all the office-related details.
• Add all the family details.
• Upload the signature and latest photograph. The dimensions for the photograph should be as per the rules.
• Add in the beneficiary details.
• Add the head office information.
• Save all the details and print them out for reference purposes.

Here are the various steps to download the application form for two different categories of beneficiaries of the policy:

For State Government Employees

• Go to the WB Health Scheme website and go to the downloads section.
• From the Select Categories drop-down menu, select Employees.
• Download the form that is relevant to you.

For State Government Pensioners

• Go to the WB Health Scheme website and go to the downloads section.
• From the select categories drop-down menu, select Pensioners.
• Download the form that is relevant to you.

The West Bengal Health Scheme is a crucial initiative by the Government of West Bengal to provide affordable access to quality healthcare for government employees, pensioners, and their families. The health scheme provides the option for both cashless treatments, OPD reimbursements and coverage for major medical procedures. This scheme severely helps reduce the financial burden of healthcare expenses.

If you are looking for more comprehensive health insurance for parents or yourself, then you can check out the Tata AIG health policy.

At Tata AIG, you can get access to a wide range of benefits and hassle-free claims. From a seamless application process to fast claim settlements, our health insurance plan is an effective way to safeguard your finances during a medical emergency.