West Bengal Health Scheme (WBHS)

Launched by the West Bengal Government in 2014, the WBHS is a health insurance scheme. It offers cashless treatment facilities to All India Services (AIS) officers, state government employees, and pensioners.

 

Under the aegis of this scheme, you can take advantage of cashless indoor treatment amounting to Rs.1 Lakh. Additionally, you can also receive financial aid for OPD treatment and even avail of out-of-state treatment benefits. 

Key Features of the WBHS Scheme

Here are a few key features of the West Bengal Health Insurance Scheme (WBHS):

• Cashless Indoor Treatment

With the WB Health Scheme, you can avail the benefits of cashless indoor treatment for up to Rs. 1,00,000 from hospitals including in the WBHS hospital list. If the bill amount exceeds Rs. 1,00,000, the additional amount must be settled by you.

• OPD Treatment

As a beneficiary, you can claim the reimbursement for your OPD treatment according to the conditions provided by the scheme.

• Non-Empanelled Hospital

If you choose to avail any kind of treatment from a non-empanelled hospital, a certain amount of the bill can be reimbursed through the West Bengal Health Scheme.

• Out-of-state Hospitalisation

If you get a treatment done from an empanelled hospital belonging to a different state, you are eligible to claim the reimbursement.

Benefits of the West Bengal Health Scheme

WB Health Scheme offers coverage for over 1,000 medical procedures. The following table explains the extent of coverage for certain treatments:

1. Benefits for the IAS Officers

IAS officers can avail the benefits of West Bengal Health Scheme for themselves and their families as per the following conditions:

 

• Enrolling for the WBHS is optional

• The concerned administrative department for IAS officers and their families would be the Personnel and Administrative Reforms Department

• IAS officers and their families can avail facilities as per All India Services Rules, 1954

• They shouldn’t receive healthcare benefits under the Central Government Health Scheme (CGHS)

2. Benefits for the IPS Officers

IPS officers and their families can avail the benefits of WBHS as per the following conditions:

 

• The WB Health Scheme is optional

• Their administrative department will be the Home Department Police Service Cell

• They can avail the facilities of All India Services Rules, 1954

• They shouldn’t avail the benefits of the Central Government Health Scheme (CGHS)

3. Benefits for the IFS Officers

IFS officers and their families can benefit from the WBHS as per the following conditions:

 

• Then enrollment is optional

• The concerned department for IFS officers would be the Department of Forests

• They can avail All India Services Rules, 1954 facilities

• Officers that receive healthcare benefits under the Central Government Health Scheme (CGHS) cannot be a part of the WB Health Scheme

What is Covered & Not Covered Under the WB Health Scheme?

Here’s the list of the diseases which are included and excluded under the WB Health Scheme:

How to Enrol and Register for the West Bengal Health Scheme

The process to enrol for the West Bengal Health Scheme is easy and can be done online through the online website of West Bengal Health Department. Here are the steps you can follow to register for the West Bengal Health Scheme:

 

• Step 1: Visit the West Bengal Health Scheme official portal: https://wbhealthscheme.gov.in/

• Step 2: Click on the option that says ‘Online Enrolment’ and then select the ‘Government Employee’ option.

• Step 3: Click ‘Yes’ and enter your PRAN or GPF number if available. If not available, click on the ‘No’ option and select Non-GPF.

• Step 4: Enter your details such as your residential address, birth date, district, contact number, employee number, etc. Save them and click ‘Continue’. Make sure that all information is correct.

• Step 5: Upload scanned copies of your photograph and signature in the specified dimension.

• Step 6: Enter the details of your beneficiary and save them.

• Step 7: Take a printout of the online form for your future reference.

Registration Procedure For Pensioner Under WBHS

Follow the below-mentioned steps to register as a pensioner under WBHS:

• Navigate to the online website of the the Health Scheme Portal of the Finance Department of the Government of West Bengal.

• Click on the option “online enrollment”.

• Choose the option ‘’Govt. Pensioner’’ from the dropdown list which appears.

• Enter you P.P.O. No. on the new page which appears. 

• Tap on “Ok”.

• Enter your necessary details like your date of birth, district of birth, gender, name, email ID, mobile number, ID proof, retirement date, residential address, name of the department, previous office location, etc.

• Upload a scanned copy of your photo and signature in the required format and size.

• Upload the other necessary documents.

• Review your entered information.

• Click on ‘’Submit’’.

You are now registered as a pensioner under WBHS.

Registration Procedure For College Under WBHS

Here’s how you can register for college under WBHS:

• Navigate to the official website of WBHS.

• Click on ‘’Online Enrolment’’.

• Select your preferred beneficiaries of grants in your aid college.

• Enter your Human Resource Management System (HRMS) ID.

• Tap on ‘’Ok”.

• Fill in the necessary details as asked in the new registration form that appears on your screen.

• Click on ‘’Submit’’. 

You are now registered for college under WBHS.

Registration Procedure For University Under WBHS

Here’s how you can register for university under the West Bengal Health Scheme:

• Navigate to the official website of WBHS.

• Click on the ‘’Online Enrolment’’ tab.

• Select your preferred beneficiaries of grants in your aid university.

• Enter your PAN card number.

• Enter the necessary details as asked on the new registration form that gets displayed on your screen. 

• Click on ‘’Submit’’. 

Registration Procedure For a New Hospital Under WBHS

Here’s how you can register for a new hospital under West Bengal Health Scheme:

• Navigate to the official website of WBHS.

• Click on the ‘’Online Enrolment’’ tab.

• Click on ‘’New Hospital Registration’’ tab.

• Enter the necessary details like your organisation’s type, system’s type, district, state, service provider, etc.

• Click on the ‘’Submit’’ button.

Your hospital is now registered under the West Bengal Health Scheme.

How to Download the West Bengal Health Scheme Application Form

Follow the given steps to download the WBHS application form from the official website:

 

• Step 1: Go to the WBHS portal’s download section at: https://wbhealthscheme.gov.in/Home/wbhs_download.aspx

• Step 2: Click on the ‘Select Category’ dropdown menu and choose your relevant category

• Step 3: From the list of forms that appear, download the WBHS application form

• Step 4: Make sure to save a soft copy on your computer and take a printout for future reference

WBHS Forms for State Government Employees

To avail of the benefits of the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, state government employees must fill out and submit a designated form for availing of a particular type of service. These forms include -

 

1. Form A: This is the application form for enrolment in the West Bengal health scheme

2. Form D1: This form represents an essentiality certificate and a statement of expenditure for outpatient (OPD) treatment. It has to be certified by a treating specialist.

3. Form D2: Includes an essentiality certificate and a statement of expenditure for both IPD and OPD treatment, certified by a medical specialist.

4. Form D3: Includes an essentiality certificate and a statement of expenditure for medical treatment in non-empanelled hospitals.

5. Form C: A state government can claim reimbursement for medical expenses incurred by using these forms:

 

• Form C1: Reimbursement for the cost of OPD treatment in empanelled hospital

• Form C2: Reimbursement of inpatient department (IPD) treatment in a non-network hospital

• Form C3: Cashless IPD treatment in a hospital that is in the West Bengal health scheme hospital list

• Form C4: Non-cashless IPD treatment in non-empanelled hospital

6. Form E: Includes a checklist for reimbursement of medical claims.

WBHS Forms for State Government Pensioners

State government pensioners have to fill and submit a different set of forms. They include the following:

How to Claim the West Bengal Health Scheme

The WBHS scheme is completely cashless, implying that the beneficiaries do not have to pay any money out of their pockets. The hospital bills are directly settled by the insurers. However, if the bill amount exceeds the maximum coverage, the beneficiary would have to pay for the extra expenses. Here are the steps your can follow to claim the insured amount under the WBHS:

 

• Step 1: Submit your WBHS cashless card at the empanelled hospital where you are getting treated.

• Step 2: The hospital will send a verification request to the GAA (Government Authorised Agency).

• Step 3: The GAA will verify the details and send their approval.

• Step 4: After the treatment, the hospital will send the bills to the GAA.

• Step 5: Upon verifying the details, the GAA will settle the bill with the hospital.

Eligibility Criteria for the WB Health Scheme

Here are the eligibility parameters of the West Bengal Health Scheme:

• Central and state government employees who avail of pensions 

• Employees who have opted for the medical allowance

• Pensioners

• Officers across the country 

Parents, spouses, siblings, and children who are financially dependent on the beneficiary are eligible for the WBHS scheme.

WBHS Empanelled Hospitals in Kolkata, West Bengal [Not Exhaustive]

West Bengal Health Scheme Helpline Number

Here’s how you can contact the customer service executives in case of any queries or concerns:

 

Email address: support.wbmedicalcell@nic.in

Contact number: (033)2254-4123/(033)2254-4034

For Technical Help:

Email address: support.hshed-wb@nic.in

Contact number: 18001028014

Do I Have The Option To Opt Out Of The WBHS?

Yes, you can opt-out of the scheme if you have adequate private health insurance to take care of yourself and your family. However, if any of your family members have availed the WBHS benefit, then you won’t be able to opt-out until 5 years of availing the benefit.

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