WBHS : Coverage, Hospital List, Health Card & More

What is the West Bengal Cashless Medical Treatment Scheme?

In 2014, the state government of West Bengal established a health insurance scheme to provide cashless medical treatment to state government and All India Service (AIS) officers and pensioners in enlisted hospitals.

This West Bengal cashless medical treatment scheme was officially known as West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014. Formerly, the state government’s health insurance scheme was called the West Bengal Health Scheme (2008) but was later merged with the new West Bengal cashless medical treatment scheme on September 15, 2014.

Under this scheme, beneficiaries can avail cashless medical treatment across empanelled hospitals or health care organisations (HCOs) across the state of West Bengal. However, the benefit available under approved package rates and up to a maximum amount of Rs. 1 lakh.

Key Features of WBHS Scheme

Let's understand the features of the West Bengal Cashless Medical Treatment Scheme:

Cashless Indoor Treatment:

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

OPD Treatment:

As a beneficiary, you can claim reimbursement for 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 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 reimbursement.

Benefits of West Bengal Health Scheme

WB Health Scheme offers coverage for over 1000 medical procedures. The below table explains the extent of coverage for certain treatments.

Benefits for 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 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)

Benefits for 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 would be The Home Department Police Service Cell

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

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

Benefits for IFS Officers

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

• Then enrolment 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

Diseases Covered under the West Bengal Health Scheme

The WB Health Scheme covers over 1000 medical treatments. Here's a list of a few OPD treatment diseases covered under the scheme:

• Rheumatoid Arthritis

• Endodontic Treatment (Root Canal Treatment)

• Renal Failure

• Systemic Lupus Erythematosus

• Crohn's Disease

• Neurological Disorder/Cerebrovascular Disorders

• Malignant Malaria

• Hepatitis B/C and other Liver Diseases

• Chronic Obstructive Pulmonary Disease (COPD)

• Insulin-Dependent Diabetes (Type-2 Diabetic Melitas does not fall under insulin-dependent diabetes)

• Malignant Diseases

• Thalassaemia/Bleeding Disorders/Platelet Disorders

• Injuries caused by accidents

• Tuberculosis

• Treatments to Cure Animal Bites

What is not Covered under the WB Health Scheme?

The West Bengal Health Care Scheme only excludes cosmetic surgeries and non-medical treatments.

Eligibility Criteria for WBHS

You are eligible for West Bengal Health Scheme if you fall under either of the categories:

• State government employees, state government pensioners, and their families*

• Individuals opting for this scheme according to their medical allowance

• All India Services Officers and pensioners

The following refers to the dependent family member of the concerned government employee or pensioner:

• Husband/Wife

• Parents with income less than Rs. 3,500 per month

• Minor siblings

• Dependant, widowed, or divorced daughters

• Children (including adopted kids, step-kids, and unmarried daughters)

• Dependant, unmarried, divorced, or widowed sister

How to Enrol and Register in West Bengal Health Scheme

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

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

Step 2: On the website, 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 personal 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 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 future reference.

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 download section at: https://wbhealthscheme.gov.in/Home/wbhs_download.aspx

Step 2: On this page 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 the benefits of the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, state government employees must fill and submit a designated form for availing a particular type of service. These forms include:

1. Form A: This is the application form for enrolment to 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, meaning the beneficiaries do not have to pay any money out of pocket. 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 to claim 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.

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

West Bengal Health Scheme Helpline Number

Email address of WBHS website: 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 scheme?

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.

Conclusion

If you are eligible for WBHS, then you should take full advantage of the scheme to get medical coverage for yourself and your family. However, a cover of only ₹1 lakh may not be enough as medical costs have risen swiftly in the past few years. Ensure that you and your family members (including dependents) are well protected with adequate health insurance cover as deadly infectious diseases like the coronavirus (COVID-19) spread rapidly across the world. If you think your family health cover is not adequate, consider buying comprehensive family health insurance on Bajaj MARKETS, starting at just ₹292 per month.