West Bengal Cashless Medical Treatment Scheme

What is the West Bengal Cashless Medical Treatment Scheme?

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.

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 cost of OPD treatment in empanelled hospital

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

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

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

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

Forms for State Government Pensioners

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

Implementation of West Bengal Health Scheme 2008

The West Bengal Health Scheme, 2008 is governed by the finance department of the government of West Bengal in association with the state’s health and family welfare. These government bodies are responsible for issuing guidelines and oversight of the scheme, which is now known as West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014.

The implementation of the West Bengal cashless medical treatment scheme is the primary responsibility of the finance department. It frames rules, regulations and policies of the health scheme, as well as fixes rates for a wide range of medical treatment procedures.

On the other hand, the state’s health and family welfare department takes care of empanelling various private hospitals and diagnostic centres. They are responsible for creating the West Bengal health scheme cashless hospital list where beneficiaries can undergo medical treatment.

Finally, the finance department along with the health and family welfare department handles the following responsibilities for the smooth implementation and functioning of the West Bengal Health Scheme, 2008:

• Laying down regulations for the state govt. departments to approve reimbursement proposals

• Monitoring of empanelled healthcare organisations (HCOs) to ensure high-quality medical treatment of beneficiaries

• Grant permissions for:

• Treatment in specialty hospitals outside the state

• Medical implants

• Organ transplantations

• Cochlear surgery

Extension of West Bengal Health Scheme 2008 to IAS, IFS and IPS officers

In 2009 and 2010, the West Bengal government extended the benefits of WBHS to the employees of Indian Administrative Services (IAS), Indian Forest Services (IFS) and Indian Police Services (IPS) working in the state. However, they could only avail the benefits of the West Bengal health scheme if they were ready to forego CGHS benefits. Again in 2011, the state government also extended the WBHS scheme to include retired AIS officers who had served in West Bengal. The condition, again, was to give up CGHS benefits and to make a one-time contribution of Rs.  40,000.

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

Revised Rate List for WBHS, 2008

The chart below shows key revised rates under the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014.

Source: Antworksmoney.com

• Who is a beneficiary under the West Bengal health scheme?

If you are an employee of the West Bengal state government, all your family members are eligible for benefits of WBHS, provided the meet a few conditions:

• Employee’s spouse

• Children (Step children, adopted children, including unmarried, widowed and divorced daughters)

• Siblings below 18 years of age

• Dependent parents with an income of less than Rs. 3,500 per month

• Dependent sister (Unmarried, widowed or divorced)

• If my son is dependent on my income, can he be considered a beneficiary?

He can be considered a beneficiary until he reaches 25 years of age or until he earns a minimum of Rs. 1500 per month.

• 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.

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