West Bengal Health Scheme

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. 

 

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What is the West Bengal Health Scheme (WBHS)? 

Under West Bengal Health 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.    This scheme covers a range of illnesses, including arthritis, renal failure, neurological disorders, cardiovascular disorders, diabetes, tuberculosis, and malaria, to name a few.

How to Enrol and Register for 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 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: 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 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.

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 including 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.

Type of Treatment

Number of Days Covered

OPD and minor surgeries

1-day

Specialised surgeries

Up to 12 days

Normal deliveries and endoscopic or laparoscopic surgeries

3 - 4 days

Major surgeries

7 - 8 days

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

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

Check out the list of diseases that are included and excluded under the WB health scheme - 

Covered

Not Covered

  • 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)
  • Malignant Diseases
  • Thalassaemia/Bleeding Disorders/Platelet Disorders
  • Tuberculosis

 

 

 

 

 

Intentionally incurred diseases

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

Cosmetic surgeries and treatments

Accidental Injuries

Non-medical treatments

Animal bites or injuries caused due to animals

 

OPD Diseases include -

  • Root Canal Treatment (Endodontic Treatment)
  • Tuberculosis
  • Renal Failure
  • Malignant Diseases
  • Malignant Malaria
  • Blood Diseases (Includes Platelet disorders/ Thalassaemia/ Bleeding disorders)
  • Cerebrovascular Disorders
  • Neurological Disorders
  • Rheumatoid Arthritis
  • Liver Diseases like Hepatitis B/C and other
  • Crohn’s heart disease
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Systemic Lupus Erythematosus (LUPUS)
 

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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 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:

Type of Forms

Particulars

Form I
Application form for enrolment to the West Bengal cashless medical treatment scheme.
Form II
Reimbursement claim settlement form
Form III
Certificate of enrolment
Form IV 1
Essentiality certificate-cum-statement of expenditure (OPD)
Form IV 2
Essentiality certificate-cum-statement of expenditure (IPD & OPD)
Form IV 3
Essentiality certificate-cum-statement of expenditure for non-empanelled hospitals
Form V
Checklist for reimbursement of medical claims
Form VI
Temporary family permit

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.

Eligibility Criteria for WB Health Scheme

Check out the eligibility parameters of the West Bengal health scheme -

  • Central and state government employees who avail of pensions are also eligible for the West Bengal health scheme.

  • Employees who have opted for medical allowance are also eligible

  • Pensioners and All India officers are eligible

Parents, Spouses, Siblings, and children that are financially dependent on the beneficiary are eligible for the WBHS scheme

 

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

The 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 Superspecialty Hospital

Mission of Mercy Hospital

Susrut Eye Foundation
Institute of Neuroscience
Belle Vue Clinic
Fortis Hospital
Kothari Medical Centre
Peerless Hospitex Hospital
Rotary Narayana Nethralaya
Silverline Eye Hospital
B.P Poddar Hospital
Dr.Nihar Munshi Eye Foundation
Eye Care and Research Centre
D.M Hospital Pvt. Ltd
Bhattacharya Orthopaedics
R.G Stone Urology and Laproscopy Hospital
Dafodil Hospitals
Kothari Medical Centre
KPC Medical College
Disha Eye Hospitals
Amri Hospitals
Barrackpore Medicare
Ekbalpur Nursing Home
Nabajiban Hospital
Implants Better Sight Centre
Eskag Sanjeevani
Divine Nursing Home

 

 

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.

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FAQs

  • ✔️What is WBHS?

    It is a health care scheme offered by the government of West Bengal for State Government employees/pensioners and their families.

  • ✔️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 they 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 ₹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 ₹1500 per month.

  • ✔️What is the full form of WBHS?

    The WBHS full form is West Bengal Health Scheme.

  • ✔️What is the WBHS hospital list?

    Here are a few hospital names mentioned under the West Bengal cashless medical treatment scheme hospital list 2021 -

    • The Calcutta Medical Research Institute

    • BP. Poddar Hospital

    • DM Hospital Pvt. Ltd

    • BM. Birla Heart Research Centre

    • Susrut Eye Foundation

    • Rotary Narayana Nethralaya

    • Silverline Eye Hospital

    • Fortis Hospital

    • Daffodil Hospitals

    • Kothari Medical Centre

  • ✔️Is the scheme member’s wife considered as beneficiary?

    Yes, the scheme member’s wife and husband, both are considered as beneficiaries.

  • ✔️Can I get full reimbursement for non-empanelled hospitals?

    WBHS scheme offers reimbursement for only a specific percentage of the total bill amount in the case of non-empanelled hospitals.

  • ✔️Is the West Bengal Health Scheme and Swasthya Sathi the same?

    No, Swasthya Sathi and West Bengal Health Scheme are not the same. Swasthya Sathi health scheme is designed for the unorganised sector and does not offer OPD services or treatments to its beneficiaries.

  • ✔️Is WB Health Scheme cashless?

    Beneficiaries can avail of the cashless medical treatments and services under the WB health scheme in the empanelled hospitals for up to ₹1,50,000.