West Bengal Health Scheme (WBHS): Benefits, Eligibility, Features

Designed to provide essential healthcare services to government employees and pensioners in West Bengal, the WBHS initiative supports the state's healthcare infrastructure.
 

In this blog, we will get into the intricacies of WBHS, offering insights into its benefits, eligibility criteria, and notable features. From coverage details to the application process, we aim to equip you with a thorough understanding of how this scheme safeguards the health and well-being of beneficiaries.

What is the WBHS (West Bengal Health Scheme)?

The West Bengal Health Scheme (WBHS) is a state-level health insurance initiative inaugurated in 2008. In 2014, it underwent a transformative overhaul, merging with the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme. This merger brought about a more streamlined and comprehensive approach to healthcare coverage.
 

Under this scheme, qualified beneficiaries can receive cashless medical treatment at designated healthcare institutions, commonly called empanelled hospitals and Health Care Organisations (HCOs).

Those meeting the eligibility criteria are entitled to a generous cashless treatment allowance of up to ₹1 lakh, ensuring seamless access to essential medical services.

Eligibility Criteria for WB Health Scheme  

• State government employees and their dependents, as well as state government pensioners and their families, are eligible to avail of the policy benefits.
  
• Individuals who opt for medical allowance are also eligible for policy benefits.
  
• All India Services pensioners and service officers of West Bengal can avail of the benefits offered by the policy.

Key Features of the West Bengal Health Scheme

The WBHS has some relevant features that one should be aware of. These features collectively establish the West Bengal Health Scheme as a comprehensive and forward-thinking healthcare initiative, prioritising the well-being of government employees and their families.
 

Listed below are some of the features of the scheme:
 

• Comprehensive Coverage

  The West Bengal Health Scheme extends its protective umbrella to the employees and covers their immediate family, including dependent parents and siblings. This ensures a wide-reaching safety net for the entire household.

 

• Integrated Benefits

  Employees registered under the West Bengal Health Scheme can access a dual benefit. Alongside the scheme's offerings, they become eligible for advantages under the West Bengal Services (Medical Assistance) rules, 1964. This integrated approach enhances the range of medical support available to the employee.

 

• Cashless Convenience

  Beneficiaries receive specialised cashless cards, streamlining the process of seeking medical care. These cards facilitate seamless transactions at empanelled hospitals, sparing individuals the hassle of upfront payments and subsequent reimbursements.

   

• Timely Reimbursement

  In cases of indoor treatment, it is imperative to submit reimbursement claims within three months from discharge. This time-bound process ensures that beneficiaries receive the financial support they are entitled to promptly.

 

• Out-of-State Coverage

  The scheme acknowledges that specialised treatments may necessitate travel beyond state borders. In such cases, expenses incurred on treatment in select specialty hospitals, including journey costs and expenses for one attendant, are eligible for reimbursement.
   

  This provision reflects a commitment to ensuring beneficiaries have access to the best possible care, irrespective of geographical constraints.

Benefits of the WB Health Scheme (WBHS)

The updated WBHS scheme brings forth a host of significant advantages, offering extensive coverage across a wide array of medical procedures.
 

A comprehensive list of over 1,000 procedures falls under the protective umbrella of this scheme. To provide a clearer understanding of the scope, the following table outlines the various types of procedures and the corresponding extent of coverage:
 

• Specialised Surgeries

  The scheme caters to specialised surgical interventions, ensuring coverage for up to 12 days. This provision assures beneficiaries access to the necessary medical attention and care during the critical post-operative phase.

 

• Major Surgeries

  For major surgical procedures, the scheme extends coverage for a period ranging from 7 to 8 days. This time allocation acknowledges the extended recovery period often associated with major surgical interventions, allowing beneficiaries the necessary time for recuperation.

 

• Laparoscopic or Endoscopic Surgeries, Normal Deliveries

  Procedures such as laparoscopic or endoscopic surgeries and normal deliveries are accommodated with coverage spanning from 3 to 4 days. This duration accounts for these specific medical procedures' varying complexities and recovery trajectories.

 

• Outpatient Department (OPD) Visits and Minor Surgeries

  The scheme provides coverage for a single day for outpatient department visits and minor surgical interventions. This ensures that beneficiaries have the essential support for swift and effective medical care without incurring undue financial burdens.
   

The delineation of benefits based on the type of procedure and corresponding coverage duration underscores the scheme's commitment to providing tailored and comprehensive healthcare support to its beneficiaries.
 

This detailed approach ensures that individuals receive the necessary assistance and resources, aligning with the specific requirements of their medical treatment.

Benefits of WBHS For IAS Officers

IAS officers and their families stand to gain significant advantages under the West Bengal Health Scheme, subject to specific conditions:
 

• Participation in the WBHS for IAS officers is discretionary. This means that they can choose whether or not to avail the benefits offered by the scheme.

  This flexibility allows officers to make decisions that best suit their healthcare preferences and needs.

 

• For IAS officers, the governing department overseeing their participation in the WBHS is the Personnel and Administrative Reforms Department.

  This department is the focal point for managing the administrative aspects of their involvement in the scheme, ensuring seamless coordination and adherence to established protocols.

 

• IAS officers are entitled to avail benefits under the WBHS in accordance with the All India Services Rules of 1954.

  These rules provide a framework for the conditions and privileges associated with their participation, ensuring they receive the necessary support and coverage.

   

• To be eligible for benefits under the WBHS, IAS officers should not be enrolled in the Central Government Health Scheme (CGHS).

  This stipulation is in place to prevent duplication of healthcare coverage and resources, ensuring efficient and equitable distribution of medical benefits.

Benefits of WBHS for IPS Officers

IPS officers and their families can avail substantial advantages under the West Bengal Health Scheme, contingent on specific conditions:
 

• IPS officers are offered the choice to opt into the WBHS. This signifies that they can decide whether or not to avail the benefits offered by the scheme.

  This flexibility empowers officers to make healthcare decisions aligned with their preferences and requirements.
  

   

• For IPS officers, the Home Department Police Service Cell serves as the overseeing administrative department for their participation in the WBHS.

  This department is responsible for managing the administrative aspects of their involvement, ensuring seamless coordination and compliance with established protocols.
   

• IPS officers are entitled to benefits under the WBHS per the All India Services Rules of 1954.

  These rules lay down the conditions and privileges associated with their participation, guaranteeing they receive the necessary support and coverage.
   

• IPS officers already enrolled in the Central Government Health Scheme (CGHS) are not eligible to participate in the state scheme.

  This precautionary measure is in place to prevent overlapping healthcare coverage and resources, ensuring effective and equitable distribution of medical benefits.

Benefits of WBHS for IFS Officers

IFS officers, along with their dependent family members, can benefit from this healthcare scheme under the following conditions:

• Participation in the scheme is entirely optional for IFS officers.

• The Forest Department serves as the administrative authority overseeing the scheme implementation for IFS officers.

• Furthermore, IFS officers are entitled to avail the facilities outlined in the All India Services Rules of 1954.

• However, it is worth noting that IFS officers already enrolled in the Central Government Health Scheme (CGHS) are not eligible to participate in this state-sponsored scheme.

Covered Medical Treatments and Diseases in West Bengal Health Scheme

The West Bengal Health Scheme offers extensive coverage of 1014 medical treatments, each accompanied by its maximum approved package rate in Indian currency. Find the specific details here.
 

The OPD treatment list included in the scheme is as follows:

• Rheumatoid Arthritis

• Endodontic Treatment (Root Canal Treatment)

• Systemic Lupus Erythematosus (LUPUS)

• Crohn’s Disease

• Heart Disease

• Neurological Disorders/Cerebrovascular Disorders

• Malignant Malaria

• Chronic Obstructive Pulmonary Disease (COPD)

• Malignant Diseases

• Tuberculosis

• Hepatitis B/C and Other Liver Diseases

• Insulin-Dependent Diabetes (Note: Type-2 Diabetic Melitas is not considered as insulin-dependent diabetes)

• Thalassaemia/Bleeding Disorders/Platelet Disorders

• Renal Failure

• Injuries Caused by Accident (Including Animal Bite)

Medical Treatments and Diseases Not Covered Under West Bengal Health Scheme

The scheme does not encompass cosmetic surgeries or non-medical procedures. With the exception of these, significant treatments are expected to be provided in empanelled hospitals on a cashless basis.

Steps to Enrol in the West Bengal Health Scheme

Steps to Enrol in the West Bengal Health Scheme

• Visit the official website of the West Bengal Health Scheme.

• On the homepage, click on 'online enrollment.'

• In the pop-up menu, select 'government employee.'

• Provide your details on the 'date of entry into govt. service' box.

• Answer whether you possess a PRAN/GPF number. If yes, enter the relevant information. If not, select 'no.'

• Input your personal information, including your date of birth and residential address.

• Save the entered details for enrollment in the West Bengal Health Scheme Portal.

• Click 'next' to proceed with the enrollment process.

• Enter personal information (name, address, and mobile number) and office details (employee number).

• Upload all necessary scanned documents.

• Enter beneficiary details, ensuring to include details related to the head office.

• Save the provided information on the portal.

• Thalassaemia/Bleeding Disorders/Platelet Disorders

• Print out the registration form for future reference and convenience.

How to Download the Enrollment Application Form for the West Bengal Health Scheme?

To obtain the West Bengal Health Scheme Application Form, follow these steps based on your category:

For State Government Employees

• Visit the West Bengal Health Scheme Portal and navigate to the Downloads section.
  
• Choose 'Employees' from the "Select Category" drop-down menu.
  
• Download the applicable form.
   

For State Government Pensioners

• Go to the West Bengal Health Scheme Portal and locate the Downloads section.
  
• Select 'Pensioner' from the "Select Category" drop-down menu.
  
• Download the relevant form.

How to Make a Claim Under the West Bengal Health Scheme?

Claiming benefits under the West Bengal Health Scheme is a seamless process. Operating cashless, if the treatment falls within the specified package limit, the beneficiary need not pay the hospital bill, as the scheme will cover it.

However, in cases where the treatment cost exceeds the allocated package limit, the beneficiary will be responsible for settling the additional expenses with the hospital. It is important to note that any amount exceeding the specified limit will not be subject to a claim.

This system ensures a straightforward and transparent process for beneficiaries to access the healthcare they need.

Claim Process
 

• Admission with Cashless Card: Present the cashless card at an empanelled hospital during admission.

• Authorisation Request: The Health Care Organisation (HCO) will send an authorisation request to the Government Authorised Agency (GAA).

• Request Approval: The GAA will review and approve the request.

• Billing and Documentation: Following the treatment, the HCO or hospital will submit the bill and necessary documents, such as medical reports, doctor’s certificate, and discharge summary to the GAA.

• Document Verification: The GAA will thoroughly verify the submitted documents.

• Amount Transfer: After verification, the GAA will process the transfer of the approved amount to the Health Care Organisation (HCO).

The List of Empanelled Hospitals Under the West Bengal Health Scheme

Here is a compilation of empanelled hospitals participating in the West Bengal Health Scheme:

• 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 Super-specialty Hospital

• Mission of Mercy Hospital

• Susrut Eye Foundation

[Note: Some hospitals may no longer be part of the scheme. Confirm directly with the hospital or check the website. For up-to-date information on participating hospitals in the West Bengal Health Scheme, visit the official portal. It lists government, local, state-aided, and private hospitals.]

Helpline Number of the West Bengal Health Scheme (WBHS)

• Email: support.wbmedicalcell@nic.in
  
• Phone: (033)2254-4123/ (033)2254-4034

Conclusion

The West Bengal Health Scheme is a beacon of support, ensuring accessible healthcare for government employees and pensioners. Its comprehensive coverage and cashless transactions alleviate financial burdens during critical medical situations.

However, it is crucial to complement this security with holistic financial planning. In this reward, life insurance plans provide an invaluable layer of protection, offering peace of mind and financial security for you and your loved ones.

By considering the WBHS and some trusted life insurance offerings, you can forge a robust healthcare and financial safety net, ensuring a future of well-being and stability.