What is the West Bengal Health Scheme (WBHS)?
The central and state governments work in unison to provide advanced medical facilities to this country’s people. West Bengal Health Scheme (WBHS) is one such initiative by the Government of West Bengal.
The scheme offers pensioners, All India Services (AIS) officials, and state government employees a cashless medical treatment opportunity. It is a welfare scheme for health insurance at the state level. Willing to know about this scheme and what’s included in it?
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What is the WBHS?
The West Bengal Health Scheme is a state-level health insurance welfare policy introduced by the West Bengal government in 2008 and issued by its Finance Department. It came into effect on 1st June, 2009.
This scheme aims to provide enhanced medical facilities to state government employees, pensioners, and their families. The WB government has revised this health scheme from time to time to include a broader segment of society.
Under this scheme, a beneficiary can obtain reimbursement of treatment costs in selected hospitals within this state. This scheme also reimburses costs of OPD treatment of 18 diseases (conditions apply).
Moreover, treatment under the WBHS can be availed in 11 impanelled hospitals outside West Bengal. In addition, individuals can claim reimbursement for the cost of indoor treatment conducted in hospitals other than registered ones. In such cases, norms are subject to compliance with WBHS guidelines.
In 2014, the state government changed the name from West Bengal Health Scheme to ‘West Bengal Health for All Employees and Cashless Medical Treatment Scheme 2014’. This new scheme enables beneficiaries to avail themselves of cashless medical facilities for up to Rs. 2 lakh per indoor treatment.
Key Features of the West Bengal Health Scheme
The West Bengal Health Scheme has many unique and important features. Below mentioned are some of the salient features of this scheme:
Benefits of West Bengal Health Scheme
WBHS covers approximately 1000 odd medical procedures. Read on to know the types of treatment and the number of days under this scheme:
These are some of the West Bengal Health Scheme benefits.
Initially, the West Bengal Health Scheme was solely offered to the West Bengal government's retired and family pensioners. However, the updated scheme intends to provide healthcare facilities to employees of the Indian Administrative Services (IAS), Indian Forest Services (IFS), Indian dialysis servicesPolice Services (IPS), and retired AIS officers.
Following is a detailed discussion of the benefits extended to IAS, IFS, and IPS officers.
For IPS officers:
West Bengal Health Scheme, 2008, is available to IPS officers plus their family members, subject to certain conditions. These are:
- For IPS officers, enrollment under WBHS 2008 is optional.
- Under WBHS 2008, the Home Department Police Service Cell is the concerned administrative department of IPS officers.
- IPS officers can enjoy healthcare benefits under WBHS 2008 as well as the All India Services (Medical Attendance) Rules, 1954.
- IPS officers enrolled under the Central Government Health Scheme (CGHS) cannot claim benefits under this WB government-sponsored scheme.
For IFS officers:
IFS officers and their family members can secure healthcare facilities under WBHS 2008 as per the following conditions.
- Enrollment under the West Bengal Health Scheme, 2008, is optional for IFS officers.
- The concerned administrative department for IFS officers is the Forest Department.
- IFS officers and their family members can avail themselves of medical facilities from WBHS 2008 in addition to facilities provided under the All India Services (Medical Attendance) Rules, 1954.
- While availing of healthcare benefits under the Central Government Health Scheme (CGHS), IFS officers cannot enroll under WBHS 2008.
For IAS officers:
West Bengal Health Scheme provides healthcare benefits to IAS officers under certain conditions. These include:
- For IAS officers, enrollment under WBHS, 2008 is optional.
- Under this scheme, the concerned administrative department for IAS officers is the Personnel and Administrative Reforms Department.
- IAS officers and their families can enjoy the benefits of WBHS 2008 along with facilities under the All India Services (Medical Attendance) Rules, 1954.
- IAS officers receiving healthcare facilities under the Central Government Health Scheme (CGHS) cannot opt for the same under WBHS 2008.
Diseases Covered Under West Bengal Health Scheme (WBHS)
West Bengal Health Scheme covers 1014 medical treatments. Below is the list of diseases covered under WBHS 2008:
Note: WBHS 2008 does not cover cosmetic surgeries and non-medical treatment.
Eligibility Criteria for West Bengal Health Scheme
The following categories of individuals who are eligible for the West Bengal Health Scheme:
- State government employees, state government pensioners, and their families*
- Individuals who have selected this scheme as per their Medical Allowance
- All India Services Officers and pensioners
*Refers to the dependant family member of the concerned government employee or pensioner and includes:
- Husband/wife
- Parents with monthly income less than Rs. 8500
- Children (including step-children, unmarried daughter, adopted children)
- Minor brother(s), minor sister(s)
- Dependant, widowed, or divorced daughter(s)
- Dependant, unmarried, divorced, or widowed sister(s)
Enrollment and Registration Process of West Bengal Health Scheme
To claim reimbursement under WBHS 2008, individuals must enroll in the West Bengal Health Scheme portal.
To enroll in the WBHS portal, follow the process mentioned below. This refers to the WB Health Scheme online registration procedure.
- Step 1: Visit the official WBHS website
- Step 2: Click on ‘Online Enrollment’
- Step 3: Select ‘Government Employee’ from the drop-down list
- Step 4: Enter information in the box containing ‘Date of entry into the Govt. Service’
- Step 5: After that, check the ‘Yes’ or ‘No’ option under the section of ‘Already Have PRAN or GPF No.’? (If you have the number, select yes and enter the details, otherwise, click No and select Non-GPF)
- Step 6: Next, enter details like birth date and residential district
- Step 7: Save the document to register in the WB Health Scheme portal and select next to continue the process
- Step 8: Enter personal details including name, address, mobile no, employee no., etc.
- Step 9: Enter employment/office details
- Step 10: Enter family details.
- Step 11: Upload all the respective documents and signatures.
- Step 12: Enter details regarding the beneficiary.
- Step 13: Enter head office details.
- Step 14: Save these and print them for future reference.
This completes the West Bengal Health Scheme registration process.
Steps to Download the West Bengal Health Scheme Application Form
Now that you know how to apply for the West Bengal Health Scheme, eligible applicants can download the WBHS application form from its portal.
The download processes for both state government employees and pensioners from the WBHS portal are discussed below:
For State Government Employees
The steps for downloading West Bengal Health Scheme Application Form for State Government employees are as follows:
- Step 1: Visit the WB Health Scheme portal.
- Step 2: Click on ‘Download’ on the dialogue box appearing on the left
- Step 3: Select ‘Employee’ from the ‘Select Category’ drop-down menu
- Step 4: Download the suitable form
Government employees can find various types of forms that are enumerated in the following table.
For state government pensioners
The steps for pensioners are different from state government employees. Follow the steps below for a better understanding:
- Step 1: Visit the WB Health Scheme portal.
- Step 2: Select ‘Download’ from the left dialogue box
- Step 3: Choose ‘Pensioner’ from the ‘Select Category’ drop-down menu
- Step 4: Download the suitable form
Pensioners can find different types of forms in the West Bengal Health Scheme portal. These are listed in the table below:
Claiming Process of West Bengal Health Scheme
WBHS works in a cashless manner, where individuals can claim reimbursement for treatment costs specified in the scheme. However, if the cost exceeds the specified amount, the applicant must bear such additional costs. Beneficiaries must submit a WBHS claim form or a WBHS reimbursement form to acquire the benefits.
Here’s how one can claim benefits under WBHS:
- First, provide the cashless card issued by the Government Authorised Agency (GAA) during admission in an empanelled hospital.
- An HCO will need an authorisation from the GAA.
- GAA will verify the details before approving the request.
- On treatment completion, the HCO or the concerned hospital will remit the bills to the GAA and other essential medical documents.
- After that, GAA will check and verify those documents.
- Post-verification, GAA will wire the specified amount to HCO.
Empanelled Hospitals Under the WB Health Scheme
Having a clear list of the empanelled hospitals is helpful for the beneficiaries. Below is a list of empanelled hospitals under the West Bengal Health Scheme:
Note: Many of the hospitals mentioned above may no longer be a part of the WBHS 2008. Therefore, individuals must check if the healthcare facilities covered under WBHS can be availed from the respective hospitals. You can cross-check the updated list on the WBHS portal.
Medical Packages Under the West Bengal Health Scheme
The West Bengal Health Scheme offers many packages that beneficiaries can avail themselves of. Here is a list of packages under the WBHS:
How to Find a Hospital Under the West Bengal Health Scheme?
To find a hospital under the West Bengal Health Scheme online, you can follow these steps:
- Step 1: Visit the Official Website: Go to the West Bengal Health Scheme website or portal. The site often has resources or links to information about empanelled hospitals.
- Step 2: Look for the Hospital List Section: Search for a section dedicated to hospital lists or empanelled hospitals. This section may provide a downloadable list or a search function.
- Step 3: Use Online Portals: Check if the West Bengal Health Scheme has a dedicated online portal or mobile app for beneficiaries. These platforms may include features to search for hospitals.
- Step 4: Contact Support Online: If you can’t find the information directly, use any available contact forms or support chat options on the website to ask for assistance.
- Step 5: Check Health Department Websites: Sometimes, state health department websites provide lists or directories of hospitals under various health schemes, including the West Bengal Health Scheme.
Hospitalisation Process Under the West Bengal Health Scheme
Under the West Bengal Health Scheme, the hospitalisation process involves a few steps. First, the beneficiary must obtain a referral from a registered medical practitioner. Then, they need to identify an empaneled hospital by checking the official list provided by the scheme. Upon admission, the hospital will verify the beneficiary’s eligibility and process the claim.
The hospital will handle the documentation and claim submission to cover expenses according to the scheme's terms. Beneficiaries need to follow additional procedures specified by the scheme to ensure smooth processing and coverage.
Know about:
Important Contact Numbers of West Bengal Health Scheme
Take note of the West Bengal Health Scheme helpline details in case of any emergency.
Email Address of WBHS Portal: 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
The West Bengal Health Scheme intends to give state government workers, retirees, and their families easy access to reasonably priced healthcare. This initiative lowers the financial obstacles to vital medical care.
Now that you have come to know about the various aspects of the West Bengal Health Scheme, you can easily enroll and register under WBHS 2008 and reap its many benefits.
FAQs about West Bengal Health Scheme
Who monitors the WBHS?
The Medical Cell of the WB Government and the state’s Health and Family Welfare Department monitor activities under WBHS 2008.
Does the Certificate of Enrollment help eligible individuals avail reimbursement?
Yes, the Certificate of Enrollment helps eligible individuals get the reimbursement facility under WBHS 2008.
Is the cost of treatment for surgery reimbursable without a package rate?
Yes, the cost is reimbursable. In such cases, the cost will be determined based on similar surgeries.
Can an employee choose not to participate in this program?
Yes, workers have the option to withdraw from the program. However, they must fulfill certain prerequisites to do so.
Can an employee covered by the West Bengal Health Scheme take advantage of the amenities provided under the West Bengal Services Rules?
Yes, an employee who is enrolled in the West Bengal Health Scheme may take advantage of the services provided under the West Bengal Services Rules.
Is the spouse of a scheme participant deemed a beneficiary?
Yes, the spouse of the member of the scheme is eligible to receive benefits of the scheme.
Is it possible to receive reimbursement for surgical treatment costs in the event that no package rate is applied?
Yes, it can be refunded. The total cost of a comparable procedure will be taken into account. You have to submit original bills and receipts from the hospital or medical service provider.
What is the Health Recruitment Board for West Bengal (WB)?
The State Government established the WB Health Recruitment Board. It engages in direct recruitment while hiring candidates, such as medical officials and nurses. The board's official website is www.wbhrb.in.
What WBHS advantages are available to IAS, IFS, and IPS officers?
Officers may choose to participate in the program as long as they are not covered by the Central Government Health Scheme (CGHS) and will use the services in accordance with the All India Services Rules, 1954.
Which illnesses and medical procedures are not covered by the WBHS?
Cosmetic surgery, non-medical treatments, experimental treatments not yet proven to be useful in medicine, substance misuse, self-inflicted injuries, expensive procedures, such as organ transplants, and other chronic diseases may be disqualified.
Who governs the West Bengal Health Scheme?
The Health and Family Welfare Department ensures that the healthcare infrastructure and medical services comply with the scheme's policies, while the Finance Department is crucial in overseeing the scheme's finances and policy framework.
Does the plan set a cap on the cost of a room?
No, but in accordance with the program's guidelines, cashless coverage is restricted to the usual fees for treatments and procedures.
Know about: Room Rent Capping
Does a cashless West Bengal Health Scheme exist?
Yes, the West Bengal Health Scheme provides cashless medical services up to Rs. 2 lakh to pensioners, state government employees, and officers. This program also covers the families of AIS officers.
How can I get the digital certificate for WBHS?
After creating an ID and password during registration, access the WBHS website. After logging in, choose the Download Enrollment Certificate option to download the WBHS digital certificate.
For whom is the WB Health Scheme eligible?
Policy benefits are available to state government employees, dependents, pensioners, and families. Benefits under the scheme are available to all India Services pensioners and Best Bengal service officials.
What is the West Bengal Health Scheme?
The West Bengal Health Scheme (WBHS), a health insurance program, was introduced by the West Bengal government in 2008. It offers pensioners, All India Services (AIS) officials, and state government employees a cashless medical treatment opportunity.