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

The West Bengal Health Scheme is a health insurance welfare scheme for the existing and former state government employees and their family members. The scheme also caters to the beneficiaries of grant-in-aid colleges and universities. The WBHS was initially introduced in 2008. Six years later, it went through a structural revamp to become the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme [1].  

In accordance with the updated scheme, beneficiaries are eligible for availing cashless treatment of up to Rs.1 lakh at empaneled hospitals. Read on to understand the important details regarding the WBHS.

West Bengal Health Scheme Benefits

There are more than 1000 medical procedures covered under WBHS. The benefits of coverage under different procedures are as follows. 

Benefits for IAS Officers

IAS officials and their families are eligible for the West Bengal Health Scheme if they meet the following criteria:

• WBHS enrollment is optional
• The personnel and administrative reforms department is the administrative department in charge of IAS officers and their respective families
• According to the All India Services Rules, 1954, IAS officials and their families are entitled to various benefits
• They should not be eligible for healthcare under the Central Government Health Scheme (CGHS)

Benefits for IPS Officers

WBHS benefits are available to IPS officers and their families under the following conditions:

• The WB health plan is optional
• The Home Department Police Service Cell would be the designated administrative department
• They can utilise all the benefits of the All India Services Rules, 1954
• Their eligibility for the Central Government Health Scheme shouldn't be granted (CGHS)

Benefits for IFS Officers

WBHS is available to IFS personnel and their families under the following conditions:

• Enrollment is voluntary
• The Department of Forests would be the appropriate department for IFS officials
• They can avail of all advantages under the All India Services Rules, 1954
• Officers receiving healthcare benefits under the Central Government Health Scheme (CGHS) are not eligible to participate in the WB Health Scheme

West Bengal Health Scheme Registration

Just visit the official website of the WB Health Department to get started with the registration process. 

If you are registering as a government employee, follow these steps:

• Select the online enrollment from the header section 
• Next, select the option of a government employee.
• Enter the date when you joined government services
• If you have a GPF or PRAN number, click the yes box and fill in your number. In case you don’t have a number, select the non-GPF option. 
• Mention your details like your name, date of birth, address, and so on
• Mention your family and office details
• Upload your signature and photograph
• Enter details of other beneficiaries in the family (if any) 

West Bengal Health Scheme Eligibility

• WBHS is meant for state government employees, including those availing of pension and their families.
• This scheme can be availed by All India Services officers and those on a pension, provided they have not opted for Central Government Health Scheme (CGHS) 
• WBHS is also eligible for those who have opted for it as a medical allowance.
• The cover mentioned for the family includes any dependents of the beneficiary.

West Bengal Health Scheme Features

There are four major features of the WBHS.

OPD facilities:

You can get reimbursement for OPD treatment according to the conditions, such as that waiting period, mentioned in WBHS.

Treatment benefits at non-empaneled hospitals:

If you avail treatment at non-network hospitals, you can get a certain percentage of the treatment expenses reimbursed

Cashless treatment:

As a beneficiary, you can avail of cashless treatment of up to Rs.1 lakh. If the bill amount crosses the specified limit, you will need to bear the excess amount.

Hospitalization in different states:

You can avail yourself of compensation if you get treated from an empaneled hospital regardless of the state.

Diseases that WB Health Scheme covers under OPD Treatment

WBHS covers outdoor treatment for the following diseases:

• Tuberculosis 
• Malignant diseases
• Heart disease
• Hepatitis B/C and other liver diseases 
• Malignant malaria
• Cerebrovascular disorders / neurological disorder
• Thalassemia / platelet/ bleeding
• Rheumatoid arthritis 
• Crohn’s disease 
• Lupus
• Injuries caused by accident
• Endodontic treatment
• Ankylosing Spondylitis 
• Chronic pulmonary disease [2]

This scheme does not cover any non-medical procedures like cosmetic surgeries.

Download West Bengal Health Scheme Application Form:

Forms for the Wealth Bengal Health Scheme may be downloaded from the official website. Here's how you can do it for various areas.

Downloading Procedure for State Government Employees:-

Downloading Forms for State government pensioners:-

Hospitals Listed Under West Bengal Health Scheme:

The following is a list of hospitals that have been approved by the West Bengal Health Scheme.

• Calcutta Medical Research Institute (CMRI)
• Heart Institute and Desun Hospitals
• Nightingale Clinics
• International Institute of Cardiac Sciences R N Tagore
• Gleneagles, Apollo
• General Hospital Ruby
• BM Birla Heart Research Institute
• Super-specialty Medical Hospital
• Mercy Hospital's Mission
• The Susrut Eye Foundation

It should be noted that some hospitals may no longer be part of the plan; thus, it is best to confirm with the hospital or check the website listed below. The West Bengal Health Scheme Portal has a full list of West Bengal Health Scheme Cashless Hospitals. The website contains information on government hospitals, community hospitals, state-aided hospitals, and private hospitals.

Coverage Under the WB Health Scheme

WBHS is cashless, if the expenses for the treatment are within the sum insured, beneficiaries don’t have to bear it. If the cost goes beyond the limit, you have to pay just the excess amount. The process to make claims in such cases is as follows. 

• Hand in the cashless WB health card during your admission at any impaneled hospital
• The healthcare organization will make an authorization request to the GAA (Government Authorized Agency)
• The GAA will look at your details and then send approval.
• After the treatment, the hospital or healthcare organization will forward the bill to the GAA, accompanied by documents like the doctor’s certificate and medical reports.
• The GAA will then verify the documents and initiate reimbursement if all requirements are met.

FAQs

What is WBHS?

It is a health care system provided by the West Bengal government for state government employees/pensioners and their families.

Who is eligible for the West Bengal health scheme?

If you work for the West Bengal state government, all of your family members are eligible for WBHS benefits, providing they satisfy the following criteria:

1. Spouse of an employee.
2. Children (Step-children, adoptive children, including unmarried, widower, and divorced daughters) (Step-children, adopted children, including unmarried, widowed, and divorced daughters).
3. Siblings under the age of 18.
4. Dependent parents with a monthly income of less than $3,500.
5. A sister who is reliant (Unmarried, widowed, or divorced).

Can my kid be deemed a beneficiary if he is financially reliant on me?

He can be deemed a beneficiary until he is 25 years old or earns at least Rs. 1500 per month.

What is the full meaning of WBHS?

WBHS stands for West Bengal Health Scheme.

What hospitals are on the WBHS hospital list?

The following are a few hospital names from the West Bengal cashless medical treatment system hospital list 2021: -

1. Calcutta Medical Research Institute (CMRI)
2. Poddar Hospital BP
3. DM Hospital Private Limited
4. BM. Birla Heart Research Institute
5. The Susrut Eye Foundation
6. Narayana Nethralaya Rotary Club
7. Silverline Eye Institute
8. The Fortis Hospital
9. Daffodil Medical Centers
10. Kothari Medical Institute

Is the wife of a scheme member considering a beneficiary?

Yes, the plan member's wife and spouse are both beneficiaries.

In case you are not eligible for the WB Health scheme, you can apply for the Swasthya Sathi Health Card in West Bengal. It is a universal health scheme to provide basic health coverage to all residents of West Bengal. Apart from these two government schemes, you can also opt for private insurance. For quick processing and a range of benefits, choose from the Aarogya Care plans offered by Bajaj Finserv Health. Here you can enjoy various coverage benefits like preventive healthcare, online doctor consultations, network discounts, pre-, and post-hospitalization coverage, and more. Bajaj Finserv health also provides a health card it provides lots of benefits if you are not eligible for the West Bengal Health Scheme you can buy a Bajaj health card.