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.
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Introduced in 2008 by the West Bengal government and issued by its Finance Department, the West Bengal Health Scheme is a state-level health insurance welfare policy.
This scheme aims to provide enhanced medical facilities to state government employees. From time to time, the WB government has revised this health scheme 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 15 diseases (conditions apply).
Moreover, treatment under the WBHS can be availed in 9 empanelled hospitals outside West Bengal. On top of that, 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 cashless medical facilities up to Rs. 1 lakh per indoor treatment.
Below mentioned are some of the salient features of this scheme.
One of the distinctive characteristics of the West Bengal Health Scheme is its cashless indoor treatment facility. It covers treatment of up to Rs. 1 lakh in empanelled hospitals. However, if the total cost of the indoor treatment crosses the specified limit, the respective individuals have to pay the remaining cost to the health care organisation (HCO).
West Bengal Health Scheme extends treatment even in hospitals outside the state. However, to avail healthcare facilities in these hospitals, it must be an empanelled one.
Beneficiaries can avail OPD treatment based on the waiting period and related conditions of the scheme.
WBHS further includes reimbursement of treatment expenses in non-empanelled hospitals. In cases like this, beneficiaries can avail reimbursement of a certain percentage of the treatment cost as per the scheme guidelines.
WBHS covers approximately 1000 odd medical procedures. Read on to know the types of treatment and the number of days under this scheme.
|
Surgeries |
Days Covered |
|
Specialised surgeries |
Up to 12 days |
|
Major surgeries |
7-8 days |
|
Endoscopic or laparoscopic surgeries, natural childbirth |
3-4 days |
|
Minor surgeries and OPD |
1 day |
These are some of the West Bengal Health Scheme benefits.
Initially, the West Bengal Health Scheme was solely offered to the retired and family pensioners of the West Bengal Government. However, the updated scheme intends to provide healthcare facilities to employees of Indian Administrative Services (IAS), Indian Forest Services (IFS), Indian Police Services (IPS), and to retired AIS officers.
Following is a detailed discussion on the benefits extended to IAS, IFS, and IPS officers.
West Bengal Health Scheme, 2008 is available to IPS officers plus their family members, subject to certain conditions. These are –
IFS officers and their family members can secure healthcare facilities under WBHS 2008 as per the following conditions.
West Bengal Health Scheme provides healthcare benefits to IAS officers under certain conditions. These include:
West Bengal Health Scheme covers 1014 medical treatments. Below is the list of diseases covered under WBHS.
West Bengal Health Scheme 2008
The following categories of individuals who are eligible for the West Bengal Health Scheme –
*Refers to the dependant family member of the concerned government employee or pensioner and includes:
To claim reimbursement under WBHS 2008, individuals have to enroll themselves 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.
This completes the West Bengal Health Scheme registration process.
Now that you know how to apply for West Bengal Health Scheme, eligible applicants can download the WBHS form of application from its portal.
The download processes for both state government employees and pensioners from the WBHS portal are discussed below.
Government employees can find various types of forms that are enumerated in the following table.
|
Types of Forms |
Categories |
|
Form-A |
Enrollment application |
|
Form-C |
Claim settlement for reimbursement |
|
Form-D1 |
Essentiality certificate (OPD treatment) |
|
Form-D2 |
Essentiality certificate (Indoor treatment and OPD treatment) |
|
Form-D3 |
Essentiality certificate (non-recognised HCOs) |
|
Form-E |
Checklist |
Pensioners can find different types of forms in the West Bengal Health Scheme portal. These are listed in the table below.
|
Types of Forms |
Categories |
|
Form-I |
Enrollment application |
|
Form-II |
Enrollment certificate |
|
Form-III |
Claim settlement for reimbursement |
|
Form-IV1 |
Essentiality certificate-cum-statement of expenditure (certified by any OPD treatment specialist) |
|
Form-IV2 |
Essentiality certificate-cum-statement of expenditure (certified by any Indoor and OPD treatment specialist) |
|
Form-IV3 |
Essentiality certificate-cum-statement of expenditure (certified by any non-recognised private nursing home under WBHS 2008) |
|
Form-V |
Checklist for medical reimbursement |
|
Form-VI |
Family Permit (Temporary) |
WBHS works in a cashless manner where the individuals can claim for treatment cost reimbursement specified in the scheme. However, in case 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.
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.
Take note of the West Bengal Health Scheme helpline details in case of any emergency.
For Technical Help:
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.
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Disclaimer #1: *Customer can choose options at the time of availing insurance. Premium amount may vary accordingly. Insured is required to disclose any pre-existing condition or on going treatment before policy issuance in the proposal form.
Disclaimer #2: This information is added only for informative purposes and collected from different sources across the Internet. Digit Insurance is not promoting or recommending anything here. Please verify the information before making any decisions.
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