All about the West Bengal Health Scheme

west bengal health insurance — (Source: acko)

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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West Bengal Health Scheme (WBHS) - A brief overview

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.

Key features of West Bengal Health Scheme

Below mentioned are some of the salient features of this scheme.

Cashless indoor treatment

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).

Off-state hospitalisation facility

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.

OPD treatment

Beneficiaries can avail OPD treatment based on the waiting period and related conditions of the scheme.

Treatment coverage in non-empanelled hospitals

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.

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.

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.

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 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 medical facilities of 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 WBHS

West Bengal Health Scheme covers 1014 medical treatments. Below is the list of diseases covered under WBHS.

OPD treatment list

West Bengal Health Scheme 2008

Endodontic treatment (root canal treatment)
Crohn’s Disease (heart disease)
COPD (Chronic obstructive pulmonary disease)
Rheumatoid arthritis
Neurological disorders/cerebrovascular disorders
Malignant malaria
Malignant diseases
Thalassaemia/bleeding disorders/platelet disorders
Tuberculosis
Hepatitis B/C and other liver diseases
Insulin-dependent diabetes (Type-2 Diabetes mellitus is not considered as insulin-dependent diabetes)
Renal failure
Injuries caused by accident (including animal bite)
Systemic Lupus Erythematosus (LUPUS)

Eligibility 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. 3500
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 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.

Visit the official WBHS website
Click on ‘Online Enrollment’
Select ‘Government Employee’ from the drop-down list
Enter information in the box containing ‘Date of entry into the Govt. Service’
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)
Next, enter details like birth date and residential district
Save the document to register in the WB Health Scheme portal and select next to continue the process
Enter personal details including name, address, mobile no, employee no., etc.
Enter employment/office details
Enter family details.
Upload all the respective documents and signatures.
Enter details regarding the beneficiary.
Enter head office details.
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 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.

For state government employees

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.

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

For state government pensioners

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.

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)

Claiming process of West Bengal Health Scheme

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.

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, HCO or the concerned hospital will remit the bills to the GAA along with 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 West Bengal Health Scheme

Below is a list of empanelled hospitals under the West Bengal Health Scheme.

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
KPC Medical College
Implants Better Sight Centre
Medica Superspecialty Hospital
The Mission of Mercy Hospital & Research Centre
RN Tagore International Institute of Cardiac Sciences
Apollo Gleneagles
Ruby General Hospital
Dr Nihar Munshi Eye Foundation
Eye Care and Research Centre
Barrackpore Medicare
Disha Eye Hospitals
Bhattacharyya Orthopaedics& Related Research Centre (P) Ltd.
Eskag Sanjeevani
Desun Hospitals and Heart Institute
Nightingale Hospitals
Institute of Neuroscience
AMRI Hospitals
Belle Vue Clinic
Peerless Hospital
Apex Institute of Medical Sciences
Ekbalpur Nursing Home
RG Stone Urology & Laparoscopy Hospital
Divine Nursing Home
Fortis Hospital
Daffodil Hospitals
Kothari Medical Centre
Nabajiban Hospital

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.

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

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.

Frequently Asked Questions

All

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 in getting 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.