Indian state and federal governments frequently introduce social programs for the general population. They are occasionally for the less fortunate members of society and occasionally for other groups. There are also specific health-related programs. One such specialized health program is the West Bengal Health Scheme.
In 2008, the state of West Bengal introduced and released the West Bengal Health Scheme (WBHS), a state-level insurance welfare program. Beneficiaries of this program can receive OPD treatment for 15 ailments, cashless medical coverage up to Rs. 15 lakh, and reimbursement for medical expenses incurred in certain hospitals.
Continue reading to learn more about this plan.
Eligibility For West Bengal Health Scheme
Listed below are the eligibility criteria to be a part of the scheme.
- This program is intended for state government personnel, retired government employees, and their families.
- Those who chose to participate in this program via the Medical Allowance are also eligible.
- Pensioners and officials of All India Services are eligible for this coverage.
- The family insurance coverage indicated covers coverage for the beneficiary’s spouse, parents, dependent children, and dependent siblings.
Features and Benefits of the West Bengal Medical Treatment Scheme
Here is the list of the features and benefits of the West Bengal Medical Treatment Scheme.
- Up to INR 100,000 in cashless indoor treatment facilities
It offers the benefit of a waiver of up to Rs. 1,000,000 for indoor treatment, provided it is received in one of the private hospitals with whom the West Bengal Health Scheme has contracted and is empaneled. The DDO/PSA provisions apply to the reimbursement if the cost exceeds Rs. 1,00,000.
- OPD Treatment Reimbursement
The cost of OPD treatment is reimbursable, provided that it is disclosed at the time of admission for both the 30-day treatment period and the 30-day recovery period. Costs are covered as long as the procedure is carried out in one of the hospitals that are approved by the program.
- Non-empanelled hospitals
60% of the approved amount or the actual cost, whichever is smaller, may be claimed as compensation for non-empanelled hospitals. When a hospital has more than 80 beds, 80% of the actual cost or approved cost is reimbursable.
- Cost of certain specified investigations
Only doctors who have been seen in accredited hospitals or whose disease has been investigated there can request reimbursement for certain investigations as listed in Medical Memo 10 on OPD prescriptions.
Extended Benefits of the Scheme to IAS, IFS, & IPS Officers
- Benefits for the IAS Officers
The following requirements must be met for IAS officers to get the benefits of the West Bengal Health Scheme for themselves and their families:
- It is not required to enroll in the WBHS.
- The Personnel and Administrative Reforms Department will be responsible for administering matters about IAS officers and their families.
- As per 1954, All India Services Rules, IAS officers and their families may utilize certain facilities.
- They shouldn’t be eligible for benefits under the Central Government Health Scheme (CGHS) for medical care.
- Benefits for the IPS Officers
The following criteria must be met for IPS officers and their families to benefit from WBHS:
- WB Health Scheme participation is optional.
- The Home Department Police Service Cell will serve as its administrative division.
- They can utilise the All India Services Rules, 1954 amenities.
- They shouldn’t utilise the Central Government Health Scheme’s (CGHS) advantages.
- Benefits for the IFS Officers
The WBHS is available to IFS personnel and their families under the following conditions:
- So enrolment is not required.
- The Department of Forests would be the relevant department for IFS officers.
- They have access to All India Services Rules, 1954 features.
- Officers who are covered by the Central Government Health Scheme (CGHS) are not eligible to participate in the WB Health Scheme.
Inclusions Under West Bengal Health Scheme
More than 1,000 medical operations, including specialised services for up to 12 days, major surgeries for up to 7-8 days, Laparoscopic or endoscopic surgeries, regular deliveries for up to 2-4 days, OPD visits, and minor surgeries for up to one day are all covered by the West Bengal Health Scheme for the insured. The following details the policy’s coverage benefits:
- OPD Treatment Reimbursement: You will be reimbursed for OPD treatment costs if you are covered by the insurance, subject to mention when inpatient, for 30 days, along with 30 days after discharge. Malignant malaria, tuberculosis, renal failure, Hepatitis B/C, and other liver illnesses are among the OPD therapies that are covered by the coverage.
- Cashless Indoor Treatment Facilities For up to Rs. 1 Lakh: If indoor treatment is had in one of the private network hospitals covered by the West Bengal Health Scheme, the insurance coverage offers a remission benefit of up to Rs. 1 lakh. The reimbursement shall be subject to clause DDO/PSA if the expenses are more than Rs. 1 lakh.
- Non-Empanelled Hospitals: If the therapy is received at a non-network hospital, payment is available for 60% of the actual cost or the permitted amount, whichever is less. In hospitals with more than 80 beds, reimbursement is allowed for 80% of the approved or actual cost.
- Cost of Specified Investigations: Only OPD prescriptions recommended by doctors in recognised hospitals or if the investigation is performed in a network hospital will result in expenses for some of the investigations indicated in medical Memo 10 being reimbursed.
Exclusions Under West Bengal Health Scheme
Cosmetic procedures and non-medical treatments are not covered by the plan. In addition to them, major procedures should be paid for in empanelled institutions without the use of cash.
Enrollment For West Bengal Health Scheme
You must go to the West Bengal Health Department website to enlist in and register for the West Bengal Health Scheme. You can enroll as a government pensioner, a grant-in-aid college student, a grant-in-aid university student, or a government employee.
Follow the instructions below to apply to become a government employee:
- Go to the portal for the West Bengal Health Scheme.
- Select “government employee” under “Online Enrolment”
- If you have a PRAN/GPF number, then select Yes and fill out the form. If you do not have the information, tick the No box and choose Non-GPF.
- Include information such as your birthplace and postal code. Save the data for the West Bengal Health Portal registration. To continue with the process, click next.
- Types of personal information like your name, phone number, address, and employee number.
- Add your office information.
- Add your family’s information.
- Include your signature and photo. Be sure you post it in the appropriate dimensions.
- Include information about the recipient.
- Include information about the head office.
- Save the information. Print the report after that in case you need it later.
How To Download West Bengal Health Scheme Application Form?
Forms for the Wealth Bengal Health Scheme are available for download on the official website. Here’s how to do it for various areas.
The method for State Government Employees to Download Forms
Step 1: Visit the West Bengal Health Scheme Portal’s Downloads section.
Step 2: From the “Select Category” drop-down menu, choose “Employees.”
Step 3: Download the necessary form.
Process for State Government Pensioners to Download Forms
Step 1: Visit the West Bengal Health Scheme Portal’s Downloads section as the first step.
Step 2: From the “Select Category” drop-down menu, choose “Pensioner.”
Step 3: Download the necessary form.
How To Claim Your West Bengal Health Scheme?
The WBHS program is entirely cashless, which means that the recipients don’t have to pay anything out of pocket. The insurance companies pay the hospital fees in full. The beneficiary, however, would be responsible for covering any additional costs if the bill amount exceeded the maximum coverage. The following are the steps you can take to submit a claim for the WBHS-insured amount:
Step 1: Present your WBHS cashless card at the hospital where you are receiving care if it is accredited.
Step 2: The hospital will contact the GAA (Government Authorised Agency) to obtain verification.
Step 3: The GAA will check the information and submit its approval.
Step 4: The hospital will send the GAA the costs following the treatment.
Step 5: The GAA will pay the hospital’s bill after confirming the information.
West Bengal Health Scheme Helpline Number
You may find the relevant contact information in the table below.
Email id: firstname.lastname@example.org
Contact Number: (033)2254-4123/(033)2254-4034
Empanelled Hospitals Listed Under West Bengal Health Scheme
Here is the list of empanelled hospitals under WBHS that are as follows:
- AMRI Hospitals
- Apex Institute of Medical Sciences
- Apollo Gleneagles
- Barrackpore Medicare
- Belle Vue Clinic
- Bhattacharyya Orthopaedics& Related Research Centre (P) Ltd.
- BM. Birla Heart Research Centre
- BP. Poddar Hospital
- Daffodil Hospitals
- Desun Hospitals and Heart Institute
- Disha Eye Hospitals
- Divine Nursing Home
- DM Hospital Pvt. Ltd
- Dr. Nihar Munshi Eye Foundation
- Ekbalpur Nursing Home
- Eskag Sanjeevani
- Eye Care and Research Centre
- Fortis Hospital
- Implants Better Sight Centre
- Institute of Neuroscience
- Kothari Medical Centre
- KPC Medical College
- Medica Superspecialty Hospital
- Nabajiban Hospital
- Nightingale Hospitals
- Peerless Hospital
- RG Stone Urology & Laparoscopy Hospital
- RN Tagore International Institute of Cardiac Sciences
- Rotary Narayana Nethralaya
- Ruby General Hospital
- Silverline Eye Hospital
- Susrut Eye Foundation
- The Calcutta Medical Research Institute
- The Mission of Mercy Hospital & Research Centre
People should further verify the list on the WBHS webpage because some hospitals might no longer be covered by the program.
Frequently Asked Questions
Yes, any employee or retiree of the West Bengal Government, as well as IAS officials and retirees, may choose to leave the program at any time.
Yes, given the total cost of a comparable surgery, this is reimbursable.
No, they are two distinct health plans. Swasthya Sathi has a cap and was created specifically for unorganized sectors. Unlike WBHS, it does not pay for OPD treatment costs.
The WB health system allows beneficiaries to receive cashless medical care and services in hospitals that have been appointed for a maximum cost of Rs. 1,50,000.
Under the West Bengal Health Scheme, each surgical treatment is treated according to a specific package fee. Therefore, the cost is mapped to any other packages whose cost is comparable if there is no specified package rate for that particular surgery. However, when a specific Package Rate is not available, approval must be obtained from the Finance Department.
The reimbursement for indoor therapy must be requested within three months after the date of discharge. The reimbursement for outdoor therapy must be requested from each OPD within three months.