West Bengal Health Scheme (WBHS)

West Bengal Health Scheme (WBHS) is a state government initiative that aims to provide comprehensive health coverage to the residents of West Bengal, India. Launched with the objective of ensuring affordable and accessible healthcare services to government employees, pensioners, and their dependents, the West Bengal Health Scheme (WBHS) has become an important healthcare program in the state.

In this article, we will explain in detail the details of WBHS, its benefits, eligibility criteria, and steps to avail of its services.

In place of the West Bengal Health Scheme, the government announced that the program would be renamed as “West Bengal Health Cashless Medical Treatment Scheme 2014 for all employees and pensioners” and cashless medical facilities up to Rs. 1,50,000.00 (Rupees One and a Half Lakh) per indoor treatment.

Understanding West Bengal Health Scheme (WBHS)

West Bengal Health Scheme is a health insurance scheme implemented by the Government of West Bengal. It provides cashless medical treatment and reimbursement of medical expenses to the beneficiaries. The plan covers a wide range of medical procedures including hospitalization, surgery, diagnostic tests, and outpatient consultations.

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Eligibility Criteria (WBHS)

To be eligible for WBHS, the following criteria must be met:

• Applicant should be a regular serving government employee, pensioner, or a family member of an employee or pensioner.
• The employee should be enrolled under the Contributory Provident Fund of the State Government.
• Those pensioners who were enrolled in WBHS during their service period are automatically eligible.

Benefits of West Bengal Health Scheme (WBHS)

WBHS offers a variety of benefits that ensure comprehensive healthcare coverage for the beneficiaries. Some of the key benefits include:

Cashless indoor treatment facilities:

The cost of OPD treatment relating to indoor treatment is available for reimbursement during the period of thirty days before admission as well as during the period of thirty days after discharge.

Reimbursement of related OPD treatment costs:

In the case of treatment in non-empanelled hospitals, beneficiaries can claim reimbursement for their medical expenses.

Cost of OPD treatment reimbursement:

If you have one of the listed ailments, you may be eligible for reimbursement as long as you receive your care at one of the approved hospitals.

Coverage for pre-existing conditions:

WBHS covers pre-existing conditions from the first day of enrollment.

Outpatient Services:

Beneficiaries can avail of out-patient consultation, diagnostic tests, and prescribed medicines under the scheme.

Maternity Benefit:

This plan provides coverage for maternity-related expenses including delivery and post-natal care.

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To Enroll and Register in West Bengal Health Scheme (WBHS), follow these steps:

Government. Employee
Employees can submit the filled manual application form (available in the download section) by attaching the required documents to make online entry on behalf of the Head of Office.

Registration for pensioner
All categories of pensioners can submit the filled manual application form (available in the download section) enclosing the required documents for making online entries from the office of the Pension Sanctioning Authority.

How to Get Application Form:

To collect the West Bengal Health Scheme (WBHS) application form visit the official website https://wbhealthscheme.gov.in/ of the West Bengal Health Scheme or visit the concerned department.
Alternatively, the application form may be available for download from the official website.

Fill up the application form:

Read the instructions carefully and fill out the application form with accurate and complete information.
Provide personal details as required such as name, address, contact information, employee/pensioner details, and family member details.

Attach the required documents:

Collect the necessary documents required for enrolment. These may include identity proof, proof of employment/pension, proof of address, and other supporting documents as specified in the application form. Ensure that all documents are verified and submitted in the prescribed format.

Submit application:

Once you have filled out the application form and attached the required documents, submit the filled application form to the concerned department or designated authority. Make sure that the application is submitted within the specified deadline mentioned in the application form or as directed by the authorities.

Verification and Enrolment:

The submitted application will be verified by the authorities to determine the eligibility and accuracy of the information provided.
On successful verification, the applicant will be enrolled in the West Bengal Health Scheme. The enrolled applicant will be issued a unique WBHS card, which will serve as proof of enrollment in the scheme.

Collect WBHS Card:

Once the enrollment is processed, the applicant can obtain the WBHS card from the concerned department or as directed by the authorities.
The WBHS card should be kept safe as it will be required to avail the benefits of the scheme.

Claim Process of West Bengal Health Scheme (WBHS)

In case of treatment in non-empanelled hospitals or for reimbursement of medical expenses, beneficiaries can follow these steps to file a claim:

• Fill the claim form with accurate details, and attach all the necessary documents, such as medical bills, prescriptions, and diagnostic reports.
• Submit the claim form to the concerned authority within the prescribed time limit.
• The claim will be processed, and if approved, the reimbursement will be credited to the beneficiary’s bank account.

Grievance Redressal

West Bengal Health Scheme (WBHS) has a dedicated grievance redressal mechanism to resolve any issues faced by the beneficiaries. In case of complaints or grievances, beneficiaries can contact the WBHS helpline or the concerned authority for resolution.

Helpline numbers for West Bengal Health Scheme (WBHS):

Toll-free helpline number: 18001028014
This toll-free number can be used to get assistance and information regarding WBHS. It is available for the beneficiaries to address their queries and concerns related to the scheme.

Other Helpline Number: 033-2254-4730, 033-2254-5049, 033-2254-4197
This helpline number connects you to the headquarters of West Bengal Health Scheme. You can contact these numbers for specific inquiries or to raise any issue that requires immediate attention.

Reimbursement of costs of follow-up medical care and treatment
Follow-up medical treatment cost is reimbursed in the case of certain specified diseases under treatment undertaken in recognized hospitals.

Reimbursement of the cost of treatment in certain specialized hospitals outside the State
The actual cost of treatment including the cost of travel with an attendant is reimbursable provided the treatment is done in certain specified specialized hospitals outside the State.

Family members: The scheme also provides coverage to family members of eligible government employees and pensioners. Family members include the spouse of the government employee or pensioner, dependent children and dependent parents.

Hospitals listed under the West Bengal Health Scheme:

Here is the list of hospitals empaneled under the West Bengal Health Scheme.

• The Calcutta Medical Research Institute
• Desun Hospitals and Heart Institute
• Nightingale Hospitals
• R N Tagore International Institute of Cardiac Sciences
• Apollo Gleneagles
• Ruby General Hospital
• BM Birla Heart Research Centre
• Medica Super-specialty Hospital
• Mission of Mercy Hospital
• Susrut Eye Foundation

List of Speciality Hospitals Outside the State

 

Note that some hospitals may no longer be part of the scheme, so it is better to confirm with the hospital or check on the website below. The complete list of West Bengal Health Scheme cashless hospitals can be found in West Bengal. Health scheme portal. The website contains information related to government hospitals, local hospitals, state-aided hospitals, and private hospitals.

Some important links:

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Frequently Asked Questions on West Bengal Health Scheme (WBHS)

Question 1: Can an employee opt out of WBHS at his will?
Answer: Yes. However, if he or any of his beneficiaries have ever received a benefit from WBHS, he is not eligible to leave the Scheme within five years of the month that follows the month in which he received the benefit.

Question 2: Is there any time limit to claim reimbursement under WBHS??
Answer: Yes. Reimbursement for indoor treatment is to be claimed within 6 months from the date of discharge.

Question 3: If there is no Package Rate for a particular surgical procedure, how can I claim reimbursement?
Answer: Every surgical case must be completed on a package rate. When there is no Package Rate for a certain surgical treatment, a claim must be made using the Package Rate for an identical procedure.