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

The West Bengal Health Scheme (WBHS) is governed by the Medical Cell of the Finance Department of West Bengal. The Medical cell is formed to administer the above scheme. This scheme was primarily for state government employees and pensioners. The eligibility of this scheme was extended to beneficiaries of Grant-in-aid college and Grant-in-aid university. It is used by the majority of state government employees and other individuals associated with the payroll. The term ‘beneficiary’ includes the state government employee as well as his/her family members. It is one of the best health insurance schemes provided by the government.

The West Bengal Health Scheme is a master stroke scheme which aims at providing health cover in the form of reimbursement of operational procedures, Inpatient treatment, OPD treatment (Outpatient treatment), Implantation, reports/tests and many more.

The territorial range of this scheme is subjected to West Bengal hospitals, however through proper application and permission. The beneficiary can get treatment from other state-speciality hospitals after obtaining proper permission.

The key features of the West Bengal Health Scheme (WBHS):

1. Health Security

WBHS offers financial protection for medical expenses to state government employees, pensioners, and their dependents, ensuring health security.

2. Quick Claims

The claim process is streamlined, with faster settlement timelines for both cashless and reimbursement claims through departmental coordination.

3. Online Process

All enrollment, claim submission, and tracking can be done online via the official WBHS portal, ensuring ease and transparency.

4. Non-package Treatment

In cases where no fixed package exists, actual expenses are reimbursed as per WBHS rules with necessary documentation.

5. Empanelled List of Hospitals

A wide network of government and private hospitals is empanelled under WBHS, allowing beneficiaries to access quality treatment across the state and outside.

Below are the benefits of the West Bengal Health Scheme and a few are subject to prior permissions:

• Non-package treatment where treatment exceeds Rs 5,00,000 for Tata Medical Center, Rajarhat and 3,50,000 for other private empanelled hospitals.

• The cost of 2 procedures can be claimed, where the cost exceeds 50,000 rupees.

• Chemotherapy/ Immunotherapy where the medical cost exceeds Rs 50,000. (once for entire chemo schedules).

• Cashless Treatment

• Wide range of packaged treatment

Benefits for IAS Officers under WBHS

IAS officers posted in West Bengal are entitled to cashless treatment up to ₹2 lakhs in empanelled hospitals. They can claim reimbursement for OPD treatment of chronic diseases and indoor treatment in non-empanelled hospitals. Treatment outside West Bengal and special surgeries are also covered with prior approval.

Benefits for IPS Officers under WBHS

IPS officers serving in West Bengal receive comprehensive medical coverage under WBHS, including cashless hospitalisation. Their eligible dependents are also covered, and they can seek treatment in both government and empanelled private hospitals. Expenses beyond limits may be reimbursed on submission of medical claims.

Benefits for IFS Officers under WBHS

IFS officers stationed in West Bengal get cashless treatment at empanelled hospitals for themselves and family. They are eligible for reimbursement for specialized treatments and OPD care of specified chronic conditions. Treatment in reputed hospitals outside the state is also admissible with proper approval.

Below is the list of diseases and treatments covered under the Wealth Bengal Health Scheme:

• Malignant Disease

• Tuberculosis

• Hepatitis B/C and other liver diseases

• Type-1 Insulin-dependant diabetes

• Heart Disease

• Neurological Disorders/ Cerebrovascular Disorder

• Malignant Malaria

• Renal Failure

• Thalassaemia/Bleeding disorder/ Platelet disorder

• Injuries caused by accidents (caused by anime bite)

• Rheumatoid Lupus Erythematosus (LUPUS)

• Crohn’s Disease

• Endodontic Treatment (Root Canal treatment)

• Chronic Obstructive Pulmonary Disease (COPD)

• Ankylosing Spondylitis

Below is the list of treatments and diseases not covered under the West Bengal health scheme:

1. Cosmetic Surgery – Any surgery done for aesthetic purposes.
2. Self-Inflicted Injuries – Injuries caused intentionally by the patient.
3. Substance Abuse Treatment – Treatment for drug or alcohol addiction.
4. Experimental or Unproven Treatments – Procedures not approved or lacking established medical validity
5. Organ Transplants – Not covered unless prior approval is obtained.
6. Rehabilitation Therapy – Generally excluded unless explicitly approved.
7. OPD Treatment for Non-Specified Chronic Conditions – Especially for:
• Type-2 Diabetes Mellitus
• Hypertension
8. Home-based Treatments – Including:
• Injections at home
• Wound dressing at home
• Home physiotherapy
9. Non-Essential Items – Such as:
• Spectacles
• Dentures
• Contact lenses
• Hearing aids
10. Air Travel Expenses – Even if undertaken for treatment.
11. Ambulance Charges – Not reimbursable.
12. Improper Hospitalization Duration – Extended stay due to:
• Nosocomial infections
• Poor procedural handling (unless medically certified)
13. Treatment Without Prior Permission (for specified high-cost procedures) – E.g., certain surgeries, and treatments outside India.
14. Diseases or Procedures Not Included in the WBHS Disease List – You can find the list of covered diseases here.

Primarily the state government employees are eligible for the West Bengal Health Scheme. However, the range of eligibility under the definition of state government employees is as below:

Government employees

It also includes those employees who are working under the contractual/temporary payroll of the state government. The range of benefits is extended to the family members of the state employee.

Pensioners and Beneficiaries of GIA colleges

The Grant in Aid college employees as well as all pensioners are covered under the scheme. Individuals who are drawing pension as of (01-06-2009).

Employees of Universities of Bengal

The employees of Universities of Bengal are also eligible for the West Bengal Health Scheme. Further Employees and Pensioners of the PR body of the state government are eligible for this scheme too.

Below are the steps to enrol and register in the West Bengal Health Scheme:

• Visit the West Bengal Health Scheme website

• Click under the online enrol section.

• The registration should be under the criteria available: Government employees, Government pensioners, Beneficiaries of grant-aid colleges, Beneficiaries of grant-in-aid universities, Employees of the PR body, and Pensioners of the PR body.

• Primary information such as date of joining, and employee number will be asked to proceed under the above sub-criteria above.

• Fill in the requested information asked.

• After completing, personal information, health information and government employee information, your application number will be generated and it will go under review.

• After a review, you will be registered under the scheme.

To download the application form for the West Bengal Health Scheme follow the below steps:

Step 1: Visit the WBHS website.

Step 2: On the left-hand side, click on the ‘download’ section.

Step 3: Scroll down among the list of forms, and click on “Manual Application for ( government employee type) by selecting from your required form.

The West Bengal Health Scheme (WBHS) offers two ways to make a medical claim: a cashless process for treatment in empanelled hospitals and a reimbursement process for treatment in non-empanelled hospitals or for specific treatments.

For Treatment in Empanelled Hospitals (Cashless Process)

• Present Your WBHS Identity Card: At the time of admission or OPD consultation, show your WBHS ID card and provide a photocopy to the hospital.

• Hospital Verification: The hospital will verify your eligibility and initiate the treatment process.

• Bill Submission by Hospital: Post-treatment, the hospital submits the bills directly to the WBHS authority for settlement.

• No Direct Payment: Beneficiaries are not required to make any payment up to the approved limit, as the scheme covers the expenses directly.

For Reimbursement Claims (Non-Empanelled Hospitals or Specific Treatments)

• Obtain Necessary Documents: Collect all relevant documents, including Original medical bills and receipts, Prescriptions, Diagnostic reports, Discharge summaries and Essentiality Certificates (Form D1/D2 for employees; Form IV1/IV2 for pensioners

• Submit the Claim: File the reimbursement claim to the concerned authority within three months from the date of discharge (for indoor treatment) or from the date of each consultation or purchase (for OPD treatment)

• Processing and Settlement: The respective department or office will examine and settle the medical claim following the prescribed guidelines.

The Empanelled Hospitals are bifurcated into various classes such as Class 1, Class 2, and Class 3 depending on the facilities provided and coverage. Consider the below pointers to help you identify empanelled hospitals:

• All hospitals/Clinics and medical services are under the management of the government of West Bengal, the Government of India and other state governments.

• All hospitals, clinics and diagnostic centres are under the municipal corporations, municipalities and other local bodies of West Bengal state.

• 13 state-aided hospitals

• Private hospitals and diagnostic hospitals as per the list

The helpline numbers for the West Bengal Health Scheme are as below:

Helpline Number- (033)2254-4123/ (033)2254-403

Day and Timings- Monday to Friday between 11 am- 5 pm

Email- support.wbmedicalcell@nic.in

This scheme is under constant regulation by the medical cell. It is empowered to empanel Private Hospitals, Nursing Homes, Institutions, Clinics, Laboratories, and Diagnostic Centres within the state and classify them into Class-1 and Class-2 service providers on the basis of facilities available there. Further, any Department must consult The West Bengal Health Scheme Authority (WBHSA), the apex policy-making body of the Medical Cell before obtaining permission for treatment in a Speciality Hospital outside the State subject to certain exceptions. Medical Cell fixes the approved rate for various surgical procedures and investigations from time to time.