West Bengal Health Scheme (WBHS): Check Eligibility, Coverage, Benefits

Explore the benefits, objectives, eligibility, application process, and more about the West Bengal Health Insurance Scheme.
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3 min
29-February-2023

In 2008, the West Bengal Government initiated the West Bengal Health Scheme (WBHS), an insurance program aimed at providing cashless medical treatment to state government employees, All India Services (AIS) officers, and pensioners. This scheme serves as a state-level health insurance welfare policy.

West Bengal Health Scheme (WBHS):  An overview

The primary objective of the WBHS is to enhance medical provisions for state government employees. Under this initiative, eligible beneficiaries are entitled to reimbursement for inpatient treatment expenses incurred at affiliated hospitals within West Bengal and certain affiliated hospitals located outside the state, accessible through the West Bengal Health Scheme portal.

In 2014, the Government of West Bengal announced modifications to the name of the WBHS, renaming it as the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme. Alongside this renaming, the scheme introduced cashless medical services up to Rs. 1.5 lakh per treatment, details of which can be found on the West Bengal Health Scheme portal.

The management of this scheme falls under a medical cell established within the Finance Department of the Government of West Bengal. Working in conjunction with the Health and Family Welfare Department, this medical cell oversees and regulates the scheme's operations, while also issuing guidelines for its implementation.

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Features and benefits of (West Bengal Health Scheme) WBHS

All beneficiaries can claim the following benefits under the scheme:

  • Reimbursement for indoor treatment: You can get reimbursement for inpatient treatment in all empanelled hospitals within the state of West Bengal. Treatment can also be availed at 11 enlisted hospitals outside West Bengal.
  • Medical cost for listed diseases: Get the cost of treatment for seventeen diseases as per the list mentioned in the WBHS scheme clause.
  • Cashless treatment facility: A cashless treatment facility of up to Rs.1.5 lakh per indoor treatment is provided when the treatment is done in empanelled hospitals. Beneficiaries can also claim the reimbursement of indoor treatment costs beyond Rs.1.5 lakh.

List of diseases covered under West Bengal Health Scheme

The West Bengal Health Scheme hospital list provides details on affiliated healthcare facilities where these benefits can be availed. Within this program, expenses incurred for outpatient treatment are eligible for reimbursement for the particular illnesses listed below:

Condition

Description

Malignant diseases

Cancerous growths requiring specialised medical attention and treatment.

Hepatitis B/C and other liver diseases

Viral infections and liver-related conditions necessitating medical intervention.

Tuberculosis

Infectious disease affecting the lungs, requiring prolonged treatment.

Type-1 insulin-dependent diabetes

Chronic condition where the body produces insufficient insulin, requiring lifelong management.

Neurological disorders or cerebrovascular disorders

Conditions affecting the brain or blood vessels in the brain, requiring specialised care.

Heart diseases

Various conditions affecting the heart's function and structure, requiring cardiac care.

Renal failure

Kidney dysfunction requiring dialysis or transplant for management.

Malignant malaria

Severe form of malaria requiring immediate medical attention and treatment.

Thalassemia, bleeding disorders, or platelet disorders

Blood-related disorders necessitate ongoing medical management.

Injuries caused by accident (including animal bites)

Trauma resulting from accidents or animal encounters requiring medical treatment.

Systematic Lupus Erythematosus (LUPUS)

Autoimmune disease-causing inflammation and damage to various body systems.

Rheumatoid arthritis

Chronic inflammatory disorder affecting joints and other tissues, requiring ongoing treatment.

Crohn’s disease

Inflammatory bowel disease affecting the gastrointestinal tract, requiring specialised medical care.

Chronic Obstructive Pulmonary Disease (COPD)

Progressive lung disease affecting breathing, often due to smoking or environmental factors.

Endodontic treatment (Root canal treatment)

Dental procedure to treat infections or save a damaged tooth.

COVID

Infectious disease caused by the coronavirus, requiring medical care and isolation measures.

Ankylosing spondylitis

Inflammatory arthritis affecting the spine and large joints, causing stiffness and pain.


Explore: List of diseases covered in health insurance

Eligibility criteria for West Bengal Health Scheme

Given below are the eligibility criteria for West Bengal Health Scheme (WBHS):

  • State government employees, retired government employees receiving pension benefits, as well as their families.
  • Individuals who have chosen this scheme through their medical allowance are also entitled to its benefits.
  • All India Services officers and retirees can also access this coverage.
  • The family coverage encompasses spouses, parents, dependent children, and dependent siblings of the beneficiary.

How to apply online for WBHS?

Step-by-step guide to enrolling in the West Bengal Health Scheme:

Step 1: Visit the official website of the West Bengal Health Scheme portal.

Step 2: Click on the ‘Online Enrolment’ tab and choose either the ‘Govt. Employee’ or ‘Govt. Pensioner’ option.

Step 3: Provide the ‘Date of entry into Govt. Service’ or ‘Date of Retirement from Govt. Service’ along with the ‘PRAN/GPF’ or ‘PPO’ number.

Step 4: Fill in all required personal details, including residential address, date of birth, contact number, district, and employee number. Then, click on ‘Continue’.

Step 5: Upload your photograph and signature according to the specified dimensions and click on ‘Save’.

Step 6: Print out the completed online form for your records and future reference.

Beneficiaries are eligible to request reimbursement for inpatient treatment, outpatient treatment, follow-up medical care, and investigative expenses by presenting their West Bengal Health Scheme certificate to the hospitals enlisted in the scheme.

Helpline number: West Bengal Health Scheme

You can contact the officials for any queries through the contact details given below:

Email address

support.wbmedicalcell@nic.in

Phone number

(033)2254-4123/(033)2254-4034


Read more: List of government health schemes in India

Frequently asked questions

How do I reach the website of the Health and Family Welfare Department of the Government of West Bengal?

You can visit www.wbhealth.gov.in to access the website of the Health and Family Welfare Department of the Government of West Bengal.

What diseases and treatments are not covered by the WBHS?

Exclusions under the WBHS may include cosmetic surgeries, non-medical treatments, experimental treatments lacking established medical usage, self-inflicted injuries, substance abuse-related treatments, high-cost procedures such as organ transplants, and specific chronic conditions.

Which department regulates the West Bengal Health Scheme?

The Finance Department is responsible for managing the financial aspects and policy framework of the scheme, while the Health and Family Welfare Department ensures that medical services and healthcare infrastructure are in line with the objectives of the scheme.

Does the scheme consider the member’s spouse as a beneficiary?

Yes, the member’s spouse can be regarded as a beneficiary.

What diseases and treatments are excluded from the WBHS?

The WBHS typically excludes cosmetic treatments, fertility treatments, alternative therapies, and experimental treatments not approved by medical authorities. Dental treatments unless related to accidental injuries are also usually not covered.

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