West Bengal Health Scheme (WBHS)

The West Bengal Health Scheme is an important healthcare program initiated in the year 2008 by the Government of West Bengal, aimed at providing quality medical services and financial assistance to the state government employees. 

This enterprising scheme is designed to offer comprehensive health coverage to eligible individuals, making healthcare accessible and affordable. The government periodically introduces revisions to this scheme, expanding the scope of its benefits. 

This healthcare program offers eligible beneficiaries reimbursement for their inpatient medical expenses at affiliated hospitals in West Bengal. Additionally, reimbursement is available for outpatient treatment for 15 specified diseases, in accordance with the stipulated terms and conditions.

In this article, we will delve into the eligibility criteria, features, benefits, enrollment process, claim procedure, empanelled hospitals, and important details about the West Bengal Health Scheme.

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Eligibility for the West Bengal Health Scheme:

The West Bengal Health Scheme extends its benefits to a wide range of individuals, including state government employees, pensioners, and family members. Here are the key eligibility criteria:

1. State Government Employees: Both serving and retired employees are eligible for the scheme.
2. Family Members: Spouses and dependent family members, including children up to the age of 25 or unmarried daughters, are covered.
3. Individuals who have opted for a medical allowance are also entitled to access the policy’s advantages. 
4. The policy benefits are open to both All India Services pensioners and service officers from the state of West Bengal.

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Features of the West Bengal Health Scheme:

The West Bengal Health Scheme encompasses several key features:

1. The scheme extends its coverage to the employee and their family, encompassing dependent parents and siblings.
2. An employee registered under the West Bengal Health Scheme is not only eligible for its benefits but can also claim advantages under the West Bengal Services (Medical Assistance) rules, 1964.
3. Beneficiaries of the scheme receive cashless cards, facilitating access to cashless medical treatment at partner hospitals.
4. Reimbursement for inpatient treatment should be sought within a three-month period from the date of discharge.
5. Expenses incurred for treatment in specialised hospitals, which may include costs related to travel and one attendant, situated outside the state, are eligible for reimbursement.

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Benefits of the West Bengal Health Scheme:

The West Bengal Health Scheme has evolved to encompass a wider beneficiary base. Initially designed for West Bengal Government retirees and family pensioners, the revised program now extends its medical facilities to include officers of the Indian Administrative Services (IAS), Indian Forest Services (IFS), and Indian Police Services (IPS), along with retired AIS (All India Services) officials. However, certain stipulations apply for each category:

For IPS Personnel:

1. Enrollment in the West Bengal Health Scheme is optional for IPS officers.
2. IPS officers are administratively overseen by the Home Department Police Service Cell under West Bengal Health Scheme.
3. They are entitled to healthcare benefits as per the West Bengal Health Scheme and the All India Services (Medical Attendance) Rules, 1954.
4. IPS officers enrolled in the Central Government Health Scheme (CGHS) do not have access to benefits under this WB government-sponsored program.

For IFS Personnel:

1. Participation in the West Bengal Health Scheme, 2008, is optional for IFS officers.
2. The Forest Department is the relevant administrative department for IFS officers.
3. IFS officers and their families can access healthcare facilities under the West Bengal Health Scheme, in addition to services compliant with the All India Services (Medical Attendance) Rules, 1954.
4. IFS officers already benefiting from the Central Government Health Scheme (CGHS) cannot simultaneously will not be able to take advantage of the West Bengal Health Scheme.

For IAS Officials:

1. IAS officers have the option to enrol in the West Bengal Health Scheme.
2. The Personnel and Administrative Reforms Department is responsible for the administrative aspects of IAS officers under this scheme.
3. Benefits under West Bengal Health Scheme, in conjunction with healthcare services in compliance with the All India Services (Medical Attendance) Rules, 1954, are available to IAS officers and their families.
4. IAS officers who are presently availing healthcare services through the Central Government Health Scheme (CGHS) will not be able to take advantage of the West Bengal Health Scheme.

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How to Join the West Bengal Health Scheme and Register?

To initiate the enrollment and registration process, visit the West Bengal Health Department’s West Bengal Health Scheme website. Follow these steps for a successful registration:

1. Access the West Bengal Health Scheme Portal.
2. In the header section, select “Government Employee” for Online Enrollment.
3. Check the “Yes” box if you possess a PRAN/GPF number, then input the required information. If you don’t have this information, mark the “NO” box and opt for “Non-GPF.”
4. Provide details such as your birthdate and locality. Save this essential data for WB Health Portal registration, and then proceed by clicking the “next” button.
5. Enter your personal information, including your name, address, phone number, employee number, and any necessary identification particulars. Include a photograph and signature, ensuring adherence to the prescribed guidelines.

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How to Download the Application Form for the West Bengal Health Scheme

To download the West Bengal Health Scheme application form from the official website, follow these steps:

1. Step 1: Go to the download section of the West Bengal Health Scheme Portal at https://wbhealthscheme.gov.in/Home/wbhsdownload.aspx.
2. Step 2: On this page, use the drop-down menu labelled “Select Category” to choose the relevant category.
3. Step 3: Download the WBHS health scheme application form from the list of available forms.
4. Step 4: Ensure you print a hard copy of the document and save an electronic copy on your computer for future reference.

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How to Claim Benefits of the West Bengal Health Scheme?

Claiming benefits under the West Bengal Health Scheme is a streamlined process. The program operates on a cashless basis, alleviating the need for beneficiaries to settle hospital bills if the treatment cost falls within the predefined package range. Such treatments are fully covered by the system. 

However, if the treatment cost surpasses the predetermined package limit, both the beneficiary and the hospital will jointly bear the additional expenses, and there will be no claims for the excess amount. Here’s the procedure for submitting a West Bengal Health Scheme benefit claim:

1. When seeking admission to a hospital with empanelled status, present the cashless card issued by the Government Authorized Agency (GAA).
2. An authorization from GAA is mandatory for healthcare services.
3. GAA will verify the provided information before granting approval.
4. Once the course of treatment is concluded, the Healthcare Organization (HCO) or the respective hospital will forward the bills and essential medical records to GAA.
5. GAA will carefully review and authenticate these documents.
6. Following verification, GAA will transfer the predetermined amount to the HCO as agreed upon.

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West Bengal Health Scheme Hospital List

Silverline Eye Hospital 

Eye care & Research Centre 

Care & Cure Hospital 

Bankura Seva Niketan 

Gitaram Hospital 

Dr. Nihar Munshi Eye Foundation

Indus Nursing Home PVT. LTD.

Greenview Clinic and Nursing Home 

Dafodil Hospitals PVT. LTD.

Nabajiban Hospital PVT. LTD.

Paramount Healthcare 

Hardik Medical Diagnostic Centre PVT. LTD. Sarkar Memorial N.H

Eskag Sanjeevani 

Sahid Khudiram Bose Hospital 

North Bengal Neuro Centre PVT. LTD.

Dr. S.S. Chatterjee Heart Centre 

Renaissance Hospital PVT. LTD.

Jeeban Suraksha Hospital 

Spectra Eye Foundation PVT. LTD.

Netralok 

Shanti Swasthalaya & Anusandhan Kendra PVT. LTD.

Re-life 

Aaloey Phera 

Nayonika Eye Care

Alolika Nursing Home 

St. Joseph’s Hospital 

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Helpline Numbers for West Bengal Health Scheme

To ensure you have access to assistance during emergencies, please keep the West Bengal Health Scheme helpline details handy:

Email: support.WBMedicalCell@nic.in

Contact Numbers: (033) 2254-4123 or (033) 2254-4034.

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FAQs

Q: Where can I access the latest list of empanelled hospitals under the West Bengal Health Scheme?

A: The most current and comprehensive list of empanelled hospitals under the West Bengal Health Scheme is readily available on the West Bengal Health Scheme Portal portal. You can visit the portal to find the updated directory of healthcare facilities that are part of the scheme’s network. This ensures that you can access quality healthcare services at the hospitals included in the West Bengal Health Scheme.

Q: How can I find the West Bengal Health Scheme hospital list?

A: Accessing the list of hospitals participating in the West Bengal Health Scheme is easy. You can find the comprehensive West Bengal Health Scheme hospital list on the official West Bengal Health Scheme portal. This list provides you with valuable information about the healthcare facilities that are part of the program, making it convenient for beneficiaries to access the medical services they need.

Q: Is the West Bengal Health Scheme the same as the West Bengal Government Health Scheme?

A10: Yes, the West Bengal Health Scheme is often referred to as the West Bengal Government Health Scheme. They both refer to the same comprehensive healthcare initiative established to provide medical services and financial support to government employees and their families in the state of West Bengal. The scheme operates with a focus on cashless healthcare services, making quality healthcare more accessible to beneficiaries.

Q: What is West Bengal Health Scheme cashless limit?

A: The cashless limit under the West Bengal Health Scheme refers to the maximum amount covered by the scheme for specific medical treatments. To get accurate information about the cashless limits for various medical procedures, beneficiaries should refer to the latest list of empanelled hospitals under the West Bengal Health Scheme. This ensures that they have a clear understanding of the financial coverage provided for their healthcare needs.

Q: How to apply for West Bengal Health Scheme?

A: Applying for the West Bengal Health Scheme is a straightforward process. To begin, eligible individuals can obtain the necessary West Bengal Health Scheme form, which is available on the West Bengal Health Scheme portal. The form includes all the essential details and guidelines for completing the application. Beneficiaries should carefully follow the outlined steps for submission to ensure their enrollment in the scheme and access to quality healthcare services for themselves and their families

Q: What is the West Bengal Health Scheme reimbursement procedure?

A: The West Bengal Health Scheme primarily operates on a cashless basis. However, in instances where the treatment expenses exceed the predetermined cashless limit, the beneficiary and the hospital may need to share the additional costs of the bill. Detailed reimbursement procedures are available on the West Bengal Health Scheme portal, providing a comprehensive guide on how to navigate the process when the treatment costs surpass the cashless limit. It is advisable to familiarise yourself with these procedures to ensure a clear understanding of the reimbursement process when seeking healthcare services under the West Bengal Health Scheme.

Q: Where can I find the West Bengal Health Scheme form?

A: The West Bengal Health Scheme form, which is essential for enrollment in the program, is conveniently accessible on the official West Bengal Health Scheme portal. This form contains all the necessary fields and instructions for completing the application process. Beneficiaries should visit the West Bengal Health Scheme portal to easily locate, download, and submit the required form, ensuring they can access the benefits of the West Bengal Health Scheme for themselves and their eligible family members.

Q: Are there specific hospitals under the West Bengal Health Scheme?

A: Yes, the West Bengal Health Scheme includes a designated list of hospitals that have been empanelled to provide healthcare services to beneficiaries. To identify the hospitals that are part of the scheme’s network and to access quality healthcare services, individuals should refer to the official West Bengal Health Scheme portal.

 The West Bengal Health Scheme portal contains the complete and up-to-date directory of empanelled healthcare facilities under the West Bengal Health Scheme, making it easy for beneficiaries to choose their preferred medical institution.

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Conclusion

In conclusion, the West Bengal Health Scheme has emerged as a significant lifeline for government employees in the state, providing them with essential healthcare services and financial security. This initiative reflects the government’s commitment to the well-being of its workforce and their families. However, despite the government’s efforts, there are still many individuals and families in need of critical medical support beyond the scope of the scheme.

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