West Bengal Health Scheme (2023): Enrollment Process, Eligibility and Benefits
The West Bengal government provides financial assistance for medical treatment to government employees, pensioners, and their families under the West Bengal Health Scheme. Beneficiaries can get cashless treatments in any government hospital or an empanelled private hospital. Moreover, they can get reimbursement when they undergo treatment in certain non-empanelled hospitals within WB.
Read this to know more about the coverage, eligibility, and benefits of this scheme!
West Bengal Health Scheme at a Glance
The West Bengal state government aims to cover the medical treatment expenses of its government employees and pensioners with this health scheme. It allows eligible people to get facilities of cashless treatment from any empanelled hospitals and Health Care Organisations (HCO).
In the initial phase, only retired pensioners and their families were covered. However, WB Government has revised the scheme to include all government employees, including IAS, IPS and IFS.
Implementation of WBHS 2008
The West Bengal Health Scheme, 2008 is governed by West Bengal’s finance department. The government is responsible for issuing and implementing a cashless medical treatment scheme. All rules, regulations and policies with respect to health schemes and fixed rates for medical treatment procedures are designed and framed by the government.
5 Facilities & Benefits of the West Bengal Govt Health Scheme
This health scheme covers various treatment costs. Here are the five most beneficial facilities:
1. Cashless Medical Treatment
Eligible people can get the benefits of cashless treatment. However, the limit of these cashless facilities is up to Rs. 100,000 for every in-door treatment. Still, when the treatment amount exceeds West Bengal health scheme cashless limit, one can apply for reimbursement.
2. Follow-up Treatment
They can get coverage for specific follow-up medical treatments. This includes the following 6 diseases:
- Neurosurgery
- Cancer Surgery- Radiotherapy or Chemotherapy
- Cardiac Surgery
- Surgery for Knee replacement and Hip replacement
- Accidents
- Renal transplant
3. Medical Treatment in Other States
One can get treatment from specific hospitals in other states in India. However, in this case, those hospitals must be empanelled.
4. Reimbursement of OPD Treatment
Individuals can get coverage of OPD treatment expenses for some specific diseases under the West Bengal health scheme.
5. Non-empanelled Hospital Coverage
They can also avail 60% of the treatment coverage when opting for treatment from non-listed hospitals. This is provided only if the hospital holds a government license or is a state-provided hospital.
Eligibility Criteria for Health Scheme in WB
Individuals are eligible for the WB Health Scheme if they fall under the following groups:
- State government employees and their family members
- Pensioners of the WB government, including their family members
- Officers, pensioners and family members of All India Services, such as IAS, IPS and IFS.
The scheme also covers the medical treatment expenses of the dependants as well.
The dependents maybe:
- Parents with low monthly income
- Husband or wife
- Minor brothers and sisters
- Children
Enrolment Process of West Bengal Health Scheme
You can enrol for the health scheme online via the West Bengal health scheme portal. You need to follow the below-mentioned steps for registering:
- Visit the portal of the West Bengal Health Scheme.
- Click on Online Enrolment.
- Select the section for which you want to enrol. Available options for enrolling on the scheme are Government Employee, Government Pensioner, Beneficiaries of Grant in Aid (GIA) Universities and Beneficiaries of GIA Colleges.
- Provide one of the following numbers–
- PRAN or GPF No., if you are a govt. employee
- PPO No. if you are applying as a pensioner
- HRMS Id No. if you apply as a beneficiary of GIA college
- PAN Id No. when you apply as a beneficiary of GIA University
- Fill in the details, such as name, mobile no., address, date of birth etc.
- Mention details of your family and service.
- Upload your photograph and signature.
- Save the details and get a printout for reference.
Procedures to File a Claim Under This Health Scheme
Beneficiaries of WBHS can send a request for cashless treatment online through the portal. They can also file for reimbursement after treatment from non-listed hospitals or when the amount exceeds the coverage limit of the scheme. The process to file claims is given below:
- They need to produce a cashless card that they got from the Government Authorised Agency (GAA) to the listed hospitals before treatment.
- The concerned hospital will get approval from GAA.
- After the treatment process is over, the hospital will send all medical documents and the bills to GAA.
- After verification, GAA will settle the expenses with the hospital.
Which Hospitals are Under the West Bengal Health Scheme?
Eligible individuals can get cashless treatment under this scheme from any of the hospitals mentioned below:
1. Government Hospitals
Beneficiaries can get the scheme’s benefits from all government hospitals, including those of the central government, West Bengal government and other states. They can also get cashless treatment from government clinics, laboratories and diagnostic centres.
2. Hospital Run by Local Body
This refers to any hospital operated by municipal corporations, municipalities and other local bodies under the West Bengal government.
3. Empaneled Private Hospitals
The scheme also gives the option to get treatment from empanelled private hospitals, nursing homes and diagnostic centres in WB.
Also Read
Exclusions of WBHS
There are as such no exclusions or terms mentioned in the scheme. However, the scheme does not cover expenditure incurred on cosmetic treatments or any non-medical procedures.
Final Word
Government employees and pensioners in West Bengal and their family members can get medical coverage under the West Bengal Health Scheme. Cashless benefits of this scheme are very beneficial as these people do not have to worry about the initial expenses of treatment.
Now that you understand this scheme, you can enrol yourself and your family to get free medical coverage. If you do not fall under the eligibility criteria of this scheme, you can consider other reputed health insurance providers like Navi. Navi has a network of over 10,000 network hospitals and premiums start as low as Rs.241 per month. You can avail of plans in a completely paperless and time-efficient manner through the Navi app which is available on the play store.
FAQs
Ans: Yes, beneficiaries can opt-out of the scheme if they have not ever utilised its benefits. However, if they have availed coverage under this in the past, they must wait five years to dismiss their names from the beneficiary list.
Ans: The primary criterion for including parents is that their family income (from all sources) must be lower than Rs. 3500. In case the parents get a pension, you must include that within their monthly income. Dearness relief for pension can be excluded from monthly income.
Ans: Yes, an employee is free to opt out of the West Bengal Health Scheme. However, he cannot opt out until five years from the execution of the scheme if his beneficiaries have enjoyed the benefits.
Ans: The health scheme excludes sons when they –
Become 25 years old
Start earning
However, the scheme includes sons with permanent physical or mental disabilities as they are considered dependent. No age limit is applicable in such cases.
Ans: Yes, beneficiaries of WBHS can request an advance to cover medical costs if the authority permits them to do so. However, they must be admitted to an empanelled hospital for indoor treatment to request medical advances.
Ans: This health scheme gives coverage to diseases as mentioned below:
• Tuberculosis
• Heart diseases
• Ankylosing Spondylitis
• Rheumatoid Arthritis
• Malignant Malaria
• Hepatitis B/C and
• Liver diseases
• Renal failure
• Crohn’s disease
• Chronic Obstructive Pulmonary Diseases (COPD)
• Endodontic treatment
• Systemic Lupus Erythematosus (LUPUS)
• Accidental injuries
• Neurological disorders
• Type-1 Insulin-dependent Diabetes
• Thalassemia
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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