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!
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.
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.
This health scheme covers various treatment costs. Here are the five most beneficial facilities:
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.
They can get coverage for specific follow-up medical treatments. This includes the following 6 diseases:
One can get treatment from specific hospitals in other states in India. However, in this case, those hospitals must be empanelled.
Individuals can get coverage of OPD treatment expenses for some specific diseases under the West Bengal health scheme.
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.
Individuals are eligible for the WB Health Scheme if they fall under the following groups:
The scheme also covers the medical treatment expenses of the dependants as well.
The dependents maybe:
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:
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:
Eligible individuals can get cashless treatment under this scheme from any of the hospitals mentioned below:
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.
This refers to any hospital operated by municipal corporations, municipalities and other local bodies under the West Bengal government.
The scheme also gives the option to get treatment from empanelled private hospitals, nursing homes and diagnostic centres in WB.
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.
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.
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
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:
• 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
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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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