West Bengal Health Scheme 2021 WBHS: Facilities Procedure and Claim

West Bengal Health Scheme 2021, WBHS was introduced in the year 2008 by Finance Department for State GOVT employees or retired pensioner to provide them better medical facilities. In the year 2014 the name of the scheme was changed to West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme 2014.

The amount of rupees one lakh will be provided by govt in this scheme for one indoor treatment. All the govt employees will get cashless medical treatment alternatively of their medical allowance. All the beneficiaries will get OPD treatment in West Bengal and 10 other special hospitals outside of West Bengal.

Facilities of West Bengal Health Scheme

Contents

  1. Cashless indoor treatment facilities: An amount of rupees one lakh will be provided by govt for any indoor treatment in any private hospital. If the amount is more than one lakh then you can submit a claim the amount from DDO or PSA.
  2. Reimbursement of related OPD treatment cost: All the expenses for OPD treatment will be given under 30 days before or after discharge.
  3. Reimbursement of OPD treatment cost: Expenses for Follow-up treatment or after-Disease treatment will also be given.
  4. Reimbursement of the cost of follow-up medical attendance and treatment: Medical expenses of prescribed medicine or testing are done by the doctor in the diagnostic center.
  5. Reimbursement of cost of treatment in certain Speciality Hospitals outside the State: Expenses for treatment in some special hospitals outside of West Bengal.
  6. Reimbursement of indoor treatment cost in Non Empanelled Hospitals:Treatment fees of 60% will be given for the treatment at non-listed hospitals.

Who are eligible for the West Bengal Health Scheme?

  1. All the State govt employees or pensioners and dependent family members of any state govt employee or pensioner.
  2. Any employee of IAS, IFS, IPS, and dependent family members.
  3. Employees of govt aided college or university staff.

Details of West Bengal Health Scheme WBHS

Name of the schemeWest Bengal Health Scheme
Introduced in2008
Changed toFinance Department(GOVT of West Bengal)
Changed in2014
Initiated ByFinance Department (GOVT of West Bengal)
Type of SchemeHealth Scheme
Online Portalwww.wbhealthscheme.gov.in
Number of beneficiaries816698
Number of Private Hospital150

West Bengal Health Scheme Rate Chart

  • You will find the West Bengal health scheme rate chart from the online portal www.wbhealthscheme.gov.in by clicking on Package Details on the right side of the website.
west bengal health scheme rate chart
  • You can find and check rate chart from the list. You can search for particular rate of any particular treatment by treatment code or description.
West Bengal health scheme search rate list

West Bengal Health Scheme COVID-19

  1. All kinds of In-Patient Treatment will be given to the beneficiary through this scheme during this COVID-19 pandemic. For COVID-19 patient fees of test rupees 2250, for PPE rupees 1000, and consultation fees 1000 rupees will be provided by this scheme.
  2. When a beneficiary admits to a hospital in an emergency without a COVID-19 test he will be given a private isolation bed for the first two days. If there is no seat available please show your enrollment certificate. The treatment of the beneficiary shall be continued keeping in private isolation bed. The beneficiary shall be shifted immediately to his entitled bed when the report comes negative.
  3. During COVID-19 the beneficiary or dependent family member should produce COVID-19 report to the hospital during admission.

List of Diagnosis under West Bengal Health Scheme

The following list of diagnosis checkup cost will be given to the beneficiary.

  1. Magnetic Resonance Imaging or MRI
  2. CT Scan
  3. Endoscopy
  4. Colonoscopy
  5. Ultrasonography
  6. Endoscopic Retrograde Cholangio Pancreatography or ERCP
  7. Sigmoidoscopy

Surgeries under this Scheme

You will get benefited for the following surgery cases under this scheme.

  1. Neurosurgery
  2. Cardiac surgery
  3. Cancer surgery/chemotherapy/radiotherapy
  4. Renal transplant
  5. Body part replacement surgery
  6. Accident Cases

List of diseases for outdoor treatment

  1. Malignant Dieases
  2. Tuberculosis
  3. Liver diseases like Hepatitis A/C
  4. Diabetes
  5. Heart Diseases
  6. Neurological Disorder or Cerebrovascular Disorders
  7. Malignant Malaria
  8. Renal Failure
  9. Thalassemia/Bleeding orders/Platelet Disorders
  10. Injuries Caused by Accident(including animal bite)
  11. Rheumatoid Arthritis
  12. Systematic Lupus Erythematous (LUPUS)
  13. Crohn’s Disease
  14. Endodontic Treatment (Root Canal Treatment)
  15. COPD (Chronic Obstructive Pulmonary Disease)
  16. Ankylosing Spondylitis

List of Hospital Under this Scheme

You can get treatment in all the govt organized hospitals, clinics, laboratories, diagnostic centers. There are many other govt aided and private hospitals which are empaneled in this scheme. You can find empaneled hospitals under this scheme below.

List of govt aided hospitals

  1. Ramkrishna Mission Seva Pratisthan, Sarat Bose Road, Kolkata.
  2. Islamia Hospital, Kolkata.
  3. Marwari Relief Society Hospital, Kolkata.
  4. Institute of Child Health, 11, Dr. Biresh Guha Street, Kolkata-17.
  5. Balananda Brahmachari Hospital, Behala, Kolkata.
  6. Chittaranjan Cancer Hospital, Kolkata.
  7. Ramkrishna Sarada Mission Matri Bhavan, 7A, Sree Mohan Lane, Kolkata-28.
  8. Dr. M. N. Chatterjee Memorial Eye Hospital, Kolkata.
  9. Ramkrishna Matri Mangal Pratisthan and B.C. Roy Sishu Sadan, Ariadaha, North 24 Parganas.
  10. J.N. Roy Sishu Seva Bhavan, Kolkata.
  11. Chartoris Hospital, Kalimpong, Darjeeling.
  12. Kalimpong Leprosy Hospital, Kalimpong, Darjeeling.
  13. Sri Balaram Seva Mandir, Khardah, North 24 Parganas.

Download list of Private Hospital under west Bengal Health Scheme

Download list of Diagnostic center under this scheme

List of Hospitals outside of West Bengal

  1. All India Institute of Medical Sciences, New Delhi
  2. Post Graduate Institute of Medical Education and Research, Chandigarh
  3. Tata Memorial Hospital, Mumbai
  4. NIMHANS, Bangalore
  5. Christian Medical College, Vellore, Tamil Nadu
  6. Apollo Hospital, Chennai, Tamil Nadu
  7. Sankara Netralaya, Chennai, Tamil Nadu
  8. L.V. Prasad Eye Hospital, Hyderabad, Andhra Pradesh
  9. Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh
  10. Metro Hospital & Cancer Institute, New Delhi

How to apply online enrollment for West Bengal Health Scheme?

For Govt Employers

  • Go to the online portal of WBHS www.wbhealthscheme.gov.in and point your mouse to online enrollment. Click on Govt. employee option and a new page will be open.
west bengal health scheme apply online govt employees
  • Enter your date of entry in govt service and click on yes or no if you have your PRAN/GPF number or not. If you don’t have PRAN/GPF number you will be provided that after clicking on no option. Kindly note the given number for further use. Then click on the ok button.
  • After that, select the district where your office is located and enter your date of birth and click on save and then the next button.
West Bengal health scheme apply online govt employees
  • A form like that will be open. Fill all the required personal details in the form and click on next button and follow the process.
Note:- Group D employees can aplly offline by submitting form attached with necessary documents for making online entry from the end of Head of Office. Other employess also can apply offline.

Download the offline form for Group-D staff.

Download the form other than Group-D staff.

For Govt. Pensioners

  • Go to the online portal of WBHS www.wbhealthscheme.gov.in and pointer your mouse to online enrollment then click on Govt. Pensioner option.
West Bengal health scheme for pensioners
  • Then a new page will be open asking you whether you have PPO number or not. Click on yes and enter your number if you have or No if you don’t have the number. If you don’t have PPO number and click on no then you will be given that number. Kindly note the number for further use and click on the ok button.
  • Select your district where your office is located and enter your date of birth and then click on save and then next button.
for pensioner
  • Fill all the personal details and click on next button and follow the steps.
  • You can also apply offline by submitting an offline form to the Head Office.

Download offline form for Pensioner.

Download offline form for pensioner’s family member after death of pensioner.

Online registration for college

  • Go to the online portal of West Bengal Health Scheme www.wbhealthscheme.gov.in and point your mouse to Online Enrollment and click on Beneficiaries of Grant-in-Aid College.
  • Then enter your HRMS ID number and date of birth and click on Save and then the Next button.
Online registration for gia collage
  • Fill your all personal details and click on Save and Continue button.
Medical Benefits for University College Teachers Grant in AID 1
  • Follow the next steps to continue your registration.

Online Registration for University

  • Go to the website www.wbhealthscheme.gov.in and point your mouse or click on online enrollment then select Beneficiaries of Grant-in-Aid University.
wbhs for university
  • Enter your PAN ID number and date of birth then click on save and next button.
  • Then fill your all personal data bank account number and IFSC code then click on save and continue button.
wbhs for university
  • Follow the next step to complete your enrollment.

How to claim online or reimbursement?

All the beneficiaries for govt employees and GIA beneficiaries both can claim online for reimbursement. You have to create an account or sign up on WBHS Portal. If you have already an account, you can claim online for reimbursement by logging in with your username and password. Follow the steps for the online claim.

Step1: Go to the online portal wbhealthscheme.gov.in and point your mouse to online claim and then click on Government Beneficiary or GIA Beneficiary.

Step2: Log into your account by entering your User ID and Password and click OK. You should know that your HRMS ID is your first-time username and your date of birth is your password. You can change it after logging in.

Step3: Then click on claim reimbursement option left side of your screen. A form like below will be open. Fill all the details like Hospital empaneled or not, location, hospital name and finally select your treatment type OPD treatment or Indoor treatment.

West Bengal health scheme claim online

Step4: Fill your treatment details like investigation, Disease type, Disease name and cost than click on save button. You will complete the process by saving.

How to register for West Bengal Health Scheme?

Register for wbhs

If you don’t have an account, you can easily create one by following the below steps. After creating your account or sign up you can do a lot of things like
1. Download the enrollment certificate
2. Change your photo, sign, or blood group
3. Claim reimbursement
4. Check Claim status
5. Objection Compliance
6. Check your cashless treatment reimbursement history etc

West Bengal Health Scheme Portal
  • Click on Government employee/Pensioner or Employees of GIA College/University below of your webpage as shown on the above image with the arrow mark.
  • Enter ID number and set security question.
create account for west bengal health scheme
  • Click on Employee/Pensioner or Grant-In-Aid College/University and then enter your HRMS ID or Application number or Unique ID which you have got while online enrollment. Then select your security question and answer it and click on the ok button. Note that your ID number is your user ID and your date of birth is the first password. You can change it by logging in using that.

If you cannot understand, kindly watch the video.

Cashless limit, benefit and treatment (CARC)

In a private hospital, an amount of rupees one lakh of cashless treatment facilities will be given to the beneficiary. If the treatment cost is more than one lakh then have to pay the extra amount to the hospital. The limit of cashless treatment is only rupees one lakh. The Private Hospitals have to submit the bill to the medical cell of the Finance Department to get the payment. The extra cost of treatment will be reimbursed to the employee, pensioner, or dependent family member. A Cashless Admissible Reimbursement Certificate (CARC) is generated from the system at DDOs end. If the total expense is less than one lakh then no CARC will be generated.

Frequently Asked Question (FAQ) about West Bengal Health Scheme

Who are eligible for WB Health Scheme?

1. All the state GOVT employees and pensioner and their dependent family members are eligible for this scheme.
2. The scheme was extended in the year 2009-10 according to All India Services rules 1954 (Medical Attendance) to the Indian Administrative Services or IAS employees and retired employees in the year 2011.
3. Govt in approved colleges and university employees are also eligible for this scheme.

How can I apply for West Bengal Health Scheme?

You can apply for this scheme online by going to the online portal www.wbhealthscheme.gov.in. Click on online enrollment and select your category employee, pensioner, GIA-approved college, or university employees.

Which hospitals are included in West Bengal Health Scheme?

All the govt hospital are included in this scheme. Some other private hospitals are enlisted in this scheme. There are 10 special hospital outside the state are also included.

How can I check my West Bengal health plan?

You can check all the plans or rate charts in the online portal. You can also download the rate chart from the download link given above. For your particular diseases, you can find the reimbursement amount by logging on the website.

How can I opt out of West Bengal Health Scheme?

An employee can easily opt out from this scheme in his own decision if he wants. Note that the beneficiary can not opt out for five years if he/she got the benefit of the scheme before.

How do I claim reimbursement in WB Health Scheme?

Just go to the website and login to your account. After log in you will see claim reimbursement option on the left of the opened webpage. Click on it and fill up all the details of your treatment and your expenses and save it.

Who can be beneficiary as dependent family member?

1. Husband or Wife
2. Parents whose monthly income does not exceed rupees three thousand five hundred
3. Children including Step-children, legally adopted children and unmarried daughters
4. Dependent widowed/ divorced daughters
5. Minor brothers, minor sisters
6. Dependent unmarried / widowed/ divorced sisters

If the disease is not listed, then how can I claim reimbursement?

If the treatment is not listed then the reimbursement will be on the basis of identical procedure package rate. Identical code is to be sought by the treating Hospital from the Medical Cell, Finance Department through WBHS Portal.

What is the Procedure for taking advance under West Bengal Health Scheme?

You can get medical advance for indoor treatment in empaneled hospitals by submitting certificate of estimate from the hospital where you are going to admit on the following condition-
1. Advance may be sanctioned for treatment in empanelled hospitals only. No advance is available for treatment in non empanelled hospitals. 
2.  Advance is available only for indoor treatment including day care treatment. No advance can be sanctioned for OPD treatment.
3.  The advance should be under 80 per cent of the estimated cost of medical attendance and treatment.

Helpline for WBHS

Non-technical helplineMail ID[email protected]
Govt’s offices technical helplineMail ID[email protected]
Hospitals technical helplineMail ID[email protected]
Technical HelplineMail ID[email protected]
Technical HelplineToll-free number18001028014
Sri Aloke Kumar Mukherjee, WBA & ASMail ID[email protected]
Phone Number033-2254-4197

Important Downloads

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