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West Bengal Health Scheme

Introduction:

From time to time, the Centre and the Indian State Government continue to provide social welfare programs. In some cases, they are for the poor section of society and sometimes for others. There are also dedicated health programs. The West Bengal Health Scheme is one of the dedicated health programs.

Health insurance is a measure to ensure financial security in the event of a medical emergency leading to hospitalization. Social insurance programs that provide health insurance help people manage their medical expenses better. Read on to find out more about the West Bengal Health Scheme (WBHS).

WBHS is a state-owned health insurance scheme. The program began in 2008. However, in 2014, a change was made and became known as the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme. Both of these programs are integrated.

According to the plan, eligible people can receive free treatment at a specified list of hospitals, also known as unhealthy hospitals and health organizations (HCOs). Those who qualify can receive free treatment for Rs 1 lakh.

Key Benefits of the updated WBHS Scheme:

More than 1000 medical procedures are covered by this program. The following table is about the type of process and the size of the cover in terms of amount.

Benefits

Cover

Laparoscopic or endoscopic surgery, general delivery

Up to 3 to 4 days

OPD and minimally invasive surgery

In 1 day

Special surgery

Up to 12 days

Major surgery

Up to 7 to 8 days

Benefits of West Bengal Health Scheme:

In the following years of the 2008 program, certain benefits were extended to officials of the Indian Administrative Service (IAS), Indian Forest Service (IFS), an Indian Police Service (IPS).

Benefits for IAS Officers:

IAS officials and their family members can benefit from the scheme in the following cases:

  • To be a part of the program is optional.

  • Their relevant administrative department will be the Personnel and Administrative Reforms Department.

  • You may benefit from the resources in accordance with the All Indian Services Act, 1954.

  • They must not be part of the Central Government Health Scheme (CGHS).

Benefits for IPS Officers:

IPS officials and their family members can benefit from this program in the following cases:

  • They have the option to be part of the program.

  • The administrative department of IPS officials will be the Home Affairs Police Service Cell.

  • All India Service Regulations, 1954 facilities are available.

  • Those officers who are part of the Central Government Health Scheme (CGHS) will not be part of the state government program.

Benefits for IFS Officers:

IFS officials and their family members may be a part of the program subject to the following conditions.

  • Their registration can be selected.

  • Their department concerned with this program will be the Department of Forestry.

  • All India Service Laws, institutions 1954 can be found through them.

  • Those officers who are part of the Government Central Health Scheme (CGHS) will not be allowed to be part of this state program.

Key Features of West Bengal Health Scheme:

  1. Cashless Indoor Treatment

The beneficiary can receive free medical treatment up to INR 1 lakh in an impaneled hospital. If the cost is more than the said limit, the additional amount in the bill will be paid by the beneficiary.

  1. OPD Treatment

You can get a refund for OPD treatment in the waiting period and also the other scheme conditions.

  1. Non-impaneled Hospital

If treatment is available at a non-impaneled hospital, a certain % of the amount may be refunded according to the terms and conditions.

  1. Out-of-state Hospitalisation

Costs can be paid if the treatment is available at a hospital in a different state, as long as we are on the list of hospitals that are impaneled.

List of Diseases and Treatments Covered under West Bengal Health Scheme:

The program covers 1014 treatments. It also means the maximum allowable package for each process in Indian currency. Details can be viewed here.

OPD Treatment Diseases List:

The scheme covers crucial Out-patient Department diseases. Here’s the West Bengal Health Scheme 2008 OPD treatment list

  • COPD (Chronic obstructive pulmonary disease)

  • Malignant diseases

  • Tuberculosis

  • Hepatitis B / C and other liver diseases

  • Arthritis

  • Kidney failure

  • Accidental injuries (including animal bites)

  • Lupus Erythematosus System (LUPUS)

  • Crohn's Disease Heart Disease

  • Neurological disorders / Cerebrovascular disorders

  • Deadly Malaria

  • Endodontic Therapy (Root Canal Treatment)

  • Insulin-dependent diabetes mellitus (Type-2 Diabetic Melitas is not considered an insulin-dependent diabetes mellitus)

  • Thalassemia/Bleeding orders/Platelet disorders

What is uncovered under the Scheme?

This program does not include cosmetic surgery and non-medical treatment. Apart from this, major treatment options should be covered in a cost-effective manner at impaneled hospitals.

Eligibility Criteria - West Bengal Health Scheme:

Listed below is the eligibility for being a part of the program.

  • This program is aimed at the state government, pensioners, employees, and their families.

  • Those who have chosen this scheme in terms of Medical Allowance are also eligible.

  • This fund can be obtained from all All-India Services officials and pensioners.

  • Family coverage includes spouse, parents, dependent children, and sibling’s dependent on the beneficiary.

How to Apply for the West Bengal Health Scheme: 

You can visit the West Bengal Department of Health site to begin the registration and the application process. From there, you can choose to register as a Government employee, a pensioner, a financial aid college beneficiary, and a Grant University beneficiary. It also encourages new hospital registrations.

How to register as a Government Employee:

Step 1 - Visit the West Bengal Health Scheme Portal

Step 2 - Click on Online Registration from the header section and select Government employees.

Step 3 - In case you have a PRAN / GPF number, then check the Yes box and enter the details. If you do not have the details, then check the NO box and select Non-GPF.

Step 4 - State details such as location and date of birth. Save details to sign up for the WB Health Portal and click next to the entire process.

Step 5 - State personal information such as name, address, cell phone number, job number, etc.

Step 6 - State office details.

Step 7 - Mention family details.

Step 8 - Insert photo and signature. Make sure you comply with the rules regarding the size.

Step 9 - State the details of the beneficiary.

Step 10 - State the details of headquarters.

Step 11 - Save the details and print the report for future reference.

How to Download West Bengal Health Scheme Application Form:

West Bengal Health Scheme forms can be downloaded from the official site. Here's how to put it in various other sections.

Procedure for Downloading Govt Employee Service Forms

  • Step 1 - Visit the West Bengal Health Scheme Portal> Download section

  • Step 2 - Select 'Employees' from the "Select Category" drop-down menu

  • Step 3 - Download the appropriate form

Procedure for Downloading State Government Pensioners Forms

  • Step 1 - Visit the West Bengal Health Scheme Portal> Download section

  • Step 2 - Select ‘Pensioner’ from the “Select Category” drop-down menu

  • Step 3 - Download the appropriate form

How to Claim the West Bengal Health Scheme:

The system operates without pay. Therefore, if the cost of treatment is less than the prescribed package, the beneficiary does not have to pay the hospital bill as treatment will be charged per program. If the cost exceeds the limit specified in the package allocated for treatment, the additional costs of the bill will be determined by the beneficiary and the hospital, and there will be no claims.

Here is the claim process:

  • Step 1 - Submit a cashless card when you are admitted to an impaneled hospital.

  • Step 2 - The Health Care Organization will submit an application for accreditation to the Government Authorized Agency (GAA).

  • Step 3 - GAA will review the details and approve the request.

  • Step 4 - After treatment, HCO or hospital will send the bill to GAA. The bill will be accompanied by the necessary documents such as a medical report, doctor's certificate, a summary of discharge, etc.

  • Step 5 - GAA will verify the submitted documents.

  • Step 6 - GAA will transfer the value to the HCO.

Empanelled Hospitals Listed Under West Bengal Health Scheme:

Hospitals that are listed under the West Bengal Health Scheme:

Here is a list of hospitals that are included in the West Bengal Health Scheme.

  • R N Tagore International Institute of Cardiac Sciences

  • BM Birla Heart Research Center

  • Calcutta Medical Research Institute

  • Medica Special Hospital

  • Design Hospitals and Heart Institute

  • Apollo Gleneagles

  • Ruby General Hospital

  • Nightingale Hospitals

  • Purpose of Mercy Hospital

  • Susrut Eye Foundation

Note that some hospitals may no longer be part of the program, so it is best to check with the hospital or check the site listed below. A complete list of West Bengal Health Scheme Cashless Hospitals can be found in the West Bengal Health Scheme Portal. The website contains information on Government Hospitals, Local Hospitals, state-aided hospitals, and Private Hospitals.

Helpline Number - WBHS:

The following table will provide you with the required contact details.

Email: support.wbmedicalcell@nic.in

Contact Number: (033) 2254-4123 / (033) 2254-4034


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