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West Bengal Health Scheme

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West Bengal Health Scheme

Overview of West Bengal Health Scheme

The West Bengal (WB) Health Scheme, introduced in 2008, aims to provide improved medical facilities to government employees of West Bengal. To avail of these facilities, government employees must forgo their medical allowance from their salary.

This scheme was later extended to include superannuated employees and family pensioners of the West Bengal government in 2009. They must also forgo their Medical Relief from their pension to benefit from this scheme.

In 2009 and 2010, the scheme was further expanded to include employees of All India Services (IAS, IFS, IPS) deputed to the affairs of West Bengal, with the condition of forgoing benefits from CGHS.

In 2011, the benefits of WBHS were extended to retired AIS officers who served in the state of West Bengal, again with the requirement of forgoing CGHS benefits and a one-time contribution of ₹40,000.

Under WBHS-08, beneficiaries can claim reimbursement for the cost of indoor treatment in associated hospitals within West Bengal. Outpatient treatment for 17 specified diseases is also covered. Additionally, treatment is available in 11 enlisted hospitals out of the state. Reimbursement for indoor treatment in non-empanelled hospitals is subject to specific guidelines.

What is the West Bengal Health Scheme?

In 2008, the state government introduced the West Bengal (WB) Health Scheme with the welfare of its employees in mind. This state-level healthcare program continually expands its benefits through periodic amendments. It provides eligible beneficiaries with reimbursement for inpatient treatment in approved West Bengal hospitals. Additionally, specific outpatient treatment for 15 diseases is reimbursed according to defined terms and conditions.

Moreover, beneficiaries can leverage this scheme even when seeking treatment at nine designated hospitals located outside West Bengal. In 2014, the state government rebranded the scheme as the ‘West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme 2014.’ According to the scheme’s provisions, eligible beneficiaries can access cashless medical treatment at select West Bengal hospitals, with a coverage limit of ₹1 lakh.

Purpose of West Bengal (WB) Health Scheme

The purpose of the West Bengal (WB) Health Scheme is to provide healthcare benefits and financial support to employees of the State Government, pensioners, and their family members. It aims to ensure their access to medical treatment, including inpatient and outpatient care, by offering reimbursement and cashless treatment options in-network hospitals in West Bengal and select facilities outside the state.

Medical packages and hospitalisation process in West Bengal (WB) Health Scheme

Medical Packages

1. Cashless indoor facilities for treatment are available for beneficiaries, covering up to ₹1,50,000 for every indoor treatment in Private Empanelled Hospitals.
2. In instances where the indoor treatment expenses exceed ₹1,50,000, beneficiaries can opt for reimbursement. However, this reimbursement is subject to submitting a claim to the designated DDO/PSA for processing.

Hospitalisation Process

1. When beneficiaries need hospitalisation, they should present their West Bengal (WB) Health Scheme card.
2. The Health Care Organisation (HCO) responsible for the treatment submits an authorisation request to the Government Authorised Agency (GAA).
3. The GAA verifies and approves the request after confirming all the provided details.
4. After completing the treatment, the HCO sends all medical bills to the GAA to settle the claim.
5. The GAA reviews and verifies all medical bills and accompanying documents.
6. Once the claim is processed, the approved amount is transmitted to the HCO to settle the claim.

How does the West Bengal (WB) Health Scheme work?

The West Bengal (WB) Health Scheme operates cashlessly, making it convenient for beneficiaries. This means that if the treatment cost falls within the specified package limit, the beneficiary doesn’t need to pay the hospital bill. The scheme covers the treatment expenses as per its provisions.

However, suppose the cost of treatment exceeds the predetermined limit allocated for that specific procedure. In that case, the beneficiary and the hospital will jointly settle the additional expenses, and there won’t be a claim for the exceeding amount. This cashless approach ensures that beneficiaries can receive essential medical care without immediate financial burden within the scheme’s limits.

List of Diseases and Treatments Covered under West Bengal (WB) Health Scheme

This program covers the reimbursement of outpatient treatment expenses for a range of designated medical conditions, which include:
1. Malignant diseases
2. Liver conditions
3. TB or Tuberculosis
4. Diabetes (Type 1)
5. Renal failure
6. Systematic Lupus Erythematosus (LUPUS)
7. Neurological or cerebrovascular issues
8. Cardiac ailments
9. Rheumatoid arthritis
10. Crohn’s disease
11. COPD
12. Thalassemia, bleeding disorders, or platelet imbalance
13. Covid
14. Malignant malaria
15. Endodontic treatment
16. Injuries resulting from accidents (including those caused by animal bites)
17. Ankylosing spondylitis.

Furthermore, the subsequent medical treatment costs are eligible for reimbursement for the specific medical conditions:
1. Neurosurgery
2. Cardiac surgeries (inclusive of implants and coronary angioplasty)
3. Renal transplants
4. Cancer-related surgeries
5. Cases involving accidents
6. Hip replacement surgeries.

OPD Treatment Diseases List

Here are some OPD Treatment diseases.
1. CT Scan
2. Sigmoidoscopy
3. Endoscopy
4. Ultrasonography
5. Colonoscopy
6. MRI scan

Things to Consider When Applying for the West Bengal (WB) Health Scheme

Here are important points to keep in mind regarding the West Bengal (WB) Health Scheme:
1. Eligibility
This scheme is open to employees of the State Government Pensioners of the State Government as well as their respective family members.

2. Income Threshold
If the parents of the beneficiaries earn a monthly income exceeding ₹3,500, they won’t qualify for the financial benefits offered by this scheme.

3. Exclusions
Cosmetic surgeries and non-medical treatments are not covered under this scheme.

4. Cost Limit
If the treatment expenses exceed ₹1 lakh within empanelled hospitals, the beneficiary is responsible for the additional costs.

5. Voluntary Participation
Participation in this scheme is voluntary; it is not mandatory.

6. CGHS Enrollment
Those enrolled in the Central Government Health Scheme (CGHS) are not eligible for benefits under this scheme.

7. Correct Application Forms
The West Bengal (WB) Health Scheme Portal offers various application forms designed for employees and pensioners of the state government.

Eligibility Criteria for West Bengal (WB) Health Scheme

Take a look at the eligibility criteria to be fulfilled to qualify for the WBHS:

1. Employees of the State Government, as well as Pensioners
This category includes active employees of the State Government and retired employees. It provides them with vital health coverage.

2. Dependent Family Members
The scheme encompasses the dependent family members of employees of the State Government or their pensioners. These family members include:

○ Husband/Wife: Spouses of government employees or pensioners are covered.
○ Parents: With an income of less than ₹3500/ month, they can access the scheme’s benefits.
○ Children: This includes a wide range, such as step-children, unmarried daughters, and legally adopted children.
○ Siblings: Under the age of 18 years are eligible under this scheme.
○ Dependent Daughters: Those who are single or dependent.
○ Dependent Sisters: Unmarried, divorced, or widowed sisters who are dependent on government employees or pensioners.

3. All India Services Officials as well as Pensioners.

Benefits of the Chiranjeevi Yojana Health Scheme

Initially, the WBHS primarily catered to retired people and family pensioners working in the West Bengal Government. Nonetheless, the new scheme has expanded its scope to include additional beneficiaries, such as employees of the Indian Administrative Services (IAS), Indian Forest Services (IFS), etc.

For IPS Officers
IPS officers and families are eligible for the scheme 2008 under certain conditions, which include:

  1. Enrollment in WBHS is optional for IPS officers.
  2. The Home Department Police Service Cell oversees the administrative aspects of IPS officers under WBHS 2008.
  3. IPS officers can access scheme benefits through WBHS 2008 and the All India Services Rules of 1954.
  4. IPS officers enrolled in the Central Government Health or (CGHS) scheme cannot claim benefits under this state government scheme.

For IFS Officers
IFS officers and their families can access healthcare facilities based on the following criteria:

  1. Enrollment in the West Bengal (WB) Health Scheme 2008 is optional for IFS officers.
  2. The Forest Department is responsible for overseeing administrative matters concerning IFS officers.
  3. IFS officers and members of the family can get medical services offered by WBHS 2008 in addition to those provided by the All India Services (Medical Attendance) Rules, 1954.
  4. While receiving benefits under the CGHS (Central Government Health Scheme), IFS officers are not permitted to enroll in WBHS of 2008.

For IAS Officers
The West Bengal (WB) Health Scheme offers healthcare benefits to IAS officers under specific conditions, which are as follows:

  1. Enrollment in WBHS 2008 is optional for IAS officers.
  2. The Personnel and Administrative Reforms Department is the administrative authority for IAS officers under this scheme.
  3. IAS officers as well as their family members can enjoy the advantages of WBHS 2008 and the benefits of the All India Services (Medical Attendance) Rules, 1954.
  4. IAS officers already receiving healthcare services under the Central Government Health Scheme (CGHS) must opt for different benefits under WBHS 2008.

Key Features of the West Bengal (WB) Health Scheme

Here are the main features of the WBHS scheme:

1. Cashless Hospitalisation
Under this scheme, beneficiaries can receive indoor treatment within the network hospitals without the need for upfront payment, with a coverage limit of up to ₹100000. The beneficiary must pay any amount exceeding this limit.

2. Outpatient Treatment (OPD)
You can seek reimbursement for outpatient treatment, subject to specified waiting periods and other conditions outlined in the scheme.

3. Non-Empanelled Hospital Care
In case you receive treatment in a hospital not listed in the scheme’s empanelment, you may be eligible for partial reimbursement based on the scheme’s terms and conditions.

4. Hospitalisation Outside the State
If you need treatment in a hospital in another state and it is identified as an empanelled hospital, the scheme may cover your medical expenses. This is subject to the hospital’s inclusion in the scheme’s network.

Inclusions Under West Bengal (WB) Health Scheme

Below are the inclusions under the West Bengal (WB) Health Scheme.

1. Outpatient Treatment Reimbursement
If the policy covers you, you can get reimbursed for outpatient treatment expenses during hospitalisation and up to 30 days after discharge. Covered outpatient treatments include tuberculosis (TB), malignant malaria, renal failure, as well as Hepatitis B/C.

2. Cashless Inpatient Treatment
The policy offers a benefit of waiver of up to ₹1 Lakh for inpatient treatment when received in private network hospitals affiliated with the West Bengal (WB) Health Scheme. If the treatment costs exceed this limit, reimbursement is possible, subject to DDO/PSA regulations.

3. Non-Network Hospitals
If you receive treatment at a non-network hospital, you can claim reimbursement for 60% of the actual cost or the approved amount, whichever is lower. However, in hospitals with more than 80 beds, you can claim 80% of the actual cost or the approved amount.

4. Cost of Specified Investigations
Expenses incurred for specific medical investigations are eligible for reimbursement, provided they are prescribed by doctors from identified hospitals or performed in-network hospitals.

Exclusions Under West Bengal (WB) Health Scheme

The West Bengal (WB) Health Scheme excludes coverage for the following costs:

1. Cosmetic surgeries
2. Non-medical treatments

How to Register for the West Bengal (WB) Health Scheme

Here is the process for registering with the West Bengal (WB) Health Scheme:
1. Begin by visiting the official West Bengal (WB) Health Scheme website.
2. Navigate to the ‘Online Enrolment’ section and select either the ‘Govt. Employee’ or ‘Govt. Pensioner option.
3. Provide the date of entering the service of the West Bengal State Government or the date of retiring from the service of the West Bengal State Government along with the PRAN (Permanent Retirement Account Number) or the GPF (General Provident Fund) number or even the PPO (Pension Payment Order) number.
4. Input the necessary information, including your date of birth, district, residential address, contact number, employee number, and more. Then, click on ‘Continue.’
5. Upload a photograph along with your signature within the specified dimensions, and save the changes.
6. Finally, print a copy of the form for your future reference.

Required Documents to Register

You need the following documents:

Employee/Pensioner Details

  1. Employee ID or Pensioner ID
  2. Date of entering into Government service or date of retirement from Government service
  3. PRAN (Permanent Retirement Account Number) or GPF (General Provident Fund) number for pensioners
  4. PPO (Pension Payment Order) for pensioners

Personal Information

  1. Name
  2. Date of Birth
  3. Residential Address
  4. Contact Number
  5. District

Photograph and Signature

  1. Passport-sized photograph in the specified dimensions
  2. A scanned copy of your signature

Other Supporting Documents (if required)

  1. Marriage certificate (for including a spouse in the scheme)
  2. Dependent children’s birth certificates (if applicable)

Medical Documents

  1. Medical report
  2. Doctor’s certificate
  3. Discharge summary

How to Apply for West Bengal (WB) Health Scheme Online

For government employees, here’s a simple guide to enrolling:

1. Visit the West Bengal (WB) Health Scheme Portal
Start the process by visiting the dedicated portal for the West Bengal (WB) Health Scheme.

2. Select Your Category
Choose the “Government Employee” category as you begin the enrollment process.

3. PRAN/GPF Details
If you have a PRAN (Permanent Retirement Account Number) or GPF (General Provident Fund) number, indicate this by checking the “Yes” box and providing the required details. If you don’t possess these details, check “No” and proceed as a non-GPF employee.

4. Personal Information
Fill in essential personal details such as your residential district, date of birth, and other pertinent information. Save this information as you proceed to register on the West Bengal Health Portal.

5. Enter Your Information
Complete your registration by entering details like your name, mobile number, address, employee number, and more.

6. Office Details
Input relevant data related to your office, ensuring all particulars are accurate and up to date.

7. Family Matters
Provide necessary family details as part of the registration process.

8. Upload Documents
To make your registration complete, upload a clear photograph and a signature that adheres to the specified dimensions. Attention to detail here is essential.

9. Beneficiary Information
Include information regarding the beneficiaries covered under your scheme.

10. Head Office Details
Input the required details related to your head office.

11. Save and Print
Once you’ve meticulously filled out all the information, don’t forget to save your details. It’s advisable to print the report as well, as this documentation may come in handy in the future.

How to Download the West Bengal (WB) Health Scheme Application Form

The process for downloading the necessary forms from the WBHS portal varies for employees and pensioners, as outlined below:

For West Bengal Government Employees

  1. Begin by visiting the WB Health Scheme official portal.
  2. Navigate to the ‘Download’ option on the left side of the dialogue box.
  3. Select ‘Employee’ from the ‘Select Category’ dropdown menu.
  4. Proceed to download the appropriate form.

For government employees, various form types are available, each serving a specific purpose. The forms are categorised as follows:
Form-A, Form-C, Form-D1, Form-D2, Form-D3 and Form-E

For Government Pensioners

  1. Start by visiting the WB Health Scheme portal.
  2. Opt for the ‘Download’ option within the left box.
  3. Choose ‘Pensioner’ from the ‘Select Category’ dropdown menu.
  4. Download the relevant form as needed.

Pensioners will find a range of form types available on the West Bengal (WB) Health Scheme portal, categorised as follows:

Form-I, Form-I, Form-III, Form-IV1, Form-IV2, Form-IV3, Form-V and Form-VI

How to Claim the West Bengal (WB) Health Scheme?

To initiate the process for claiming health benefits under the West Bengal health insurance scheme, follow these steps:

Step 1:
When seeking admission to the designated hospital (an empanelled hospital chosen for this scheme), present the West Bengal (WB) Health Scheme card given by the Government Authorised Agency (GAA).

Step 2:
The Health Care Organisation (HCO) will submit an authorisation request to the GAA.

Step 3:
The GAA thoroughly verifies all the provided details before granting approval for cashless treatment.

Step 4:
After the completion of the treatment, the HCO forwards all medical billings to the GAA for the settlement of the claim.

Step 5:
The GAA reviews and verifies all the medical bills and accompanying documents.

Step 6:
The claim is processed, and the approved amount is transmitted to the HCO to settle the claim.

Empanelled Hospitals Listed Under West Bengal (WB) Health Scheme:

Presenting the roster of affiliated hospitals within the West Bengal (WB) Health Scheme:

  1. The Calcutta Medical Research Institute
  2. The mission of Mercy Hospital
  3. Desun Hospitals and Heart Institute
  4. Nightingale Hospitals
  5. BM Birla Heart Research Centre
  6. Medica Super-specialty Hospital
  7. Apollo Gleneagles
  8. Peerless Hospital
  9. Ruby General Hospital
  10. Apex Institute of Medical Sciences
  11. RG Stone Urology & Laparoscopy Hospital
  12. Fortis Hospital
  13. Divine Nursing Home
  14. Daffodil Hospitals
  15. Susrut Eye Care

Please be aware that the participation of certain hospitals in the program may have changed. Therefore, verifying the status with the hospital or referring to the official website mentioned below is advisable.

West Bengal (WB) Health Scheme Helpline Number

Below is the essential information to reach out to:

For email inquiries

support.wbmedicalcell@nic.in 

For phone contact

(033) 2254-4123 or (033) 2254-4034

How Can I Check the West Bengal (WB) Health Scheme Status Online?

Here are the steps you need to follow to check the West Bengal (WB) Health Scheme status online:

  1. Visit the website or click on http://wbfin.nic.in
  2. Log in using your credentials. In case you have not registered yet, you will need to create an account
  3. You can now access your profile
  4. Click on ‘Status’ and check the status of your health scheme application
  5. You may be asked to enter details like your application or reference number, name, etc.
  6. Once all the details are filled in correctly, you’ll see the status of your WBHS application.

How to renew the West Bengal (WB) Health Scheme

To renew the West Bengal (WB) Health Scheme, follow these steps:

  1. Visit the Official Website
    Visit the official West Bengal (WB) Health Scheme website. They typically provide online renewal options.
  2. Login
    If you already have an account on the website, log in using your credentials. If you don’t have an account, you may need to create one.
  3. Navigate to the Renewal Section
    Look for a section on the website that relates to policy renewals. This could be labelled as “Renew Policy” or something similar.
  4. Enter Policy Details
    Provide the necessary policy details, which may include your policy number, personal information, and the renewal period.
  5. Payment
    Pay the renewal premium, which is typically due annually or periodically.
  6. Confirmation
    Once the payment is processed, you should receive a confirmation of your policy renewal.

Frequently Asked Questions (FAQs)

No, if you are already enrolled in the Central Government Health Scheme (CGHS), you are not eligible to avail of the West Bengal (WB) Health Scheme benefits. This scheme is designed for employees of the State Government, pensioners, and their respective family members.

Yes, there are income limits for beneficiaries. If the parents of the beneficiaries earn a monthly income exceeding ₹3500, they won't qualify for the financial benefits offered by this scheme.

If the cost of your medical treatment exceeds the predetermined limit allocated for that specific procedure in the scheme's packages, you and the hospital will need to jointly settle the additional expenses.

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