The West Bengal Health Scheme, initiated by the Finance Department of the Government of West Bengal, is a significant healthcare program designed to cater to the medical needs of government employees and pensioners in the state. This comprehensive scheme offers a range of medical facilities to its beneficiaries, ensuring their well-being. In this article, we delve into the details of the West Bengal Health Scheme, including eligibility criteria, facilities provided, and how to register for the program.
Eligibility for West Bengal Health Scheme
- State Government Employees and Pensioners: All state government employees, as well as pensioners, are eligible to apply for the West Bengal Health Scheme.
- Opted Medical Allowance: Individuals who have opted for this scheme under medical allowance are also eligible to avail of its benefits.
- All India Service Officers: All India service officers and pensioners of West Bengal can take advantage of this scheme.
- Family Coverage: The scheme covers not only the beneficiaries but also their immediate family members, including self, spouse, parents, dependent children, and dependent siblings.
Facilities under West Bengal Health Scheme
The West Bengal Health Scheme offers a wide range of medical facilities to its beneficiaries, ensuring their healthcare needs are met. Here are some of the key facilities provided:
- Cashless Indoor Treatment: Beneficiaries can receive cashless indoor treatment of up to Rs. 1,00,000 in empanelled hospitals per indoor admission.
- Non-Empanelled Hospitals: In case treatment is carried out in non-empanelled hospitals, beneficiaries are eligible for reimbursement. This reimbursement covers 60% (80% in cases where the number of beds exceeds 80) of the approved cost or the actual amount paid, whichever is less.
- Reimbursement for Exceeding One Lakh: If indoor treatment costs exceed one lakh, beneficiaries can claim reimbursement by submitting a claim to the Drawing and Disbursing Officer (DDO) or Pension Sanctioning Authority (PSA).
- OPD Treatment Costs: The scheme also provides reimbursement for OPD (Outpatient Department) treatment costs incurred during a thirty-day period for the same medical condition for which indoor treatment was sought.
- Specific Disease OPD Treatments: Reimbursement for certain specific disease OPD treatments is also provided.
- Follow-Up Treatment Costs: Beneficiaries can claim reimbursement for follow-up treatment costs related to their medical condition.
- Treatment in Speciality Hospitals: The scheme covers reimbursement for the cost of treatment in certain specialty hospitals located outside the state.
Empanelled Hospitals Under West Bengal Health Scheme
The West Bengal Health Scheme includes a wide network of empanelled hospitals, clinics, laboratories, and diagnostic centers. Some of the notable empanelled hospitals are:
- All Government Hospitals, clinics, laboratories, and diagnostic centers
- Hospitals, clinics, and diagnostic centers managed by Municipal Corporations/Municipalities and other Local Bodies
- Ramkrishna Mission Seva Pratisthan, Sarat Bose Road, Kolkata
- Islamia Hospital, Kolkata
- Marwari Relief Society Hospital, Kolkata
- Institute of Child Health, Kolkata
- Balananda Brahmachari Hospital, Kolkata
- Chittaranjan Cancer Hospital, Kolkata
- Ramkrishna Sarada Mission Matri Bhavan, Kolkata
- Dr. M. N. Chatterjee Memorial Eye Hospital, Kolkata
- Ramkrishna Matri Mangal Pratisthan and B.C. Roy Sishu Sadan, North 24 Parganas
- J.N. Roy Sishu Seva Bhavan, Kolkata
- Chartoris Hospital, Kalimpong, Darjeeling
- Kalimpong Leprosy Hospital, Kalimpong, Darjeeling
- Sri Balaram Seva Mandir, Khardah, North 24 Parganas
West Bengal Health Scheme Statistics
- Beneficiaries Covered: 807,783
- Private Hospitals Empanelled: 148
- Ongoing Treatments: 600
OPD Treatment Diseases List
The scheme covers a wide range of diseases for OPD treatments, including but not limited to:
- Ankylosing Spondylitis
- COPD (Chronic Obstructive Pulmonary Disease)
- Crohn’s Disease
- Endodontic Treatment (Root Canal Treatment)
- Heart diseases
- Hepatitis B/C and other liver diseases
- Injuries caused by accidents (including animal bites)
- Insulin-dependent diabetes (Type-2 Diabetic Melitas is not considered as insulin-dependent diabetes)
- Malignant diseases
- Malignant Malaria
- Neurological disorder/Cerebrovascular disorders
- Renal failure
- Rheumatoid Arthritis
- Systematic Lupus Erythematosus (LUPUS)
- Thalassemia/Bleeding orders/Platelet disorders
- Tuberculosis
Follow-Up Treatment List
The scheme also covers follow-up treatments for various medical conditions, including:
- Accident cases
- Cancer surgery/Chemotherapy/Radiotherapy
- Cardiac surgery (Including Coronary angioplasty and implants)
- Hip/Knee replacement surgery
- Neurosurgery
- Renal Transplant
Speciality Hospitals outside the State
In addition to local empanelled hospitals, beneficiaries can also seek treatment in certain specialized hospitals located outside West Bengal. Some of these hospitals include:
- All India Institute of Medical Sciences, New Delhi
- Apollo Hospital, Chennai, Tamil Nadu
- Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh
- Christian Medical College, Vellore, Tamil Nadu
- L.V. Prasad Eye Hospital, Hyderabad, Andhra Pradesh
- Metro Hospital & Cancer Institute, New Delhi
- NIMHANS, Bangalore
- Post Graduate Institute of Medical Education and Research, Chandigarh
- Sankara Netralaya, Chennai, Tamil Nadu
- Tata Memorial Hospital, Mumbai
How to Register for West Bengal Health Scheme
The registration process for the West Bengal Health Scheme varies depending on your category. Below are the steps for different categories:
Employee Registration Procedure:
- Visit the official website of the West Bengal Health Scheme: http://wbhealthscheme.gov.in/
- Click on the “Online Enrollment” option.
- Select “Govt. Employee” from the dropdown list.
- Provide details such as date of entry into government service and PRAN/G.P.F No. (if applicable).
- Complete the application form with personal information, including district, date of birth, name, gender, marital status, mobile number, email id, address, ID Proof, office location, department name, and more.
- Upload your photo and signature in JPEG format (size: 10 kb to 50 kb).
- Upload any other required documents.
- Review the details you entered.
- Submit the application form.
Pensioner Registration Procedure:
- Visit the Health Scheme Portal of the Finance Department, Government of West Bengal.
- Click on the “Online Enrollment” option.
- Choose “Govt. Pensioner” from the dropdown list.
- Provide details such as district, date of birth, name, gender, mobile number, email id, address, ID Proof, date of retirement, department name, last office location, and more.
- Upload your photo and signature in JPEG format (size: 10 kb to 50 kb).
- Upload any other required documents.
- Review the details you entered.
- Submit the application form.
Registration for College and University:
For college and university registrations, you can follow similar steps on the official website.
New Hospital Registration:
- Go to the official website of the West Bengal Health Scheme.
- Click on “Online Enrollment” and select “New Hospital Registration.”
- Complete the registration form with details such as organization type, system type, service provider, state, district, and more.
- Submit the form to register a new hospital.
Other Online Services under West Bengal Health Scheme
Apart from registration, the West Bengal Health Scheme website offers various other online services, including:
- Get Doctor’s Details: You can search for doctors’ details by name or hospital name.
- Authentication of Beneficiary by Hospital: Hospitals can authenticate beneficiaries using employee numbers, mobile numbers, or enrollment certificate numbers.
- View Permission of Hospital: Check permission status from the hospital.
- Lodge Grievance: Lodge a grievance online.
- Get Package Details: Search for package details by treatment code or description.
- View Cashless Admissible Reimbursement Certificate: Check cashless admissible reimbursement certificates.
- View Claim Reimbursement Details: Access claim reimbursement details.
- Download Circulars and Memos: Download important circulars and memos.
- View Online Claim of Government Beneficiary: View online claims.
- Online Claim of GIA Beneficiary: Process online claims for beneficiaries under Grant-in-Aid.
- Empanelled Hospital List: Access a list of empanelled hospitals.
- Login on the Portal: Log in to the portal for various services.
- Available Facilities: Check available facilities.
- Download All the Important Forms: Download necessary forms.
- View Dashboard: Access the dashboard for updates.
West Bengal Health Scheme Helpline
For any technical queries, you can contact the helpline at 033-2254-4123/4034 between 10:30 AM to 5:30 PM or 18001028014 at any time. You can also email for assistance at support.wbmedicalcell@nic.in or support.hshed-wb@nic.in.
The West Bengal Health Scheme stands as a testament to the state government’s commitment to the well-being of its employees and pensioners, providing them with accessible and comprehensive healthcare services.
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West Bengal Health Scheme FAQs
Who is eligible to apply for the West Bengal Health Scheme?
All state government employees, pensioners, individuals who have opted for this scheme under medical allowance, and All India service officers and pensioners of West Bengal are eligible. The scheme also covers immediate family members, including self, spouse, parents, dependent children, and dependent siblings.
What is the maximum cashless indoor treatment amount that beneficiaries can receive?
Beneficiaries can receive cashless indoor treatment of up to Rs. 1,00,000 in empanelled hospitals per indoor admission.
Can beneficiaries get reimbursement if treatment is carried out in non-empanelled hospitals?
Yes, beneficiaries can get reimbursement if treatment is carried out in non-empanelled hospitals. The reimbursement covers 60% (80% in cases where the number of beds exceeds 80) of the approved cost or the actual amount paid, whichever is less.
How can beneficiaries claim reimbursement if indoor treatment costs exceed one lakh?
If indoor treatment costs exceed one lakh, beneficiaries can claim reimbursement by submitting a claim to the Drawing and Disbursing Officer (DDO) or Pension Sanctioning Authority (PSA).
Does the West Bengal Health Scheme cover OPD treatment costs?
Yes, the scheme provides reimbursement for OPD (Outpatient Department) treatment costs incurred during a thirty-day period for the same medical condition for which indoor treatment was sought.
Are there specific diseases for which OPD treatments are reimbursed?
Yes, reimbursement for certain specific disease OPD treatments is provided. The list of diseases is available under the scheme.
Does the scheme cover follow-up treatment costs?
Yes, beneficiaries can claim reimbursement for follow-up treatment costs related to their medical condition.
Are there specialized hospitals outside West Bengal where beneficiaries can seek treatment?
Yes, the scheme covers reimbursement for the cost of treatment in certain specialty hospitals located outside the state. A list of such hospitals is available.
How can government employees register for the West Bengal Health Scheme?
What online services are available under the West Bengal Health Scheme?
The scheme's website offers various online services, including finding doctor details, beneficiary authentication by hospitals, checking permission status, lodging grievances, accessing reimbursement details, downloading circulars, and more. Users can also log in for additional services.
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