West Bengal Health Scheme (WB): Features, Benefits & Registration

Posted on: Jun 13, 2024 | 3 mins | Written by: HDFC ERGO Team

West Bengal Health Scheme (WB): Features, Benefits & Registration

The WB health scheme is a state-level health insurance scheme introduced back in 2008. However, from 2014 onwards, it is officially known as the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, after merging the two schemes.

What is the West Bengal Health Scheme?

As per the terms of the West Bengal Health Scheme, eligible individuals can avail of cashless treatment at empanelled hospitals and Health Care Organisations. Cashless treatment up to INR 1 lakh can availed of under this scheme.

This scheme has been introduced by the West Bengal State government.

Features and Benefits of the WB Health Scheme:

West Bengal Health Scheme is a unique family health insurance plan, allowing comprehensive coverage under specific circumstances. Some of its salient features and benefits include:

1. Cashless Domiciliary/Hospital Treatment:

The beneficiary is eligible to avail of cashless domiciliary/hospital treatment up to INR 1 lakh at any empanelled hospital. The plan holder must settle the excess dues if it rise above the sum assured limit.

2. OPD Treatment Coverage:

As per the plan terms and conditions, OPD treatment reimbursement coverage is also allowed. This includes regular health expense coverage along with preventive healthcare.

3. Non-Empanelled Hospital:

As per the plan terms, if the treatment is availed of at any non-network hospital, a specific percentage of the expenses will be covered. This allows financial flexibility up to a certain extent even if an empanelled hospital is unavailable during an emergency.

4. Out-Of-State Hospitalisation:

If the beneficiary is treated at any empanelled hospital out of the state, he/she can enjoy the coverage under this scheme. This scheme does not limit treatment coverage only within the state.

5. Procedures Covered:

Over 1000 medical procedures are covered under this scheme. It allows coverage for specialised surgeries up to 12 days, major surgeries up to 7-8 days, endoscopic surgeries, laparoscopic surgeries, and normal deliveries up to 3-4 days and 1-day coverage for OPD and other minor surgeries.

Eligibility Criteria of the WB health scheme:

The eligibility criteria for subscribing under the WBHS scheme are:

• This scheme has been directed towards all the state government employees, government employees availing pension along with their families

• People who have chosen this scheme as per Medical Allowance

• Officers and pensioners of the All India Services can avail of this scheme's benefits

• The family members included in this coverage are spouses, parents, dependent children, and dependent siblings.

What’s Covered and What’s Not Covered under the WB health scheme?

A. Inclusions

WBHS allows coverage for the following ailments:

a. Rheumatoid arthritis

b. RCT

c. LUPUS

d. Malignant malaria

e. COPD

f. Malignant diseases

g. TB

h. Hepatitis B/C and other liver ailments

i. Insulin-dependent diabetes

j. Bleeding disorders/thalassemia/platelet disorders

k. Renal failure

l. Injuries caused by accident including animal bites, etc.

B. Exclusions

a. Any self-inflicted injury

b. Non-medical treatment costs

c. Cosmetic procedures

d. Any unproven medical treatments

e. Substance abuse

f. Organ transplants

g. Rehabilitation therapies

h. OPD services for chronic conditions like hypertension and diabetes.

How To Enrol and Register Under the West Bengal Health Scheme?

The enrolment and registration process under the West Bengal Health Scheme is quite simple:

• Visit the official WBHS portal

• Click on the online Enrolment form present in the top section and your employee status

• If you have a GPF/PRAN number, tick the Yes box and enter the relevant details. If it is no, then choose the box for “NO” and select non-GPF

• Mention personal details like birth date, address details, etc. and click Next

• Enter name, address, contact number, employee number, etc.

• Mention relevant office details

• Mention relevant family details

• Upload a recent photo and signature following the dimensions

• Mention details of the beneficiary

• Enter head office details

• Save all the details and take a printout for future reference.

How To Download the West Bengal Health Scheme Application Form?

You can download the WB health scheme form by visiting the official website:

• Visit the official WEHS portal and go to the “Downloads” section

• Choose “Employees” from the “Select Category” drop-down options

• Download the necessary form

In the case of pensioners:

• Visit the official WBHS portal

• Choose “Pensioner” from the “Select Category” drop-down option

• Download the necessary form.

How To Claim Under the West Bengal Health Scheme?

WB Health Scheme is a cashless health insurance scheme, allowing family health insurance coverage too as per the plan terms. You need to follow these few simple steps to ensure smooth claim settlement:

• Submit your cashless health insurance WBHS card while getting admission under an empanelled hospital

• Health Care Organisation will send a special authorisation request to the designated Government Authorised Agency

• GAA will verify the details before approving the request

• After the treatment, either the hospital or the HCO will forward the bill to the designated GAA along with other documents like medical reports, discharge summaries, doctor’s certificates, prescriptions, etc.

• GAA will verify the documents

• GAA will transfer the approved claim amount to the respective HCO.

Empanelled Hospitals Listed Under the West Bengal Health Scheme

The list of hospitals empanelled under the West Bengal Health Scheme includes:

• The Calcutta Medical Research Institute

• Desun Hospital and Heart Institute

• Nightingale Hospitals

• R N Tagore International Institute of Cardiac Sciences

• Apollo Gleneagles

• Ruby General Hospital

• BM Birla Heart Institute

• Medica Super Speciality Hospital

• Mission of Mercy Hospital

• Susrut Eye Foundation.

West Bengal Health Scheme Helpline Number

The helpline numbers of the West Bengal Health Scheme are:

(033)2254-4123/(033)2254-4034

Email id: support.wbmedicalcell@nic.in.

Regulation of the Scheme

A special medical cell of the Finance Department of the West Bengal State Government maintains and administers the WBHS. This cell works in collaboration with the state’s Health and Family Welfare department to ensure smooth monitoring. This particular Cell also states and revises the operational guidelines as required.

Conclusion

The West Bengal Health Scheme targets to offer easy accessibility to quality healthcare services at affordable costs along with cashless treatment facilities. It is accessible to all state government and central government employees and pensioners. It targets to improve the overall healthcare services of the state.

FAQs

1. Is it possible for any employee to opt out of the WBHS?

Yes, under certain specific requirements, an employee may choose to opt out of the WBHS.

2. Is it possible for the concerned beneficiary or his/her family members to benefit from the WBHS reimbursement facility using the Certificate of Enrolment?

Yes, this is possible using the enrolment Certificate.

3. Does the WB Health Scheme consider a spouse to be a beneficiary?

Yes, as per the regulations of the WB Health Scheme, the spouse is considered to be a beneficiary.

4. Can the surgery cost be reimbursed if there is no assigned package rate?

Yes, reimbursement is possible. The package cost of a similar surgery will be considered under such circumstances.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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