Looking for information on the West Bengal Health Scheme?
In 2008, the state of West Bengal launched its official scheme, known as the West Bengal Health Scheme, intending to provide better medical facilities to its entire ecosystem of state government employees. Simply put, it is the state’s health insurance scheme for all government employees in West Bengal, it also replaces the earlier Medical Attendance Rules of 1964 and it further requires employees to give up their medical allowance.
Can retired government employees of West Bengal avail this scheme?
Notably, the scheme has also been extended to retired government employees and their families, who must give up their medical relief from their pension. In 2009 and 2010, the Government of West Bengal extended the benefits of WBHS to employees of IAS, IFS, and IPS, in addition to the existing All India Services (Medical Attendance) Rules. They delegated the affairs of West Bengal to these services.
In 2011, the state government further extended these benefits to retired IAS officers who served in the state, with a one-time contribution of ₹40,000.
What other information should I know about the West Bengal Health scheme?
Under the WBHS-08 scheme, individuals can receive reimbursement for the cost of indoor treatment in approved hospitals within West Bengal, as well as outpatient treatment for 17 specified diseases. Treatment is also available in 11 designated hospitals outside of West Bengal. Reimbursement for indoor treatment in non-approved hospitals within the state is also possible, but guidelines must be followed.
In 2014, the name of the scheme was officially changed and it became "West Bengal Health for All Employees and Pensioners. Also, the previous "Cashless Medical Treatment" scheme has further increased its cashless coverage to ₹1,50,000 for each hospital stay.
What benefits does the West Bengal Scheme offer?
Cashless indoor treatment can be availed up to ₹ 1,50,000 for each indoor treatment in empanelled hospitals. If the treatment cost exceeds this limit, submit a claim to the DDO/PSA.
There are 9 empanelled hospitals outside the state of West Bengal where treatment can be availed. Reimbursement covers the cost of indoor treatment conducted in hospitals other than registered ones. However, it is subject to compliance with the guidelines of the scheme. .
State government employees can get reimbursed for the cost of outpatient treatment that is related to your hospital stay, if it occurred within thirty days before or after your admission.
The cost of outpatient treatment and follow-up medical treatment can be reimbursed for certain specified diseases if the treatment is carried out in recognised hospitals.
What if medical treatment is in a hospital not on the approved list?
If you receive medical treatment in a hospital that is not on the approved list, you can be reimbursed for 60% of the cost (or 80% if the hospital has more than 80 beds), as long as the hospital had a valid license under the West Bengal Clinical Establishment Act and Rules at the time of treatment. The reimbursement will be based on the approved cost or the actual amount paid, whichever is lower.
What are the guidelines related to cost of treatment outside the state of West Bengal?
The cost of treatment in specific Speciality Hospitals located outside the State, including the expense of travel for one caregiver, will be reimbursed as long as the treatment is received in designated hospitals.
To initiate the enrollment process for WNHS, Step 1 is to access the West Bengal Health Scheme Portal. From there, select the option for Online Enrolment. In case you are a government employee, you will have to enter your PRAN/GPF number. If you don't possess one, choose the Non-GPF alternative.
Moving on to step 4, you will be required to provide details about your residential district and date of birth.
Step 5 involves inputting your personal information, which includes your name, address, phone number, and employee number.
Step 6 focuses on gathering information about your office, while Step 7 is dedicated to your family-related details.
In Step 8, you will be guided on how to upload your photo and signature. Step 9 demands information regarding the individuals who will benefit from this situation. The main office location is the central point of concern in Step 10. Once step 11 is completed, save the information and print the report for future reference.
How do I initiate the claim process?
To start the claim process, you need to show your cashless card at the hospital at the time of admission.The Health Care Organisation then sends a request to the Government Authorised Agency for approval. The agency carefully checks all the details and approves the request if everything is accurate. Once your treatment is done, the hospital sends the bill to the Government Assistance Agency with necessary documents. The agency verifies the documents and transfers the specified amount to the Health Care Organisation.
How to contact for queries on West Bengal Health Scheme?
For any further assistance, you can write to js3med.fd-wb@gov.in for Government Offices and Hospitals, for Government Offices wbhsgovt.officeassist@gmail.com, for all hospitals wbhshospitalassist@gmail.com
In Conclusion
All government schemes and policies may undergo changes or be replaced by new schemes over time. Therefore, we recommend checking with the relevant government authorities or official sources to get the most up-to-date information on the status of West Bengal Health Insurance Scheme or any potential replacements or similar schemes.
