West Bengal Health Scheme

What is the West Bengal Health Scheme?

West Bengal Health Scheme was introduced in 2008 by the state government of West Bengal. This state-level health scheme works for the welfare of state government employees. The government brings amendments to this scheme from time to time to extend its benefits range. Under this health scheme, reimbursement is provided to the eligible beneficiaries for their indoor treatment in empanelled hospitals in West Bengal. The reimbursement for OPD treatment of 15 diseases is also given according to the terms and conditions. Furthermore, the beneficiaries can also take advantage of this health scheme if they get their treatment done in the 9 enlisted hospitals outside West Bengal. 

In 2014, the state government renamed the scheme ‘West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme 2014’. According to the guidelines of this scheme, the eligible beneficiaries can benefit from cashless treatment of up to INR 1 lakh at the selected hospitals in West Bengal. 

Salient features of the West Bengal Health Scheme

• The eligible beneficiaries can avail of indoor treatment of up to INR 1 lakh. If the cost of treatment goes beyond West Bengal health scheme cashless limit, then the beneficiary will have to pay for the leftover charges to the HCO
• The state government of West Bengal has extended its benefits outside the state. There are 9 empanelled hospitals (outside the state) that are connected with the WB health scheme
• The benefits of OPD treatment are given to the beneficiaries according to the terms laid by the health scheme
• West Bengal government health insurance scheme includes the reimbursements for the treatment in non-empanelled hospitals as per the guidelines. 

Advantages of the West Bengal Health Scheme

Almost a thousand health treatments are covered by the West Bengal govt health scheme. Read the table to know the types of surgeries and the days covered under this scheme:

Earlier, the benefits of this health scheme were limited to state government employees and pensioners of West Bengal. But, now, its benefits are extended to the employees of Indian Forest Services (IFS), IAS (Indian Administrative Services), and the (IPS) Indian Police Services.

Read the following benefits that are given to IFS, IAS, and IPS officers under West Bengal health insurance:

For IFS Officers:

IFS officers and their dependent family members are able to take advantage of this health scheme according to the following terms and conditions

• It is an optional benefit for IFS officers.
• The administrative department is the Forest department.
• Additionally, they can also avail the facilities of All India Services Rules, 1954.
• Those who are enlisted under the (CGHS) Central Government Health Scheme can not take advantage of this scheme.

For IPS Officers:

IPS officers and their dependent family members can take advantage of the WB health scheme according to the following terms and conditions:

• For IPS officers, it is optional to enroll in this scheme.
• The related administrative department is the Police Department.
• In addition to this health scheme, they can also avail themselves of All India Services Rules, 1954 (Medical Attendance) 
• Those IPS officers and their dependent families who are enrolled on the CGHS can not take advantage of this scheme.

For IAS Officers:

IAS officers and their dependent families are able to get the benefits of the West Bengal government health scheme on the basis of the following conditions:

• It is optional to enroll in this scheme.
• The related administrative department is the Personnel and Administrative Reforms.
• Furthermore, they are eligible for the advantages of the All India Services Rules, 1954
•  (Medical Attendance).
• Those IAS officers who have already enrolled for the CGHS (Central Government Health Scheme) can not take advantage of this scheme.

Diseases covered under the West Bengal Health Scheme

A detailed list of diseases covered under the West Bengal Health Scheme is given below

1. Tuberculosis
2. Malignant malaria
3. Malignant diseases
4. Root canal treatment
5. Chronic obstructive pulmonary disease
6. Neurological disorders/cerebrovascular disorders)
7. Hepatitis B/C 
8. Other liver disorders
9. Diabetes (Diabetes mellitus is excluded as external insulin is not required for treating it)
10. Chronic renal failure
11. Accidental injuries (including animal bites)
12. Systemic Lupus Erythematosus (LUPUS)
13. Rheumatoid arthritis
14. Crohn’s disease (heart disease)
15. Thalassemia/platelet disorders/bleeding diseases

Exclusions in the West Bengal Health Scheme:

West Bengal Health Scheme excludes those beneficiaries who have undergone cosmetic surgeries. Those who have not gotten any medical treatment after getting the consultation are also exempted from this. 

Eligibility criteria for the West Bengal Health Scheme

If you want to enroll in this scheme, you should know the eligibility criteria. Hence, we have mentioned the criteria for your understanding:

1. State government employees of West Bengal (including IFS, IAS, and IPS officers), state government pensioners along with their dependent familiesDependent family members include
   • Husband/wife
   • Parents (monthly income should be less than INR 3500)
   • Children (unmarried daughter, adopted child, step-child)
   • Minor sibling(s)
   • Dependent, divorced, and widowed daughter
   • Dependent divorced and widowed sister.
2. Beneficiaries selected for this health scheme according to their Medical Allowance
3. Those who fall into the category of the All India Services Rules, 1954, are the beneficiaries.

How can I enroll in the West Bengal Health Scheme?

If you want to avail the benefits of the West Bengal Health Scheme Card, then you should follow the following steps to enroll in the scheme:

• Step 1: Firstly, visit the official website of the West Bengal Health Scheme
• Step 2: On the homepage, click on the ‘online enrollment’
• Step 3: Then, the pop-up menu will appear. Select the ‘Government employee’
• Step 4: Fill your details into the box of the ‘Date of entry into govt. Service’
• Step 5: Then, answer the question of whether you already have PRAN/GPF no. or not. If you have PRAN/GPF no, then click yes, and fill in the asked information, but if you don’t possess PRAN/GPF any, then click on no.
• Step 6: Then, enter your personal details (date of birth and residential address).
• Step 7: Save the details for enrollment in the West Bengal Health Scheme Portal
• Step 8: Select next to continue the enrollment procedure.
• Step 9: Enter personal details (name, address, and mobile number) and office details (employee no).
• Step 10: Upload all the mandatory scanned documents.
• Step 11: Enter beneficiary details. The required details related to the head office are also mentioned.
• Step 13: Save the entered information on the portal.
• Step 14: Take a printout of the registration form for future convenience.

How do I download the West Bengal Health Scheme application form?

The procedure for downloading the West Bengal Health Scheme application form is given below:

For state government employees of West Bengal:

• Step 1: Firstly, go to the West Bengal Health Scheme Portal.
• Step 2: Click on the ‘Download’
• Step 3: A pop-up menu will appear in the ‘Select Category’. Select ‘ Employee’.
• Step 4: Download the application form from various forms for different purposes. 

For state government pensioners:

• Step1: Go to the West Bengal Health Scheme Portal.
• Step 2: Click on the ‘Download’ on the homepage.
• Step 3: A pop-up menu will appear in the ‘Select Category’. Select ‘Pensioner’.
• Step 4: Download the application form as per your requirement from various forms for different purposes. 

How to make a claim for the West Bengal Health Scheme?

West Bengal health scheme is a cashless scheme. If the treatment expenditure exceeds the health scheme’s limit, the beneficiary must pay the additional cost.

Follow the following steps to settle your health claim benefits under the West Bengal health insurance scheme:

• Step 1: Firstly, provide the West Bengal health scheme card issued by the Government Authorized Agency (GAA) while taking admission to the empanelled hospital (selected hospital for this scheme).
• Step 2: HCO (Health Care Organization) will send an authorization request to the GAA.
• Step 3: The GAA verifies all the details before approving the cashless treatment.
• Step 4: After completion of the treatment, all the medical bills are sent by the HCO to GAA to settle the claim.
• Step 5: GAA verifies all the medical bills and documents.
• Step 6: The claim is settled by sending the amount to HCO.

List of Hospitals that are empanelled with West Bengal Health Scheme

List of hospitals under West Bengal Health Scheme is given below:

• R N Tagore International Institute of Cardiac Sciences
• Nightingale Hospitals
• Apollo Gleneagles
• Mission of Mercy Hospital
• Susrut Eye Foundation
• Fortis Hospital
• Institute of Neuroscience
• Daffodil Hospital
• Apex Institute of Medical Sciences
• RG Stone Urology and Laparoscopy Hospital. 

Things to remember about the West Bengal Health Scheme

The following things should be remembered about the West Bengal Health Scheme:

• State government employees, state government pensioners, and their families are eligible for this scheme.
• If the parents of the beneficiaries earn more than INR 3500 per month, they will not be able to claim the financial benefits under this scheme.
• Cosmetic surgeries and non-medical treatments are not included in this scheme.
• If the cost of treatment goes beyond INR 1 lakh in empanelled hospitals, then the beneficiary will have to pay for it.
• This is an optional scheme.
• Those who are enrolled in the Central Government Health Scheme (CGHS), can not avail of the benefits of this scheme.
• West Bengal Health Scheme Portal provides many types of application forms for state government employees and pensioners. Hence, they should select the right application form.

The West Bengal Health scheme is seen as a great relief for the state government employees and pensioners to avail the benefits of medical claims. The beneficiaries must visit the network hospitals to get the cashless treatment of INR 1 lakh. Hence, if you are also a state government employee, you can apply for the scheme and greatly reduce the burden of medical expenses. 

DISCLAIMER

This article is issued in the general public interest and is for educational purposes only. The blogs should not be used as a substitute for competent expert advice from a licensed professional to best suit your needs. Insurance is a subject matter of solicitation. For more details on policy terms, conditions, exclusions, limitations, please refer/read policy brochure before concluding sale.