West Bengal Health Scheme: 6 Important Things You Need to Know

The West Bengal Health Scheme is a health insurance welfare scheme for the existing and former state government employees and their family members. The scheme also caters to the beneficiaries of grant-in-aid-colleges and universities. The health scheme was initially introduced in 2008. Six years later, it went through a structural revamp to become the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme [1].

In accordance with the updated scheme, beneficiaries are eligible for availing cashless treatment of up to Rs.1 lakh at empaneled hospitals. Read on to understand the important details regarding the WB Health scheme.

What are the features of the West Bengal Health Scheme? 

There are 4 major features of the West Bengal Health Scheme.  

• OPD facilities – You can get reimbursement for OPD treatment as per the conditions, such as that of waiting period, mentioned in the scheme
• Treatment benefits at non-empaneled hospitals – If you avail treatment at non-network hospitals, you can get a certain percentage of the treatment expenses reimbursed 
• Cashless treatment – As a beneficiary, you can avail cashless treatment of up to Rs.1 lakh. If the bill amount crosses the specified limit, you will need to bear the excess amount 
• Hospitalization in different states – You can avail compensation if you get treated from an empaneled hospital regardless of the state 

Additional Read: All about Health Insurance in India

What are the eligibility criteria for the WB Health Scheme? 

• This scheme is meant for state government employees, including those availing pension, and their families 
• This scheme can be availed by All India Services officers and those on pension, provided they have not opted for Central Government Health Scheme (CGHS)  
• This scheme is also eligible for those who have opted for it as a medical allowance 
• The cover mentioned for the family includes any dependents of the beneficiary 

What are the benefits of the West Bengal Health Scheme? 

There are more than 1000 medical procedures covered under this scheme. The benefits of coverage under different procedures are as follows. 

Benefits	Cover
OPD and minor surgeries	1 day
Endoscopic surgeries, laparoscopic surgeries and normal deliveries	4 days
Specialized surgeries	Up to 12 days
Major surgeries	7 to 8 days

What are the outdoor treatments covered under the WB Health Scheme? 

This scheme covers a list of outdoor treatments which are as follows: 

• Tuberculosis  
• Malignant diseases 
• Heart disease 
• Hepatitis B/C and other liver diseases  
• Malignant malaria 
• Cerebrovascular disorders / neurological disorder 
• Thalassemia / platelet/ bleeding 
• Rheumatoid arthritis  
• Crohn’s disease  
• Rheumatoid arthritis 
• Injuries caused by accident 
• Endodontic treatment (root canal treatment) 
• Systematic lupus erythematous  
• Ankylosing Spondylitis  
• Chronic pulmonary disease [2] 

This scheme does not cover any non-medical procedures like cosmetic surgeries.

What is the process to register for the West Bengal Health Scheme? 

You can log on to the official website of the West Bengal Health department to get started with the registration process. 

If you are registering as a government employee, follow these steps: 

• Select the online enrollment from the header section  
• Next, select the option of government employee 
• Enter the date when you joined government services 
• If you have a GPF or PRAN number, check the yes box and fill in your number 
• In case you don’t have the details, select the non-GPF option  
• Mention your details like, your name, date of birth, address and so on 
• Mention your family and office details 
• Upload your photograph and signature 
• Enter details pertaining to other beneficiaries in family (if any)  

How to avail a claim under the West Bengal Health Scheme? 

As the scheme is cashless, if the treatment expenses are within the sum insured, beneficiaries don’t have to bear it. If the cost exceeds the limit, you have to pay just the excess amount. The process to make claims in such cases is as follows.  

• Submit the cashless WB health card during your admission at any empaneled hospital 
• The healthcare organization will make an authorization request to the GAA (Government Authorized Agency) 
• The GAA will look at your details and then send approval 
• After the treatment, the hospital or healthcare organization will send the bill to GAA accompanied by documents like the doctor’s certificate and medical reports 
• The GAA will then verify the documents and initiate reimbursement if all requirements are met  

Additional Read: Ayushman Bharat Registration

In case you are not eligible for the WB Health scheme, you can apply for the Swasthya Sathi Health Card in West Bengal. It is a universal health scheme to provide basic health coverage to all residents of West Bengal. Apart from these two government schemes, you can also opt for private insurance. For quick processing and a range of benefits, choose from the Aarogya Care plans offered by Bajaj Finserv Health. Here you can enjoy various coverage benefits like preventive healthcare, online doctor consultation, network discounts, pre- and post-hospitalization coverage and more.