The key features of the West Bengal Cashless Health Insurance Scheme are as follows:

• Cashless Indoor Medical Treatment: This component is the key feature of the West Bengal Cashless Health Insurance Scheme. Under this feature, the insured can avail cashless indoor treatment at an accredited/ network hospital worth INR 1 lakh. This is done in order to reduce the burden on the insured and their family members. It is to be noted that if the treatment cost of the insured exceeds the amount of INR 1 lakh, then the remaining cost of the treatment is to be borne by the policyholder.

• Outpatient Department (OPD) Treatment: WBHS covers various OPD treatments like the Rheumatoid Arthritis, Tuberculosis, Malignant Malaria, Chronic Obstructive Pulmonary Disease (COPD), Heart Disease, Insulin-dependent Diabetes, etc.

• Out-of-State Hospitalisation Cover: With the WBHS, in case the insured has undergone a treatment in a hospital outside West Bengal, the cost of the treatments are covered. This is true only when the hospital is empanelled and listed by the West Bengal Government under the scheme.

• Coverage for Treatment Done in A Non-empanelled Hospital: In case the treatment being done is not available in the empanelled hospitals, then the insured can choose to get their treatment done at a non-empanelled hospital. Under the West Bengal Cashless Health Insurance Scheme, a portion of this treatment will also be covered, and can be reimbursed. Please ensure you read the terms and conditions of the scheme carefully.

• Major Treatments & Procedures Covered: Under WBHS, there are over 1000 treatments and procedures covered. There is also a coverage for specialised surgeries for up to 12 days, for major surgeries up to 7 to 8 days, laparoscopic and endoscopic surgeries, normal deliveries up to 3 to 4 days, and OPD and minor injury coverage of 1 day.

The benefits of the West Bengal Health Scheme depends on the Officer Grade and are mentioned below:

Benefits For Indian Administrative Services (IAS) Officials

The IAS officers need to meet the following requirements listed below in order to avail benefits under the WBHS. Note that enrolment under WBHS 2008 is completely optional for IAS officers.

1. Under this plan, the department responsible for the administration is the Personnel and Administrative Reforms Department.
2. IAS officers and their families are eligible for WBJS 2008 and its benefits under the All India Services Medical Attendance Rules of 1954 - compliant services.
3. Officers who have healthcare services provided by the Central Government Health Scheme (CGHS) are not eligible to use those same services under WBHS 2008.

Benefits For Indian Forest Services (IFS) Officials

The Indian Forest Services officials need to meet the following requirements listed below in order to avail the WBHS benefits. Note that even for the IFS officials, taking benefits under the WBHS is completely optional.

1. The Forest Department is the department responsible for all administration under the WBHS for the IFS officials.
2. IFS officers and their families are eligible for the benefits of the West Bengal Cashless Health Insurance Scheme under the All India Services (Medical Attendance) Rules of 1954.
3. If the IFS officers are part of the Central Government’s CGHS or Central Government Health Scheme, then they are not eligible for the state-based scheme.

Benefits For Indian Police Services (IPS) Officials

In order to be eligible for the West Bengal Health Scheme, the India Police Services (IPS) officers need to meet the following criteria listed below. Enrolment in the scheme is completely optional for IPS officers as well.

1. The Home Department Police Service Cell is the administrative department for the IPS officers.
2. IPS officers and their family members are eligible to avail all services under the All India Services Rules of 1954.
3. Officers who have availed the Central Government Health Scheme (CGHS) benefits are not eligible for availing benefits under WBHS.

In order to be eligible for the West Bengal Cashless Health Insurance Scheme you must be:

1. A State Government employee, a State Government employee posted in West Bengal, or a Government employee availing pension benefits, and the families of the pensioners, (spouses, parents, dependent children, and dependent siblings).
2. Individuals who get to choose this scheme as per their medical allowance.
3. Officers and pensioners of the All India Services (AIS).

The various types of treatments and medical services available or covered under the West Bengal Health Insurance Scheme are listed in the table below [3]:

Inclusions

There are a total of 1014 surgical treatments provided to the insured under the West Bengal Cashless Health Scheme. The list of OPD treatments included under the 2008 WBHS are listed below:

• Tuberculosis
• Root Canal Treatment or the Endodontic Procedure
• Rheumatoid Arthritis
• Systemic Lupus Erythematosus (LUPUS)
• Crohn's Illness Heart Condition
• Cerebrovascular Diseases and Neurological Conditions
• Malignant Malaria
• COPD (Chronic Obstructive Pulmonary Disease)
• Liver Conditions and Hepatitis B and C
• Accidentally Inflicted Injuries (including animal bites)
• Insulin Dependent Diabetes
• Bleeding Disorders
• Platelet Disorders or Thalassemia
• Kidney Failure

Exclusions and Limitations of WBHS

The exclusions and limitations of the WBHS is mentioned below:

• Any injury which is self inflicted
• Cost for any sort of non medical items
• Cosmetic surgery
• Any medical treatment that cannot be validated
• Substance abuse related health issue
• Organ transplants
• Rehab or therapy
• O.P.D services for any serious/ critical illness like diabetes or hypertension

The top hospitals in the state of West Bengal that are empanelled with the West Bengal Cashless Health Scheme are:

1. The Calcutta Medical Research Institute
2. Desun Hospitals and Heart Institute
3. Nightingale Hospitals
4. R N Tagore International Institute of Cardiac Sciences
5. Ruby General Hospital
6. Mission of Mercy Hospital
7. Apollo Gleneagles
8. B M Birla Heart Institute
9. Medica Super Specialty Hospital
10. Susrut Eye Foundation

In order to enrol in the West Bengal Health Insurance Scheme (WBHS), follow the simple steps mentioned below [4]:

Step 1: Visit the WBHS Web Portal

Visit the West Bengal Health Insurance Scheme website.

Step 2: Select Online Enrolment

You will see the option “Online Enrolment” in the header menu. Click on that button.

Step 3: Select Your Employment Type

Select whether you are a Government Employee, Pensioner, Beneficiary of Grant-in Aid College, or Beneficiary of Grant-in Aid University.

Step 4: Enter Your Details

Once you choose your employment type, you will be redirected to the next page. Upon the page’s opening, enter the details as per the following requirement:

If You Are A Government Employee

Enter the date of your joining the service, and tick yes or no on the question “already have a PRAN/ G.P.F Number?” You will then be able to proceed further.

If You Are A Pensioner

Enter the date of your retirement from the service, now tick yes or no on the question “already have a P.P.O number?” You will now be able to proceed ahead.

If You Are A Beneficiary of Grant-in Aid College

Enter your HRMS ID to proceed further or download offline form from the same page by clicking on the Adobe PDF icon. Similarly, you can also download the college treasury and DDO list from the page.

If You Are A Beneficiary of Grant-in Aid University

Enter your PAN ID number to proceed further. You can also download the offline form or the University Treasure and DDO list from the same page by clicking on the PDF icon.

Here are the generic documents required for all eligible individuals: Address Proof, Government ID Card, Registered Mobile Number, Email ID

1. For Existing/ Current Government Employees: You will also require the details of date of joining the service and the PRAN or G.P.F number.

2. For pensioners or retired Government employees: You will need the details on the date of your retirement, and the P.P.O number.

3. For Grant-in Aid College Beneficiaries: You will need their HRMS ID.

4. For Grant-in Aid University Beneficiaries: You will need their PAN card number.

In order to avail cashless treatment under the West Bengal Health Scheme (WBHS) 2008, read the details mentioned below:

1. Get your treatment done in a Government Hospital that is recognised by the WBHS or an empanelled hospital.
2. In order to receive medical treatment in a recognised hospital or diagnostic centre, the policyholders can show their identity card received from the WBHS. In some cases, a photo copy of the WBHS ID Card may be required to be submitted at the hospital or the diagnostic centre for verification.
3. At the time of admission for any indoor treatment, retired policyholders must register the address of the Head of their Department or the Pension Sanctioning Authority.
4. Ensure that your identification card number is correctly entered in your hospital or diagnostic bills to avoid claim rejection.
5. Make sure that all the bills and reports include the code numbers of your WBHS ID card.
6. Ensure that all the surgical procedure related bills have the right code updated as per their description.
7. Make sure you make your claims within three months of being discharged in case you have undergone an indoor treatment.
8. Similarly, get reimbursement for O.P.D treatments within three months of each consultation or medicine purchase.
9. Ensure that you take permission from the Authorities of the West Bengal Health Scheme before you undergo:

1. 1. Human Organ Transplantation
   2. Cochlear Implant Surgery
   3. Implantation of Dual Chamber Pacemaker
   4. Implantation of more than one Drug Eluting Stents
   5. Implantation of more than two Stents
   6. Implantation of AICD/ CRT with AICD
   7. Implantation of Neuro implants, viz., Deep Brain Stimulator Implants, Intra- Thecal Pumps, Spinal Chord Stimulators

10. In case you are going for a treatment in a Speciality Hospital outside of West Bengal, it is necessary to take permission from the WBHS Authority first.
11. In case you observe over billing or carrying out of any wrongful procedure on you/ the policyholder, immediately bring this to the notice of the Hospital Authority and WBHS within 15 days of being discharged.
12. Use the following forms of Essentiality Certificates for getting medical treatments done for Government employees and their family members:

1. 1. O.P.D treatment under the Health Scheme - Form D-1, Clause 7
   2. Indoor and related O.P.D treatment under the Health Scheme - Form D 2, Clause 6 & 9
   3. Medical treatment procedure in non-empanelled hospital or nursing home - Form D 3

13. Use the following forms of Essentiality Certificates for getting medical treatments done for Government Pensioners and their family members:

1. 1. O.P.D. treatment under Clause-7 of the Health Scheme - Form IV 1
   2. Indoor treatment and related O.P.D. treatment under Clause-6 & 9 of the Health Scheme- Form IV 2
   3. Medical treatment done in non-empanelled hospital/ nursing home - Form IV 3

Irrespective of whether you are a Government employee, pensioner,or Grant-in aid college or university beneficiary, major steps for claim is the same as mentioned below:

Step 1: Submit your cashless health insurance ID card of WBHS at the empanelled hospital while you get admitted there

Step 2: A special authorisation request will be sent to your designated Government Authorised Agency or GAA

Step 3: Your Government Authorised Agency or GAA will first verify the details before complying with the request or before the request can be processed

Step 4: Once the treatment is complete, the hospital authorities will forward the details of the bill to the designated GAA along with all medical reports, discharge document, doctor's certificate and NOC, prescriptions, etc.

Step 5: A verification will be done at the GAA’s level

Step 6: After verification, GAA will transfer the claim amount to the respective hospital

In order to connect with the customer support team of WBHS in relation to any query that you may have regarding the scheme, registration process, claim process or more you can:

• Call on (033)2254-4123 or (033)2254-4034
• Email on support.wbmedicalcell@nic.in

1. https://wbhealthscheme.gov.in/Home/wbhs_about_scheme.aspx
2. https://wbhealthscheme.gov.in/First_page.aspx
3. https://wbhealthscheme.gov.in/Home/wbhs_facilty_available.aspx
4. https://wbhealthscheme.gov.in/Online_Registration/wbhs_continue_registration_emp.aspx
5. https://wbhealthscheme.gov.in/Home/wbhs_guideline_med.aspx
6. https://wbhealthscheme.gov.in/Home/wbhs_faq.aspx