West Bengal Health Scheme (WBHS): Check Eligibility, Coverage, Benefits

Explore the benefits, objectives, eligibility, application process, and more about the West Bengal Health Insurance Scheme.
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3 min
23-June-2025

Launched in 2008, the West Bengal Health Scheme (WBHS) is a state-run health insurance initiative introduced by the Government of West Bengal. It aims to provide cashless medical treatment to state government employees, All India Services (AIS) officers, and pensioners, serving as a comprehensive health welfare policy at the state level.

West Bengal Health Scheme (WBHS):  An overview

The WB Health Scheme is a government-backed health insurance program launched in 2008 by the Government of West Bengal to provide cashless medical treatment for state government employees, pensioners, and AIS officers. It covers inpatient treatment costs at empanelled hospitals within the state and select hospitals outside West Bengal.

In 2014, the scheme was renamed the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, introducing cashless coverage up to Rs. 1.5 lakh per treatment.

Managed by the Finance Department’s medical cell in collaboration with the Health and Family Welfare Department, the scheme’s services and updates are accessible through the official WB Health Scheme portal.

Features and benefits of (West Bengal Health Scheme) WBHS

What is West Bengal Health Scheme (WBHS)

The West Bengal Health Scheme (WBHS) is designed to offer improved medical benefits to state government employees as well as officers from the IAS, IFS, IPS, and those deputed to serve the affairs of West Bengal.

Eligible beneficiaries under this scheme can claim reimbursement for indoor treatment at empanelled hospitals within West Bengal and select hospitals outside the state. It also allows reimbursement for OPD treatment related to specific illnesses.

The scheme is managed by a dedicated medical cell under the Finance Department, in coordination with the Health and Family Welfare Department. This cell is responsible for monitoring the scheme and issuing operational guidelines.

In 2014, the scheme was renamed as the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, introducing cashless coverage up to Rs. 1.5 lakh per treatment.

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End Uses

West Bengal Health Scheme Benefits (WBHS)

All beneficiaries can claim the following benefits under the scheme:

Reimbursement of OPD treatment costs

Beneficiaries can claim reimbursement for Outpatient Department (OPD) treatment expenses related to specific diseases such as diabetes, hypertension, cardiac issues, and more. The scheme covers diagnostic tests, consultations, and prescribed medicines, subject to conditions mentioned under WBHS guidelines.

Reimbursement of the follow-up medical treatment costs

Patients undergoing long-term care can also claim reimbursement for follow-up treatments. This includes post-hospitalisation consultations, tests, and medications linked to the primary illness, as approved under the scheme’s list of eligible conditions.

Reimbursement of treatment costs in non-empanelled hospitals

In emergency situations, treatment at non-empanelled hospitals may be reimbursed. This is subject to medical justification and adherence to WBHS rules. Prior approval or post-treatment certification may be required for claim processing.

Reimbursement of investigation costs

Diagnostic tests prescribed by authorised medical professionals for covered conditions can also be reimbursed. These investigations must be conducted at approved labs or hospitals, and relevant prescriptions and reports must be submitted along with the claim.

Reimbursement of treatment costs in certain hospitals outside West Bengal

Apart from the 11 listed hospitals, treatment in other out-of-state hospitals may be reimbursed under special circumstances like lack of specific facilities within West Bengal. These claims are subject to approval from the WBHS medical cell.

Medical cost for listed diseases

The WBHS outlines treatment costs for 17 specific diseases, which serve as a standard for reimbursement. These rates ensure uniformity and transparency in the claim process and are detailed in the official scheme documentation.

Cashless treatment facility

Eligible beneficiaries can avail cashless treatment up to ₹1.5 lakh per treatment at empanelled hospitals. This facility covers hospitalisation, surgeries, diagnostics, and medicines, making healthcare more accessible and financially stress-free.

Eligibility criteria for West Bengal Health Scheme

Given below are the eligibility criteria for West Bengal Health Scheme (WBHS):

  • State government employees, retired government employees receiving pension benefits, as well as their families.

  • Individuals who have chosen this scheme through their medical allowance are also entitled to its benefits.

  • All India Services officers and retirees can also access this coverage.

  • The family coverage encompasses spouses, parents, dependent children, and dependent siblings of the beneficiary.

List of diseases covered under West Bengal Health Scheme

The West Bengal Health Scheme hospital list provides details on affiliated healthcare facilities where these benefits can be availed. Within this program, expenses incurred for outpatient treatment are eligible for reimbursement for the particular illnesses listed below:

Condition

Description

Malignant diseases

Cancerous growths requiring specialised medical attention and treatment.

Hepatitis B/C and other liver diseases

Viral infections and liver-related conditions necessitating medical intervention.

Tuberculosis

Infectious disease affecting the lungs, requiring prolonged treatment.

Type-1 insulin-dependent diabetes

Chronic condition where the body produces insufficient insulin, requiring lifelong management.

Neurological disorders or cerebrovascular disorders

Conditions affecting the brain or blood vessels in the brain, requiring specialised care.

Heart diseases

Various conditions affecting the heart's function and structure, requiring cardiac care.

Renal failure

Kidney dysfunction requiring dialysis or transplant for management.

Malignant malaria

Severe form of malaria requiring immediate medical attention and treatment.

Thalassemia, bleeding disorders, or platelet disorders

Blood-related disorders necessitate ongoing medical management.

Injuries caused by accident (including animal bites)

Trauma resulting from accidents or animal encounters requiring medical treatment.

Systematic Lupus Erythematosus (LUPUS)

Autoimmune disease-causing inflammation and damage to various body systems.

Rheumatoid arthritis

Chronic inflammatory disorder affecting joints and other tissues, requiring ongoing treatment.

Crohn’s disease

Inflammatory bowel disease affecting the gastrointestinal tract, requiring specialised medical care.

Chronic Obstructive Pulmonary Disease (COPD)

Progressive lung disease affecting breathing, often due to smoking or environmental factors.

Endodontic treatment (Root canal treatment)

Dental procedure to treat infections or save a damaged tooth.

COVID

Infectious disease caused by the coronavirus, requiring medical care and isolation measures.

Ankylosing spondylitis

Inflammatory arthritis affecting the spine and large joints, causing stiffness and pain.

Explore: List of diseases covered in health insurance

How to apply online for WBHS?

Step-by-step guide to enrolling in the West Bengal Health Scheme:

Step 1: Visit the official website of the West Bengal Health Scheme portal.

Step 2: Click on the ‘Online Enrolment’ tab and choose either the ‘Govt. Employee’ or ‘Govt. Pensioner’ option.

Step 3: Provide the ‘Date of entry into Govt. Service’ or ‘Date of Retirement from Govt. Service’ along with the ‘PRAN/GPF’ or ‘PPO’ number.

Step 4: Fill in all required personal details, including residential address, date of birth, contact number, district, and employee number. Then, click on ‘Continue’.

Step 5: Upload your photograph and signature according to the specified dimensions and click on ‘Save’.

Step 6: Print out the completed online form for your records and future reference.

Beneficiaries are eligible to request reimbursement for inpatient treatment, outpatient treatment, follow-up medical care, and investigative expenses by presenting their West Bengal Health Scheme certificate to the hospitals enlisted in the scheme.

Steps to download the West Bengal Health Scheme application form

Follow these simple steps to download the WB Health Scheme application form:

  • Step 1: Go to the official West Bengal Health Scheme website.

  • Step 2: Click on the ‘Download’ tab on the homepage.

  • Step 3: Choose the appropriate category from the drop-down menu.

  • Step 4: Select and download the required application form from the list provided.

  • Step 5: After downloading, print the form for submission and further use.

West Bengal health scheme reimbursement procedure

The West Bengal Health Scheme (WBHS) offers a completely cashless treatment facility, meaning beneficiaries do not need to pay hospital bills upfront. The insurer directly settles the expenses with the empanelled hospital. However, if the bill amount exceeds the maximum coverage limit of ₹1.5 lakh, the beneficiary will be responsible for paying the balance.

Here’s how to claim reimbursement under the WBHS:

  • Step 1: Present the WBHS certificate at the time of admission or OPD treatment at an empanelled hospital.

  • Step 2: The hospital will forward the medical bills directly to the WBHS medical cell for processing.

  • Step 3: The medical cell will verify the bills and settle the approved amount up to ₹1,50,000 directly with the hospital.

Helpline number: West Bengal Health Scheme

You can contact the officials for any queries through the contact details given below:

Email address

support.wbmedicalcell@nic.in

Phone number

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

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Frequently asked questions

How do I reach the website of the Health and Family Welfare Department of the Government of West Bengal?

You can visit www.wbhealth.gov.in to access the website of the Health and Family Welfare Department of the Government of West Bengal.

What diseases and treatments are not covered by the WBHS?

Exclusions under the WBHS may include cosmetic surgeries, non-medical treatments, experimental treatments lacking established medical usage, self-inflicted injuries, substance abuse-related treatments, high-cost procedures such as organ transplants, and specific chronic conditions.

Which department regulates the West Bengal Health Scheme?

The Finance Department is responsible for managing the financial aspects and policy framework of the scheme, while the Health and Family Welfare Department ensures that medical services and healthcare infrastructure are in line with the objectives of the scheme.

Does the scheme consider the member’s spouse as a beneficiary?

Yes, the member’s spouse can be regarded as a beneficiary.

What diseases and treatments are excluded from the WBHS?

The WBHS typically excludes cosmetic treatments, fertility treatments, alternative therapies, and experimental treatments not approved by medical authorities. Dental treatments unless related to accidental injuries are also usually not covered.

Who is eligible for the West Bengal Health Scheme?

The West Bengal Health Scheme (WBHS) is available to:

  • State Government employees

  • Pensioners of the West Bengal Government

  • All India Services (IAS, IPS, IFS) officers serving under the West Bengal cadre

  • Employees on deputation to departments under the West Bengal Government

What is the free medical scheme in West Bengal?

The Swasthya Sathi scheme is the free medical scheme in West Bengal.

  • It offers cashless health coverage of up to ₹5 lakh per family per year.

  • It is targeted at all residents of West Bengal, especially those not covered by other government health schemes.

  • Every family is enrolled under a smart card-based system, and the scheme is fully funded by the state government.

What is the difference between Swasthya Sathi and the West Bengal Health Scheme?

Feature

Swasthya Sathi

West Bengal Health Scheme (WBHS)

Target Group

General public of West Bengal

State govt. employees, AIS officers & pensioners

Coverage Amount

₹5 lakh per family per year

₹1.5 lakh per treatment

Premium Payment

Fully funded by the govt.

Govt. funds it for employees/pensioners

Type of Facility

Cashless across empanelled hospitals

Cashless at empanelled hospitals (with reimbursement option)

Smart Card

Yes, for every family

Not applicable
What is the cashless limit for pensioners in the West Bengal Health Scheme?

Under the WBHS, pensioners are entitled to cashless medical treatment up to ₹1.5 lakh per treatment at empanelled hospitals. Expenses exceeding this limit must be borne by the pensioner or claimed through reimbursement (if applicable under scheme rules).

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