The West Bengal Health Scheme (WBHS) is a health scheme introduced in West Bengal in 2008. The Finance Department launched the Government of West Bengal for Government Employees & Pensioners. There are several schemes and policies that the Central and State Governments may introduce to alleviate poverty and make life easier for the country’s citizens, as well as those who are struggling and unable to sustain a good quality of life on their own. The country’s administration must give these people a helping hand through the various West Bengal health scheme benefits to access necessities, including sound quality and timely medical assistance and treatment for multiple issues. The WBHS is a state-level health insurance welfare scheme. This scheme began in the year 2008. However, in 2014, it underwent a revamp and became known as the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme. Both schemes have been merged. For this scheme, cashless medical services are offered to those eligible through their WB health card. Cashless health services are provided for an amount up to Rs 1 Lakh. 

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Eligibility Criteria For WBHS

West Bengal Health Scheme (WBHS) - WB Health Scheme

Different kinds of people are eligible for the West Bengal Government Health Scheme or WB Health Scheme. Once the eligibility is checked, the person may know if they qualify for the WB Health Scheme and West Bengal health scheme benefits, and may or may not proceed with their application. The eligibility criteria to avail of the facilities under the scheme are employees, pensioners and family pensioners of the State Government, All India Service officers and pensioners can avail of this scheme, dependent family members of the beneficiary such as a spouse, parent, children, sibling, widowed, or divorced daughter, and unmarried, divorced, or widowed sister as well as a beneficiary who has chosen to opt for this particular scheme as medical allowance. Various facilities would be available to the employee and their beneficiary beneficiaries. These facilities come under the WBHS 2008 alongside the West Bengal Services (Medical Attendance) Rules 1964, as amended. IAS, IFS, and IPS may be eligible for benefits under this scheme based on specific terms and conditions. There are some particular benefits that IAS, IPS, and IFS officers can avail of through the West Bengal Government Health Scheme. They may be able to take this scheme up, but it is still optional. When they avail of the scheme, they should not have taken up any CGHS scheme (central government health scheme) at the time. They may also use facilities mentioned in the All-India Service Rule Act of 1954.

Benefits Under The West Bengal Health Scheme (WBHS)

Under the scheme, one may receive several kinds of assistance at a hospital using their health card in West Bengal, which is mentioned in the West Bengal Health Scheme Hospital list. For example, if they want to receive treatment in Kolkata, they will look at the WBHS hospital list in Kolkata. One may be eligible for OPD Treatment Reimbursement through the WB Health Scheme. They may also avail of the cashless indoor treatment facilities up to Rs. 1 Lakh. Suppose the beneficiary of the West Bengal Government Health Scheme, or patient, receives treatment at a hospital through the health card in West Bengal that is not a hospital that is included in the network of hospitals for the scheme. In that case, 60% of the actual cost or the approved amount, whichever of these is less, can be reimbursed to them. Suppose they are in a hospital from the hospital list or the West Bengal Health Scheme cashless hospital list, which can be specific to their location, such as the WBHS hospital list in Kolkata, where the total number of beds available for patients is above 80. In that case, 80% of the cost of the medical treatment may be reimbursed. 

Regarding specified investigations, a few select medical investigations mentioned in the medical Memo 10 will only be refunded on the OPD prescriptions advised by the doctors in recognized hospitals, or if the investigation is done in a network hospital. The West Bengal government health scheme provides benefits to the Beneficiaries of Grant-in-aid universities and colleges, other than the treatment at particular hospitals included in the West Bengal Health Scheme Hospital list. On the WB Health portal, one may find different kinds of health information, such as getting to know one’s COVID-19 patient status, signing up to donate plasma, and accessing an active COVID-19 vaccination centre list. They may then access the West Bengal Health Scheme Hospital list to see which hospital is close to them and what would be most suitable for the treatment they are receiving.

Limitations Of The West Bengal Health Scheme (WBHS)

There are certain limitations to the West Bengal government health scheme. The scheme does not cover certain expenses, such as cosmetic surgeries and treatments that are regarded as non-medical. The scheme itself is also only available within the confines of the state of West Bengal, so while it is a great scheme, it has some territorial limitations as well, and hospitals included in this scheme are primarily in West Bengal, so one may have access to West Bengal-specific hospital lists like the WBHS hospital list in Kolkata. There are a few specialty hospitals outside the state of West Bengal that the WB Health Scheme covers. While beneficiaries who require specialized treatment may be able to go to any of these hospitals for that particular treatment and still come under the wing of the WB Health Scheme, the rest of the beneficiaries will be restricted to the state of West Bengal. Another limitation is that the treatment costs covered by the WB Health Scheme are relatively small; it is usually only up to about 1 lakh rupees for the medical treatment of a beneficiary, when often the cure for urgent medical emergencies comes up to multiple lakhs rupees. One may have to choose a suitable scheme according to their healthcare needs. Also, several hospitals mentioned above may no longer be a part of the West Bengal Health Scheme (WBHS) 2008. It is a good idea that the beneficiary or the patient receiving the treatment first checks the healthcare facilities covered under WBHS to ensure that the treatment they plan to get at that particular hospital is covered. There is a WBHS portal to do so; however, this process may be incredibly taxing for those undergoing some medical emergency. 

Ease Of Online Application For West Bengal Health Scheme (WBHS)

One can easily apply for the WB Health Scheme or the West Bengal health insurance scheme online. The application may be made through the Scheme Portal. This would benefit people who reside in both urban and rural regions. The online application saves travel time and travelling costs for urban dwellers because of the high travel costs and busy roads in cities. In the rural areas, one would save significantly on travel time and travel costs as well, but travel time because they would have to travel possibly very long distances, as things are much farther away from each other in rural areas where not as many people reside as in more urban regions. The travel costs in rural areas may also be very high for the same reason, because that transport would have to cover long distances. The availability of things to run and maintain the vehicle or transportation, such as fuel, tire changing stations, etc., would also be far away, which would raise the costs of using that vehicle or transport. 

Process To File Claims Through The West Bengal Health Scheme (WBHS)

The process to file claims is simple. It is essential, as well as part of the normal process one must follow before availing of the benefits of a scheme. They will have to claim the amount and show why they need the money, which is part of the benefits of the particular scheme and, in this case, the WBHS scheme. The person who wants to file a claim under this scheme needs to produce a cashless card that they got from the Government Authorized Agency (GAA) to the listed hospitals that are mentioned in the scheme’s hospital list before undergoing the necessary treatment. The concerned hospital will get approval from GAA. After the medical treatment has concluded, the hospital will send all medical documents and bills to GAA. After verification, GAA will settle the expenses with the hospital.

Viewing Doctor’s Details For The West Bengal Health Scheme (WBHS)

Viewing the doctor’s details may be an aspect that is very important to a patient receiving some treatment. Patients may want to know more about the doctor, especially in sensitive medical treatments, which they may be more anxious about. When a patient who is a beneficiary has to undergo some treatment and would like to know more about who is treating them, they may proceed to the official website of the Finance Department of the Government of West Bengal. On visiting the home page of this website, the person has to click on the option of “Hospital/ Doctor detail” from the “Hospital” section. After this, a form will be displayed. One must now add specific details to this form, such as the doctor’s or hospital’s name, and click the search button. In doing this, the information about the doctor or doctors who work at a hospital will be displayed, which is included in the West Bengal Health Scheme Hospital list. 

Opting Out Of The West Bengal Health Scheme (WBHS)

Some people may decide that they do not need to avail the benefits of the scheme anymore or at all. They may want to fully opt out of the scheme for their own differing reasons. Beneficiaries may have the option to opt out of the scheme immediately if they have yet to use benefits. But if they have availed coverage under this in the past, they will have to wait for five years to be able to clear their names from the list of beneficiaries. 

Regulation Of The Scheme

Regulation of any government scheme is essential. It serves the people, so if it does not operate properly, it could severely affect the people most closely affected. In the case of the scheme, the Finance Department of the Government of Bengal has a Medical Cell. This Cell is the administrator for the WBHS scheme benefits, and one may use their WB health card to access them. The Cell, the state’s Health and Family Welfare department, and this Cell continuously monitor the scheme. The Cell also states operational guidelines for the scheme.

Conclusion

The West Bengal Health Scheme (WBHS) may provide good-quality healthcare and medical assistance to the beneficiaries. Healthcare is crucial to the proper working of a country and, if neglected, can halt the expansion of human resources. Women, as well as children, many times bear the brunt of such situations, feeling the majority of the effects. This scheme has made life much smoother for those struggling in the case of West Bengal, lifting the pressure they have felt all their lives to sustain themselves while continuing to be part of the least financially secure population. The number of beneficiaries covered by the scheme is 807783 people, while the number of private hospitals empanelled is 148 hospitals. The number of treatments going on through the scheme is 600. The scheme is crucial for the development of the state of West Bengal and the country as a whole, for the overall development of the nation.

Apart from getting support from government health schemes, one can also try crowdfunding and crowdfunding platform to raise funds for their treatment.