West Bengal Cashless Medical Treatment Scheme

The West Bengal Cashless Medical Treatment Scheme provides cashless healthcare services up to Rs.1 lakh to pensioners, officers, and employees of the West Bengal state government. AIS officers and their families are also covered under this scheme.
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The West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, notified in 2014 is a comprehensive health scheme which aims to provide cashless medical facilities to employees, officers and pensioners of state government (not excepting family pensioners) All India Service (AIS) officers and their family members across empanelled hospitals in West Bengal. The WBHS 2008 has been merged with the Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014 from September 15th, 2014.

It is important to note that the cashless facility is available on the approved package rates under this scheme. Beneficiaries under this scheme can avail of cashless medical treatment for up to Rs.1 lakh. In case the treatment costs exceed the ceiling amount, the beneficiary has to pay the remaining balance amount to the HCO (Health Care Organisation). Furthermore, cardholders of West Bengal Health Scheme (2008) should apply for online enrollment at http://wbfin.nic.in by using their GPF account number as login id. Post registration, the print outs of the registration forms should be taken which along with stamp size photographs should be submitted to DDOs. State government pensioners should also follow the same procedures.

In other words, a beneficiary under this scheme has to submit an enrolment certificate before a HCO for availing . However, no prior authorization is required for availing cashless indoor medical facilities. At the time of discharge of a beneficiary, his or her bill will consist of details regarding treatment charges and code number.

Forms for State Government Employees:

The table below shows the different types of forms for State Government Employees

Type of forms Particulars
Form-A Enrolment application
Form-D1 Essentiality Certificate (OPD treatment)
Form-C Claim settlement for reimbursement
Form-E Checklist
Form-D2 Essentiality Certificate (Indoor treatment and OPD treatment
Form-D3 Essentiality Certificate (non-recognised HCOs)

Forms for State Government Pensioners:

The table below shows the different types of forms for State Government Pensioners

Type of forms Particulars
Form-I Enrolment application (West Bengal Health Scheme, 2008)
Form-III Claim settlement for reimbursement
Form-II Enrolment certificate
FORM IV2 Essentiality certificate-cum-statement of expenditure (duly certified by a specialist for Indoor and OPD treatment)
FORM IV1 Essentiality certificate-cum-statement of expenditure (duly certified by any OPD Treatment specialist)
Form-V Checklist for medical claims reimbursement
FORM IV3 Essentiality certificate-cum-statement of expenditure (duly certified by a specialist from any non-recognised private nursing home under WB Health Scheme)
Form-VI Family Permit (Temporary)
West Bengal Health Scheme

Implementation of West Bengal Health Scheme 2008:

The finance department of the government of West Bengal along with the department of health and family welfare issue guidelines for operations and clarifications for the smooth functioning of the scheme. The West Bengal Health Scheme 2008 is implemented in the following ways:

  • The finance department prepares the respective policy, rules and regulations which need to be applied under the West Bengal Health Scheme 2008
  • The rates for various medical treatment procedures are fixed by the finance department
  • Various private HCOs along with diagnostic centres are empanelled in consultation with the health and family welfare department
  • Various regulations are laid down for government departments to approve reimbursement proposals
  • Ensure proper monitoring of HCOs for proper treatment of beneficiaries under this scheme
  • Grant permission for the following:
    • Treatment in specialty hospitals out of West Bengal which are recognized under WBHS
    • Implantation of medical implants
    • Organ transplantation
    • Cochlear surgery

Benefits of West Bengal Health Scheme 2008 extended to IAS, IFS and IPS officers:

IAS officers:

The benefits of the West Bengal Health Scheme, 2008 was extended to the members of Indian Administrative Service (IAS) and their family members, subject to the following conditions:

  • Enrolment under the WBHS 2008 scheme is optional for IAS officers
  • The Personnel and Administrative Reforms Department is the concerned administrative department for IAS officers under the West Bengal Health Scheme, 2008
  • IAS officers and their families can avail of facilities under the West Bengal Health Scheme, 2008 besides facilities under the All India Services (Medical Attendance) Rules, 1954
  • IAS Officers enrolled under the central government health scheme cannot avail of the West Bengal Health Scheme, 2008

IPS officers:

The benefits of the West Bengal Health Scheme, 2008, have been extended to members of the Indian Police Service (IPS) and their families, subject to the following conditions:

  • Enrolment under the West Bengal Health Scheme, 2008 scheme is optional for IPS officers
  • The Home Department, Police Service Cell, is the concerned administrative department for IPS officers under the West Bengal Health Scheme, 2008
  • IPS officers and their families can avail of facilities as per the All India Services (Medical Attendance) Rules, 1954 in addition to those under West Bengal Health Scheme, 2008
  • IPS officers enrolled under the health scheme of the central government cannot avail West Bengal Health Scheme, 2008

IFS officers:

The benefits of the West Bengal Health Scheme, 2008, have been extended to members of Indian Forest Service (IFS) and their families, subject to the following conditions:

  • Enrolment for IFS officers under the West Bengal Health Scheme, 2008 is optional
  • The Department of Forests is the concerned administrative Department for IFS officers under the West Bengal Health Scheme, 2008
  • IFS officers and their families can avail of facilities under All India Services (Medical Attendance) Rules, 1954 in addition to those under West Bengal Health Scheme, 2008
  • IFS officers enrolled under the health scheme of the central government cannot avail of West Bengal Health Scheme, 2008

Empanelled Hospitals in Kolkata, West Bengal:

The following is the list of empanelled hospitals in the state of West Bengal and NCR

  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. Apollo Gelneagles
  6. Ruby general hospital
  7. BM Birla Heart research centre
  8. Medica Superspecialty Hospital
  9. Rotary Narayana Nethralaya
  10. Silverline Eye Hospital
  11. B.P Poddar Hospital
  12. Mission of Mercy Hospital
  13. Dr.Nihar Munshi Eye Foundation
  14. Eye care and Research Centre
  15. D.M Hospital Pvt. Ltd
  16. Susrut Eye Foundation
  17. Bhattacharya Orthopedics
  18. Institute of Neuroscience
  19. Amri Hospitals
  20. Barrackpore Medicare
  21. Disha Eye Hospitals
  22. Belle Vue Clinic
  23. Fortis Hospital
  24. Kothari Medical Centre
  25. Peerless Hospitax Hospital
  26. Apex Institute of Medical Sciences
  27. Dafodil Hospitals
  28. Kothari Medical Centre
  29. Ekbalpur Nursing Home
  30. R.G Stone Urology and Laproscopy Hospital
  31. Nabajiban Hospital
  32. KPC Medical College
  33. Implant’s Better Sight Centre
  34. Eskag Sanjeevani
  35. Divine Nursing Home

Revised Rate list:

The following table shows some rates* under the West Bengal Health for all Employees and Pensioners Cashless Medical Treatment Scheme, 2014, Finance Department, Government of West Bengal

Description Rate Package or non-package
Consultation by super specialists (indoor) (two visits per day) Rs.250 Non-package
Consultation by specialists (Indoor - two visits) Rs.200 Non-package
Consultation by super specialists (OPD) Rs.250 Non-package
Consultation by Medical Officer (OPD) Rs.150 Non-package
Excision of moles Rs.600 Package
Excision of Corns Rs.550 Package
Excision of Molluscum Contagiosum Rs.600 Package
Excision of Warts Rs.600 Package
Excision of Venerel Warts Rs.600 Package
Cyst under LA Rs.300 Non-package
Flap operation per tooth Rs.500 Non-package
Extraction of Tooth including LA Rs.120 Non-package
Gingivectomy per tooth Rs.300 Non-package
Complicated extraction per tooth including LA Rs.250 Non-package
Retrobular Injection (both eyes) Rs.300 Non-package
Lacrimal sac for one eye Rs.200 Non-package
Subconjunctival Injection -one eye Rs.200 Non-package
Subconjunctival Injection -both eyes Rs.300 Non-package

*List is not exhaustive. Rates vary according to the medical procedure

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

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