West Bengal Health Scheme

Scheme Introduction: A Brief Overview

The West Bengal Health Scheme (WBHS) provides medical benefits to eligible West Bengal Government employees, pensioners, family pensioners and their eligible dependent family members. The scheme covers eligible medical treatment, investigations and other approved healthcare services through recognized and empanelled healthcare organisations.

One of the major benefits of the West Bengal Health Scheme is cashless inpatient treatment. From 1 October 2026, eligible beneficiaries can receive cashless inpatient treatment up to ₹5 lakh per hospitalisation at empanelled private hospitals in West Bengal. The scheme also provides reimbursement for eligible medical expenses and allows beneficiaries to receive covered treatment at recognized hospitals according to the applicable scheme rates.

The scheme also protects beneficiaries during medical emergencies. A recognised hospital cannot refuse emergency admission or demand advance payment before admission when an eligible beneficiary produces a valid scheme identity card. Eligible dependent family members can also receive benefits subject to the applicable dependency and income conditions. Beneficiaries looking for information about another government health insurance initiative can also read about Mukhyamantri Swasthya Bima Yojana.

Regular West Bengal Government employees can choose to enrol in the scheme, while eligible pensioners and family pensioners can also enrol by following the prescribed procedure. Employees must give up their monthly Medical Allowance after enrolment, while pensioners and family pensioners must give up the applicable Medical Relief. Employees who retired before 1 June 2009 can also enrol.

Eligible beneficiaries can apply for West Bengal Health Scheme enrolment online or offline. Employees can use the online enrolment facility or submit the prescribed application through the concerned authority. Pensioners and family pensioners can use the pensioner enrolment facility available through the portal or follow the prescribed offline procedure through the concerned Pension Sanctioning Authority or designated authority.

Scheme Benefits

The West Bengal Health Scheme provides medical support to eligible employees, pensioners and their eligible family members. The main benefits include:

• Eligible beneficiaries can receive cashless indoor treatment at private empanelled hospitals in West Bengal up to ₹5,00,000 per hospitalisation.
• For cashless bills up to ₹1,00,000, the Medical Cell, Finance Department pays the hospital directly.
• For the treatment cost above ₹1,00,000, the beneficiary pays the hospital first and can later claim reimbursement using the system-generated Cashless Admissible Reimbursement Certificate (CARC).
• Eligible indoor treatment at Government and recognised private hospitals is reimbursed according to the approved package rates, which cover charges such as registration, accommodation, operation, anaesthesia, nursing, medicines and investigations.
• Eligible beneficiaries can claim reimbursement for OPD treatment of specified diseases and conditions, including cancer, tuberculosis, heart disease, Type-1 diabetes, Chronic Kidney Disease, neuropsychiatric disorders, Rheumatoid Arthritis, Lupus, Crohn's Disease, COPD, Ankylosing Spondylitis and root canal treatment.
• Since September 2026, OPD reimbursement also covers Pancreatitis, Osteoarthritis, Ulcerative Colitis, Glaucoma, Idiopathic Pulmonary Fibrosis and Connective Tissue Diseases.
• Enrolled employees can receive a medical advance of up to 80% of the estimated treatment cost for ongoing or planned treatment through the WBHS Portal.
• For cashless IPD treatment, the employee's medical advance is calculated after deducting the ₹1,00,000 amount already covered directly through cashless payment.
• Pensioners cannot use the online medical advance facility, but they can receive an advance of up to 80% of the estimated cost, including implants, for certain major illnesses when treatment is taken at a Government hospital.
• The medical advance for pensioners can cover major treatments such as bypass surgery, pacemaker implantation, coronary angioplasty with stenting and kidney transplantation.
• The hospital ward entitlement depends on the employee's pay band, under which the beneficiary may be entitled to a Private Ward, Semi-Private Ward or General Ward.
• In an emergency, a beneficiary can use a higher ward category until the ward category to which they are entitled becomes available.
• Eligible beneficiaries can receive treatment at speciality hospitals outside West Bengal after obtaining the required prior approval.
• For treatment at Tata Memorial Hospital, Mumbai, for cancer, AIIMS, New Delhi or NIMHANS, Bengaluru, the beneficiary does not need WBHS Authority permission or a hospital referral and only requires approval from the Secretary of the concerned Administrative Department.
• A newborn baby can receive benefits using the parent's Identity Card for the first 6 months, after which a separate Identity Card must be obtained for the child.
• Eligible dependent family members of employees and pensioners can also receive benefits subject to the applicable income and dependency conditions.

Eligibility Requirements

The West Bengal Health Scheme covers eligible Government employees, pensioners and their eligible family members. The main eligibility conditions are as follows:

• The applicant must be a regular employee, pensioner or family pensioner of the Government of West Bengal.
• All India Service officers serving in the West Bengal cadre, including eligible retired officers, can join the scheme after giving up CGHS benefits.
• Employees and pensioners of Grant-in-Aid colleges and universities and Panchayati Raj bodies in West Bengal are also eligible.
• Enrolment is optional for employees, but an enrolled employee cannot leave the scheme within five years from the month after the employee or any beneficiary receives a scheme benefit.
• An employee must give up the regular monthly Medical Allowance after joining the scheme.
• A pensioner or family pensioner must give up the Medical Relief received with their pension after joining the scheme.
• Government employees who retired before 01 June 2009 can also enrol in the scheme.
• If both spouses are Government employees of West Bengal, one spouse must be enrolled as the dependent beneficiary of the other.

Eligibility of Dependent Family Members

Eligible family members can receive benefits if they meet the prescribed relationship and income conditions.

• Husband or wife: The spouse is eligible for coverage without the usual dependency income condition.
• Parents: Parents are eligible if their gross monthly income from all sources does not exceed ₹8,500.
• Children: Children, including step-children and legally adopted children, are eligible if their monthly income is less than ₹5,000.
• Unmarried daughters: An unmarried daughter is eligible if her monthly income is less than ₹5,000.
• Widowed or divorced daughters: A dependent widowed or divorced daughter is eligible if her monthly income is less than ₹5,000.
• Minor brothers and sisters: Minor brothers and sisters up to 18 years of age are eligible if their monthly income is less than ₹5,000.
• Unmarried, widowed or divorced sisters: A dependent sister is eligible if her monthly income is less than ₹5,000.
• Major son: A major son remains dependent until he starts earning ₹5,000 or more per month or reaches 25 years of age, whichever comes earlier.
• Son with permanent disability: A son with more than 40% permanent physical or mental disability can remain a dependent beneficiary irrespective of age, subject to submission of a Disability Certificate from the competent authority.

Income Declaration for Dependents

• Working or retired dependent beneficiaries must submit an income certificate from their own Head of Office.
• Non-working dependent beneficiaries aged 18 years or above must submit the Self Declaration of Income (Annexure-V).
• The Self Declaration of Income must be submitted every two years between May and June, as applicable.
• The Disability Certificate for a dependent son with permanent disability must also be reviewed every two years.

Required Documents

Employees and pensioners need to submit different documents for enrolment, adding dependent beneficiaries, medical reimbursement and medical advance. The main documents are listed below:

Note: Additional documents may be required depending on the beneficiary category, treatment and type of claim.

Steps to Apply

Enrolment and claims under WBHS are processed mainly online through the WBHS Portal, with a manual/offline route available for pensioners who cannot access the portal directly or who reside away from their Pension Sanctioning Authority.

How to Apply Online (Employees)

1. Visit the official WBHS Portal and access the enrolment section.
2. Submit the option for enrolment (Form A) along with family particulars, through the Cadre Controlling Authority or Head of Office.
3. Upload the required photographs, signatures, blood group details and Aadhaar numbers for the employee and all dependent beneficiaries.
4. Collect the digitally signed Enrolment Certificate (Form B) issued by the Cadre Controlling Authority/Head of Office once the application is scrutinised.
5. For treatment, use the WBHS Portal login to apply for an advance claim (if needed) or submit the final reimbursement claim with supporting bills and certificates after treatment.

How to Apply Online (Pensioners/Family Pensioners)

1. Submit the option for enrolment (Form I) to the Pension Sanctioning Authority (PSA) as usual.
2. Where enrolled while still in service, conversion from employee to pensioner status in the Health Portal can be done automatically by the Drawing and Disbursing Officer (DDO) of the PSA's office.
3. Submit the biennial Self Declaration of Income (Annexure-V), between May and June every two years, for non-working dependent beneficiaries aged 18 and above.
4. Submit reimbursement or advance claims through the WBHS Portal, or through the designated Sanctioning Authority, as applicable.

Manual/Offline Route (for Pensioners Residing Away from the PSA)

1. Submit Form I along with a declaration that no enrolment has been made elsewhere.
2. If residing far from the PSA's office, submit the option to any office up to Sub-Divisional level of the same department nearest to the place of residence, or to the office of the Sub-Divisional Officer (SDO) of the relevant Sub-Division.
3. Where no such departmental office exists, submit the option to the District Magistrate of the district of residence.
4. Pensioners who have settled in Kolkata after retirement, and whose last place of posting was elsewhere, may submit the option to the concerned Directorate office in Kolkata.
5. The receiving office will scrutinise the application, issue the Enrolment Certificate, and act as the Sanctioning Authority for that pensioner's future claims (within its sanctioning limit).

Claim Settlement and Reimbursement Rules

Eligible beneficiaries can claim reimbursement for covered medical expenses by submitting the required form and supporting documents within the prescribed time.

• Submit the claim within 6 months from the date of hospital discharge for inpatient treatment.
• For eligible OPD treatment, submit the claim within 6 months from the date of consultation.
• Submit the prescribed claim form with the required medical bills and other documents.
• Submit the Essentiality Certificate in Form D or Form D1 wherever it is required.
• Attach the original bills, vouchers and other treatment records with the claim.
• Reimbursement is allowed only for expenses covered under the scheme rules.
• Treatment at recognized or empanelled hospitals is reimbursed according to the applicable scheme rates.
• Treatment at a non-empanelled private hospital is reimbursed only in permitted cases and subject to the applicable limits.
• Treatment outside West Bengal is subject to the applicable approval and other conditions.
• The concerned authority checks the claim and supporting documents before approving reimbursement.
• Late claims are considered according to the applicable rules for delay. Claims beyond the permitted period may not be reimbursed.
• Beneficiaries can obtain their medical records from recognized healthcare organizations without paying an additional charge for the records.

Permission Required for Certain Treatments

Some treatments need prior permission before a beneficiary can be treated at a private empanelled hospital. The treating hospital must seek this permission through the WBHS Portal. A supporting document is needed for each category, as listed below.

• More than 2 procedures with a total cost above ₹50,000.
  • Needs: surgeon's justification and supporting investigation reports.
• More than 2 Drug-Eluting Stents (DES), an AICD, or CRT with AICD.
  • Needs: cardiac surgeon's justification and the angiography report.
• Deep Brain Stimulation (DBS), an intra-thecal pump, or a spinal cord stimulator.
  • Needs: neuro-surgeon's justification and supporting investigation reports.
• Cochlear implantation.
  • Needs: ENT surgeon's justification and supporting investigation reports.
• Chemotherapy or immunotherapy, where medicine cost exceeds ₹50,000 per cycle.
  • One permission covers the entire chemo schedule.
  • Needs: oncologist's clinical findings, prognosis, and the names and number of planned drug cycles.
• Non-package treatment above ₹3,50,000 (₹5,00,000 for Tata Medical Center, Rajarhat).
  • Needs: treating doctor's clinical findings and prognosis, plus Procalcitonin, NT-PRO BNP, CRP, CBC, and Culture & Sensitivity reports.
• Non-package treatment continuing beyond the approved period.
  • Fresh permission is needed every 10 days.
  • The same set of reports must be submitted again at each renewal.

Treatment at speciality hospitals outside West Bengal

• Treatment at a speciality hospital outside West Bengal requires separate approval from the Secretary of the concerned Administrative Department.
• A referral from a recognised hospital is also required.
• The WBHS Authority is ordinarily consulted to confirm that the treatment is essential.
• For Tata Memorial Hospital, Mumbai, for cancer treatment, AIIMS, New Delhi, and NIMHANS, Bengaluru, WBHS Authority permission and hospital referral are not required.
• For these three institutions, only approval from the Secretary of the concerned Administrative Department is required.

Important Forms

• West Bengal Health Scheme Form A
• West Bengal Health Scheme Form B
• West Bengal Health Scheme Form C
• West Bengal Health Scheme Form D, E, and F
• West Bengal Health Scheme Annexure -III
• West Bengal Health Scheme Annexure -IV
• West Bengal Health Scheme Annexure-V
• WB Health Scheme Forms Pdf

Relevant Links

• West Bengal Health Govt Employee Registration
• West Bengal Health Scheme Govt Pensioner Registration
• West Bengal Health Scheme Notification
• West Bengal Health Scheme Limit Enhanced Notice
• West Bengal Health Scheme Rate List
• West Bengal Health Scheme Circulars and Memo
• West Bengal Health Scheme Empanelled Hospital list

Contact Information

• West Bengal Health Scheme Contact Details