How Can I Reimburse Medical Expenses in WBHS?

WBHS Medical Reimbursement: Who’s Eligible and How to Claim

Introduced in 2008 by the Government of West Bengal, the West Bengal Health Scheme (WBHS) gained immense fame as a noteworthy health program intended to provide quality medical care and financial assistance to state government officials. These include government employees, pensioners, and their families.

WBHS covers various medical treatments at authorised, empanelled hospitals. However, understanding the process of claiming and getting reimbursed quickly can save time, effort, and last-minute rush. Let's explore how to reimburse medical expenses in WBHS, ranging from eligibility to final reimbursement.

Keep reading!

Can I Reimburse Medical Expenditures in WBHS?

Yes, you can get reimbursement for your medical outlays incurred in an empanelled hospital under the West Bengal Health Scheme. For this, you must apply to the concerned authority as per Clause 12 of the Scheme to seek reimbursement of medical charges and repayment of advances.

Remember that the application shall be made within three months from the date of completion of treatment. It is also essential to know about WBHS OPD reimbursement for outpatient treatments under the scheme.

What are the Steps to Reimburse Medical Expenses in WBHS?

The West Bengal Health Scheme is cashless, where the beneficiaries do not need to pay any hospital charges directly. Instead, the insurers will directly settle such bills. However, if the total bill goes beyond the highest coverage limit, the beneficiaries will have to pay the excess out of their own pockets.

Here is the step-by-step procedure for claiming reimbursement of the insured amount under WBHS:

Step 1: First, present the cashless card issued by the Government Authorised Agency (GAA) upon admission to an empanelled hospital.

Step 2: The Health Care Organisation (HCO) will send an authorisation request to the Government Authorised Agency (GAA).

Step 3: The GAA will then check the information and approve or reject the request.

Step 4: Upon completion of treatment, the HCO or the concerned hospital will send the bills, along with other supporting medical documents, to the GAA.

Step 5: Thereafter, the GAA will check and validate these documents.

Step 6: Upon successful verification, the GAA will pay the approved sum to the HCO.

What are the Eligibility Criteria Set Under the West Bengal Health Scheme?

Before checking the reimbursement claim procedure, make sure that you go through the list of eligible individuals who can benefit from the WBHS scheme:

• State Government Employees: Employees of the West Bengal Government who are in service can avail of the WBHS health scheme. They can be permanent or temporary, provided they are paid a salary by the state government.
• Pensioners: Retired state government employees of West Bengal are also eligible for the scheme. This includes people getting regular pensions as well as those getting family pensions.
• Eligible Family Members: The scheme is available to the family members of state employees and pensioners. This includes spouses, dependent children, dependent parents, and other family members as decided by the government.
• All India Services (AIS) Officers
  • IAS, IFS, IPS officers on West Bengal cadre and their dependents, upon opting out of CGHS (Central Government Health Scheme), are eligible.
• Special Cases
  • Employees of government-aided institutions and GIA colleges/universities recognized by the scheme may also be eligible

What is the Reimbursement Claim Process and Required Documentation Under WBHS?

To facilitate effective processing and on-time reimbursement, beneficiaries should comply with the standard guidelines, filing schedules, and proper forms. The following is a well-structured breakdown of the procedure and requirements:

Well, it’s not difficult to get reimbursed under WBHS—assuming that you stick to the procedure accurately and produce the correct documents. With proper planning and timely application, you can get your reimbursement for medical bills on time. Also, double-check hospital recognition at all times and raise reimbursement claims within the timelines to avoid hassles.

Also Read:

→ Is Eye Treatment Covered Under WBHS

→ What is the Cashless Amount for WBHS

→ What is the Maximum Limit of WBHS

→ What is the Time Limit for WBHS Reimbursement

→ Which Medicines Are Not Reimbursable Under WBHS