What is the Cashless Amount for WBHS?
All About Cashless Amount for WBHS
In cashless health insurance schemes, the insurance company settles the medical charges directly with the network hospital. This relieves individuals from the financial burden of paying hospital bills out of pocket or accumulating funds during medical emergencies.
The West Bengal Health Scheme (WBHS) offers this advantage to its beneficiaries so that they receive required medical care without concern for the cost. Let's learn about what a cashless amount entails under WBHS, how it is done, and what you must know.
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How Much is the Cashless Amount for WBHS?
As per the WBHS scheme, beneficiaries are eligible to avail of indoor cashless treatment up to ₹2 Lakhs in empanelled hospitals. If the treatment expenses exceed this limit, the beneficiary must pay the excess.
This facility helps beneficiaries save their hard-earned money during medical emergencies. Additionally, cashless hospitalization enables patients to seek medical help without delay or worrying about huge medical bills.
What are the Eligibility Criteria for WBHS?
Let’s check out the eligible individuals who can enjoy the key features and benefits of the West Bengal Health Scheme:
- State government employees and their dependents, and state government retirees and their families, can avail of this scheme.
- All India Services pensioners and service officers of West Bengal can enjoy the policy benefits.
- The beneficiaries of this policy also include individuals who opt for a medical allowance.
- This policy also benefits the family members of the scheme's beneficiaries, including their spouses, parents, children, and siblings.
What are the Empaneled Hospitals Under WBHS?
Here is a complete list of the reputed empanelled hospitals under the WBHS scheme in which you can access the cashless indoor treatment facility:
- The Calcutta Medical Research Institute
- Desun Hospitals and Heart Institute
- Nightingale Hospitals
- Ruby General Hospital
- R N Tagore International Institute of Cardiac Sciences
- Apollo Gleneagles
- Ramakrishna Mission Seva Pratishthan, Kolkata
- Balananda Brahmachari Hospital, Kolkata
- Islamia Hospital, Kolkata
- Marwari Relief Society Hospital, Kolkata
- Medica Super-specialty Hospital
- BM Birla Heart Research Centre
- Susrut Eye Foundation
- Mission of Mercy Hospital
How to Download the WBHS Application Form?
To download the appropriate application forms for the West Bengal Health Scheme, both state government employees and pensioners can follow these steps:
Step 1: Go to the West Bengal Health Scheme Portal and tap on the ‘Downloads’ section.
Step 2: After this, navigate to the "Select Category" option from the drop-down list and click on 'Employees' or ‘Pensioners’.
Step 3: Then, you can click on ‘Download’ in order to get the relevant form (either for state government employees or state government pensioners).
How to Claim Benefits Under the West Bengal Health Scheme?
The West Bengal Health Scheme offers cashless treatment within the coverage limit. Here is a step-by-step process for filing a claim:
Step 1: Submit Cashless Card During Admission: On hospital admission, submit your cashless card to proceed with the treatment under the scheme.
Step 2: Authorization Request from the Hospital: The healthcare organization (HCO) or hospital will request authorization from the Government Authorized Agency (GAA).
Step 3: Approval from GAA: The Government Authorized Agency (GAA) will thoroughly verify the information and authorize the treatment under the scheme after approval.
Step 4: Bill Submission Post-Treatment: Once the treatment is completed, the hospital will send the bill to the Government Authorized Agency (GAA). The bill should contain all the necessary documents, such as the medical report, doctor's certificate, and discharge summary.
Step 5: GAA Verification of Documents: The GAA will check the documents submitted to them to ascertain if they are in accordance with the terms of the scheme.
Step 6: Transfer of Payment: After successfully verifying the documents, the GAA will remit the approved treatment sum to the HCO or hospital for payment. If the cost of treatment exceeds the stipulated coverage limit, the beneficiary will have to pay the excess amount.
What are the Diseases Covered Under WBHS?
Under the West Bengal Health Scheme, beneficiaries get cashless treatment for a wide range of medical conditions, which include:
- Systemic Lupus Erythematosus (Lupus)
- Heart conditions
- Severe malaria
- Cancerous diseases
- Chronic Obstructive Pulmonary Disease (COPD)
- Rheumatoid arthritis
- Hepatitis B and C, along with other liver conditions
- Tuberculosis
- Root canal treatment
- Crohn’s disease
- Thalassemia, bleeding disorders, and platelet disorders
- Neurological and cerebrovascular disorders
- Insulin-dependent diabetes (Note: type-2 diabetes mellitus is not classified as insulin-dependent)
- Kidney failure
- Accidental injuries (including bites from animals)
The cashless treatment facility of WBHS brings healthcare within reach and affordability for government employees and pensioners. Understanding the cashless amount and coverage under WBHS will assist you in effectively planning healthcare expenses.
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This FAQ page contains information for general purpose only and has no medical or legal advice. For any personalized advice, do refer company's policy documents or consult a licensed health insurance agent. T & C apply.