Which Medicines are Not Reimbursable Under WBHS?

Complete Guide to Non-Reimbursable Medicines Under WBHS

With the rising healthcare costs, programs such as the West Bengal Health Scheme (WBHS) have become a boon for government servants and pensioners. Even though the scheme covers a vast array of medicines and treatments, it is crucial to understand that not every medicine is covered.

The government has categorically specified exclusions to ensure rational use and to avoid misuse of public funds. Let's discuss the types of medicines beyond the reimbursable list under WBHS.

Keep reading!

List of Medicines Not Reimbursable Under WBHS

Under the provisions made by the Finance Department (Audit Branch), Medical Cell of the Government of West Bengal, some medicines—though manufactured with a drug license—are not reimbursed under the West Bengal Health Scheme, 2008.

Under Finance Department Memorandum No. 6586-F(MED), dated 29.06.2011, these are the medicines not reimbursed under WBHS:

1. Preparations Classified as Foods

2. Preparations Commonly Used as Tonics, Vitamins, and Other Inadmissible Medicines

3. Preparations Used for Toilet Purposes (Not Reimbursable)

4. Disinfectants and Antiseptics (Not Admissible for Reimbursement)

Diseases and Treatments Covered Under the West Bengal Health Scheme

Now that you know the types of medicines excluded under WBHS, let’s take a look at the types of diseases and treatments covered within this scheme:

• Accident-related injuries (including animal bites)
• Crohn’s disease
• Cerebrovascular and neurological disorders
• Chronic obstructive pulmonary disease (COPD)
• Endodontic procedures (root canal therapy)
• Hepatitis B/C and other liver conditions
• Heart problems
• Insulin-dependent diabetes (excluding type 2 diabetes mellitus)
• Malignant conditions
• Renal failure
• Rheumatoid arthritis
• Severe malaria
• Systemic lupus erythematosus (lupus)
• Thalassemia (platelet or bleeding disorders)
• Tuberculosis
• Ankylosing spondylitis

Medical follow-up treatments are reimbursable for the following specified ailments:

• Neurosurgery
• Surgeries, chemotherapy, or radiotherapy related to cancer
• Cardiac surgeries (including coronary angioplasty and implants)
• Renal transplantation
• Replacement surgery of hip or knee
• Accident cases

The expenses for the following specific diagnostic tests will be reimbursed when they are prescribed by authorized hospitals in an outpatient department (OPD):

• Computed Tomography (CT) scan
• Ultrasonography
• Sigmoidoscopy
• Colonoscopy
• Endoscopy
• Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Magnetic Resonance Imaging (MRI)

Eligibility Criteria for the WBHS Scheme

Eligibility for the West Bengal Health Scheme (WBHS) comprises the following categories:

• All government pensioners and their families
• All India Services (AIS) officers and pensioners residing in West Bengal
• All government employees and their dependents
• Indian Administrative Service (IAS) officers and their families who have registered themselves voluntarily with the WBHS and do not avail of any healthcare benefits under the Central Government Health Scheme (CGHS).
• Members of the Indian Police Service (IPS) and their families who have opted to join the WBHS and do not receive such benefits under the Central Government Health Scheme (CGHS).
• Members of the Indian Forest Service (IFS) and their families who have registered themselves voluntarily for the WBHS and do not get benefits under the Central Government Health Scheme (CGHS).

Having a thorough understanding of what medicines are not covered under WBHS is important for beneficiaries. This will help them abide by the scheme, prevent unnecessary rejections, and facilitate the rational use of drugs. Individuals should also cross-check prescriptions against current West Bengal Health Scheme (WBHS) guidelines to avoid surprises when settling claims.

Also Read:

→ How Can I Reimburse Medical Expenses in WBHS

→ 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