Who are the Beneficiaries of WBHS?

Discover Who Qualifies for WBHS Health Coverage

Launched in 2008, the West Bengal Health Scheme (WBHS) is a state-level health insurance welfare policy. Whether you are a government employee, pensioner, or even a dependent, the scheme provides adequate financial assistance for healthcare expenses.

With this scheme, only eligible individuals can get their indoor treatment expenses reimbursed at listed West Bengal hospitals or at certain non-state hospitals. These include medical consultations, diagnostic examinations, surgeries, and maternity benefits.

Are you wondering who exactly benefits from WBHS? Let's find out.

Who is Eligible for the WBHS Scheme?

The WBHS scheme provides benefits to certain categories of people, namely:

● Government Employees

The main beneficiaries of WBHS are the employees of the West Bengal Government. These include both permanent and temporary employees belonging to different government departments in the state.

All eligible employees can take advantage of medical benefits under the scheme regardless of whether they are employed in administrative offices, educational institutions, or public service departments. Depending on their requirements, they can also opt for medical reimbursements, hospitalization, and specialized treatments.

● West Bengal Government Pensioners

Individuals who retire from government service and draw pensions from the state government also qualify for WBHS benefits. Thus, those who served the state at different levels during their service life continue to get healthcare support even after retirement.

Pensioners are eligible for the same spectrum of medical care as their active counterparts, such as hospitalization, consultancy, and medical reimbursement for themselves and their relatives.

● Family Members of Government Employees and Pensioners

WBHS provides coverage to the family members of government employees as well as pensioners, thus making it a complete health scheme. Covered dependents include spouses, children (up to a specified age), and dependent parents or parents-in-law.

The family members can avail of medical consultations, hospitalizations, and specialist treatments under the scheme, providing quality healthcare to the whole family.

● Dependent Children and Students

The dependant children of government employees and pensioners are covered under WBHS until they reach a certain age, which is usually 25 if they are continuing their education.

This protection extends to medical treatment for illnesses, injuries, and other ailments. Other dependent children who have disabilities or special needs can get extended healthcare support, including therapy and specialized treatment.

● Disabled Family Members

WBHS recognizes that disabled family members of the insured person have special health needs and provides additional support to them. Through this scheme, family members who are physically or mentally challenged can receive specialized medical care, therapy, and equipment assistance.

● Indian Administrative Service (IAS) Officers and Their Dependents

Indian Administrative Service (IAS) officers are among the leading civil servants of India who are entrusted to administer functions within and through differing levels of administration. In order to receive the healthcare benefits of WBHS, IAS officers and dependents should voluntarily enrol themselves under the scheme.

Besides, IAS officers must ensure that they are not receiving medical benefits under the Central Government Health Scheme (CGHS).

● Indian Police Service (IPS) Officers and Their Families:

IPS officers, who are entrusted with ensuring law and order, internal security, and crime prevention, are also covered under WBHS. IPS officers and their families should also enroll themselves in the WBHS in order to benefit from the scheme's facilities. Like IAS officers, they should not be availing of healthcare benefits under CGHS.

● Indian Forest Service (IFS) Officers and Their Families

IFS officers responsible for managing the nation's forest resources, wildlife, and environment conservation schemes are also eligible under WBHS. Similar to IAS and IPS officers, IFS officers are also required to enrol voluntarily for WBHS to get their health benefits.

Similarly, they should not receive healthcare benefits from CGHS. This condition helps streamline the process of healthcare coverage so that beneficiaries are not covered by more than one health scheme at a time.

List of Health Conditions with Available Treatments in the West Bengal Health Scheme (WBHS)

Now that you know who is eligible for this scheme, let's take a look at the list of health issues that have treatments available for beneficiaries under WBHS:

• Crohn's disease
• Neurological and cerebrovascular disorders
• Hepatitis B/C and other liver conditions
• Insulin-dependent diabetes (Type-2 diabetes mellitus excluded)
• Renal failure
• Systemic Lupus Erythematosus (LUPUS)
• Endodontic treatment (root canal treatment)
• Rheumatoid arthritis
• Malignant malaria
• Chronic obstructive pulmonary disease (COPD)
• Malignant conditions
• Injuries related to accidents (including animal bites)
• Tuberculosis
• Neurological disorder/Cerebrovascular disorder
• Heart disease
• Thalassemia (bleeding or platelet disorders)

The West Bengal Health Scheme is an important step towards making healthcare affordable and accessible to government servants, pensioners, and their family members. Those who are eligible for this scheme can easily download the WBHS application form from its portal.

However, even if you’re not eligible, at Star Health, we provide health coverage for families under our Super Surplus Insurance Policy on a floater basis with up to 7 family-size options. With 14,000+ network hospitals in India, we offer hassle-free claim settlements with less turnaround time. Call us today for more details!

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