West Bengal Health Scheme: All About The Scheme And Its Features

People signing up for this should thoroughly review the insurance documents to understand what is included, and what is excluded. One needs to understand the policy’s scope to ensure beneficiaries have realistic expectations.
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The West Bengal Health Scheme (WBHS) is a state-level health insurance welfare scheme. While this scheme started in 2008, in the year 2014, it underwent an overhaul and came to be known as the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment scheme. Both these schemes are merged. According to this scheme, eligible people can avail of cashless treatment in the given list of hospitals, which are also known as empanelled hospitals and Health Care Organisations (HCOs). Eligible people can avail a cashless treatment of Rs 1 lakh. 

Features Of The WBHS Scheme

Cashless Indoor Treatment: The beneficiary has access to cashless indoor treatment of up to Rs 1 lakh in a designated hospital. If the expenses exceed the limit, the recipient needs to settle it. During a difficult health situation, this feature reduces the financial burden. Thanks to the cashless access to hospitals, patients can focus on recovery rather than worry about large medical bills, facilitating critical care when necessary. 

Outpatient Department (OPD) Treatment: Based on the waiting period and other terms of the scheme, you are eligible for reimbursement for OPD treatment. Aimed at sustaining well-being, this coverage extends to routine health expenses and preventive care. Thanks to OPD treatment,  individuals can proactively manage their health through regular doctor appointments, tests, and medications, without shouldering the full financial burden.

Non-Empanelled Hospital: A specified percentage of the expenses can be reimbursed by the terms and conditions, in case treatment is sought at a non-empanelled hospital. This allows some amount of flexibility, and patients can still receive cash benefits, even when an empanelled hospital is not accessible. Partial reimbursements from non-empanelled hospitals leave patients with additional choices in an emergency and broaden overall access to healthcare services. 

Outside-The-State Hospitalisation: In case a hospital in another state is designated as an empanelled facility, costs incurred can be reimbursed for treatment. This feature is important for individuals who become ill during travel or require specialized care. By not limiting hospital coverage within the state, beneficiaries are allowed to access quality healthcare wherever it may be needed if hospitalization arises while away from home.

Exclusions: The scheme excludes cosmetic surgeries and non-medical treatment. Other than these, major treatments should be provided in a cashless manner in empanelled hospitals. 

There are other exclusions that beneficiaries need to take note of. Investigative and experimental treatments lacking established medical validity are typically not covered. Moreover, medical care resulting from substance abuse or self-inflicted injuries may not be covered by the insurance. Also, high-cost treatments such as organ transplants and rehabilitation therapy tend to be excluded depending on the fine print. While cashless hospitalization for critical illnesses is facilitated in empanelled hospitals, outpatient services for chronic conditions like diabetes or hypertension maintenance may or may not be covered.

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