West Bengal Health Scheme

Summary of the Scheme
Name of Scheme	West Bengal Health Scheme
Launch Year	2008
Benefits	Cashless inpatient treatment up to ₹5 lakh per hospitalisation. Coverage for eligible medical treatment and investigations. Medical reimbursement for eligible treatment.
Beneficiary	Eligible WB Government employees, pensioners, and dependent family members.
Nodal Agency	Finance Department, Government of West Bengal
Subscription	Subscribe here to get Update Regarding Scheme
Mode of Apply	Online and Offline.

West Bengal Health Scheme: Cashless Treatment up to ₹5 Lakh for Government Employees and Pensioners

A serious illness is stressful enough without worrying about hospital bills. The West Bengal Health Scheme (WBHS), run by the Finance Department of the Government of West Bengal since 2008, is meant to ease that worry for state government employees, pensioners and their families.

What the scheme is

WBHS gives medical benefits to eligible West Bengal Government employees, pensioners, family pensioners and their eligible dependants. It covers eligible treatment, investigations and other approved healthcare at recognised and empanelled healthcare organisations.

The biggest recent change is on cashless treatment. From 1 October 2026, eligible beneficiaries can get cashless inpatient treatment up to ₹5 lakh per hospitalisation at empanelled private hospitals in West Bengal.

How the cashless benefit works

There is a detail here that every beneficiary should understand. For cashless bills up to ₹1,00,000, the Medical Cell of the Finance Department pays the hospital directly. For treatment cost above ₹1,00,000, the beneficiary pays the hospital first and then claims reimbursement using the system-generated Cashless Admissible Reimbursement Certificate (CARC).

The scheme’s highlights describe the benefit as cashless up to ₹5 lakh, while the detailed rules describe this ₹1 lakh direct-payment step. So cashless does not mean the hospital will never ask you to pay anything, and it does not cover a bill of any size. Before admission, ask the hospital’s WBHS desk exactly how your case will be billed.

Protection in emergencies

A recognised hospital cannot refuse emergency admission or demand an advance payment when an eligible beneficiary shows a valid scheme identity card. In an emergency, a beneficiary can also use a higher ward category until the ward they are entitled to becomes available.

Other benefits

Indoor treatment at government and recognised private hospitals is reimbursed at approved package rates. These cover registration, accommodation, operation, anaesthesia, nursing, medicines and investigations.

OPD treatment is reimbursed for specified conditions: cancer, tuberculosis, heart disease, Type-1 diabetes, Chronic Kidney Disease, neuropsychiatric disorders, Rheumatoid Arthritis, Lupus, Crohn’s Disease, COPD, Ankylosing Spondylitis and root canal treatment. Since September 2026, the list also includes Pancreatitis, Osteoarthritis, Ulcerative Colitis, Glaucoma, Idiopathic Pulmonary Fibrosis and Connective Tissue Diseases.

Your ward entitlement (Private, Semi-Private or General) depends on the employee’s pay band. A newborn can use the parent’s identity card for the first six months, after which a separate card is needed.

Medical advance

Enrolled employees can get a medical advance of up to 80% of the estimated treatment cost for ongoing or planned treatment, applied for through the WBHS Portal. For cashless inpatient treatment, the advance is calculated after deducting the ₹1,00,000 already covered directly.

Pensioners cannot use the online advance facility. They can, however, receive an advance of up to 80% of the estimated cost, including implants, for certain major illnesses treated at a Government hospital. This can cover bypass surgery, pacemaker implantation, coronary angioplasty with stenting and kidney transplantation.

Treatment outside West Bengal

Treatment at speciality hospitals outside the state needs prior approval from the Secretary of the concerned Administrative Department, plus a referral from a recognised hospital. The WBHS Authority is ordinarily consulted to confirm the treatment is essential.

There is an exception for three institutions: Tata Memorial Hospital, Mumbai (for cancer), AIIMS, New Delhi, and NIMHANS, Bengaluru. For these, no WBHS Authority permission or hospital referral is needed. Only the Secretary’s approval is required.

Who can join

Regular state government employees can enrol, as can pensioners and family pensioners. All India Service officers in the West Bengal cadre, including eligible retired officers, can join after giving up CGHS benefits. Employees and pensioners of Grant-in-Aid colleges and universities and of Panchayati Raj bodies are also eligible, and so are employees who retired before 1 June 2009.

A few rules to know before you enrol:

1. Enrolment is optional for employees, but an enrolled employee cannot leave the scheme within five years from the month after the employee or any beneficiary receives a scheme benefit.
2. Employees must give up the monthly Medical Allowance, and pensioners and family pensioners must give up Medical Relief.
3. If both spouses are West Bengal Government employees, one must be enrolled as the dependant of the other.

Which family members are covered

A spouse is covered without the usual income condition. Parents are covered if their gross monthly income from all sources does not exceed ₹8,500. Children (including step-children and legally adopted children), unmarried daughters, dependent widowed or divorced daughters, minor brothers and sisters up to 18, and dependent unmarried, widowed or divorced sisters are covered if their monthly income is below ₹5,000.

A major son remains a dependant until he earns ₹5,000 or more per month or turns 25, whichever comes first. A son with more than 40% permanent physical or mental disability can stay a dependant at any age, with a Disability Certificate from the competent authority. That certificate must be reviewed every two years.

For income proof, working or retired dependants submit a certificate from their own Head of Office. Non-working dependants aged 18 or above submit a Self Declaration of Income (Annexure-V) every two years, between May and June.

Documents for enrolment

You will need the enrolment application (Form A for employees, Form I for pensioners), family particulars, an undertaking to give up Medical Allowance or Medical Relief, Aadhaar numbers for yourself and your dependants, and a recent photograph, signature and blood group details for each person for the digitally signed Enrolment Certificate. Depending on your situation, you may also need income certificates, Annexure-V or a disability certificate.

How employees enrol

Visit the WBHS Portal and go to the enrolment section. Submit the enrolment option (Form A) with family particulars through your Cadre Controlling Authority or Head of Office. Upload photographs, signatures, blood group details and Aadhaar numbers for everyone covered. Once your application is scrutinised, you collect the digitally signed Enrolment Certificate (Form B).

How pensioners enrol

Submit Form I to your Pension Sanctioning Authority (PSA) as usual. If you enrolled while still in service, your DDO can convert your status from employee to pensioner on the portal automatically. Claims and advances go through the portal or the designated Sanctioning Authority.

If you live away from your PSA, there is an offline route. Submit Form I with a declaration that you have not enrolled elsewhere. If you live far from the PSA’s office, you can submit it to any office of the same department up to Sub-Divisional level near your home, or to the Sub-Divisional Officer’s office. If no such office exists, submit it to the District Magistrate. Pensioners who settled in Kolkata after retiring from a posting elsewhere can submit it to the concerned Directorate office in Kolkata. That office issues your Enrolment Certificate and acts as your Sanctioning Authority for future claims.

This also answers a common question: yes, a pensioner living outside West Bengal can still enrol, through this route.

Claiming reimbursement

Submit your claim within 6 months of hospital discharge for inpatient treatment, or within 6 months of consultation for OPD treatment. Attach the prescribed claim form (Form C for employees), original bills and vouchers, a copy of the patient’s and employee’s or pensioner’s identity card, and an Essentiality Certificate (Form D or D1) where required.

Treatment at a non-empanelled private hospital is reimbursed only in permitted cases and within limits. Late claims are considered under the rules for delay, but claims beyond the permitted period may not be reimbursed, so do not wait.

When prior permission is needed

For some treatments at a private empanelled hospital, the hospital must get permission through the WBHS Portal. This applies to more than 2 procedures with a total cost above ₹50,000, more than 2 Drug-Eluting Stents, an AICD or CRT with AICD, Deep Brain Stimulation, an intra-thecal pump or a spinal cord stimulator, cochlear implantation, chemotherapy or immunotherapy where medicine cost exceeds ₹50,000 per cycle (one permission covers the whole schedule), and non-package treatment above ₹3,50,000 (₹5,00,000 at Tata Medical Center, Rajarhat). Non-package treatment that continues beyond the approved period needs fresh permission every 10 days.

Each category needs supporting documents from the treating specialist, such as a surgeon’s justification and investigation reports. The hospital normally handles this, but it helps to ask about it at admission.

Quick answers

Can pensioners enrol? Yes. Can employees apply online? Yes, through the WBHS Portal. Is a newborn covered? Yes, on the parent’s card for six months. Can I leave the scheme at any time? For employees, not within five years of a benefit being received. The source does not say whether pensioners can opt out, so ask the Finance Department.