If you are a government employee in West Bengal, you can now apply for West Bengal Health Scheme online claim at healthscheme.wb.gov.in. This online facility helps employees and pensioners to submit medical reimbursement claims quickly and easily. It has reduced paperwork and saves a lot of time. You don’t have to visit offices again and again. Everything can be done online.
In this article, we will explain everything about this scheme. You will get full details of the West Bengal Health Scheme online claim process, objective, eligibility, documents required, and contact information.
About West Bengal Health Scheme Online Claim
The West Bengal Health Scheme (WBHS) was launched in 2008 by the Finance Department of the West Bengal Government. It provides health coverage for state government employees, pensioners, and their families.
Under this scheme, you can get treated in government hospitals, government-aided hospitals, and recognized private hospitals. After treatment, you can claim for reimbursement of the medical expenses.
Now, the whole claim process is available online at healthscheme.wb.gov.in. The website allows you to log in, fill your claim form, upload documents, and track your application status.
Objective of West Bengal Health Scheme Online Claim
The main goal of starting the West Bengal Health Scheme online claim portal is to make the reimbursement process simple and digital.
Here are the key objectives:
- To provide hassle-free medical claim submission.
- To reduce physical visits to offices.
- To bring transparency in the process.
- To make faster settlement of claims.
- To provide medical support to employees and pensioners easily.
- To maintain a proper record of all medical claims.
Summary of West Bengal Health Scheme Online Claim
| Feature | Details |
|---|---|
| Scheme Name | West Bengal Health Scheme |
| Started In | 2008 |
| Portal for Online Claim | healthscheme.wb.gov.in |
| Who Can Apply | Govt. employees, pensioners of West Bengal |
| Type of Assistance | Reimbursement of medical bills |
| Hospital Type | Government & empanelled private hospitals (Annexure A) |
| Eligible Claims | Indoor/Outdoor treatment, medicines, tests, implants, blood transfusion |
| Time Limit for Claim | Within 3 months from date of treatment |
Eligibility Criteria for West Bengal Health Scheme Online Claim
To apply for a claim under this scheme, the following eligibility criteria must be met:
- Employee or Pensioner of West Bengal Government.
- The employee or pensioner must be enrolled under the WBHS.
- Dependent family members like:
- Spouse
- Children
- Parents (if dependent)
- Handicapped siblings
- The treatment must be done in a Government-approved hospital.
- The claim must be made within the valid time limit after treatment (generally within 6 months of discharge).
Guidelines to Keep in Mind During Claim Settlement
- Only treatments in recognized hospitals will be accepted.
- Claims from unrecognized private hospitals will not be reimbursed.
- Reimbursement is allowed up to the government-approved rate or the actual cost, whichever is lower.
- Medicines are reimbursed in full (excluding tonics, food supplements, cosmetics, etc.).
- Special nurse, attendant, aya charges are reimbursed in full.
- Blood transfusion service charge is reimbursed fully, but cost of blood is allowed as per Govt. Hospital rate.
- You can claim from insurance and WBHS, but must submit insurance certificate and copies of bills for balance reimbursement.
Documents Required for West Bengal Health Scheme Online Claim
Before applying online, keep the following documents ready:
| Document Name | Purpose |
|---|---|
| Medical Treatment Bill | Proof of expenses |
| Doctor’s Prescription | Proof of treatment |
| Discharge Certificate | Treatment confirmation |
| Diagnostic Test Reports | Medical evidence |
| Final Bill Summary | Total amount breakup |
| Hospital Admission Slip | Proof of hospitalization |
| Bank Account Details | For reimbursement |
| Aadhar Card or ID Proof | Identity verification |
| WBHS Card or GPF No. | Scheme verification |
West Bengal Health Scheme Online Claim Process
The West Bengal Health Scheme online claim at healthscheme.wb.gov.in follows a structured process. Below are the steps to submit a reimbursement claim:
- Step 1: Register and Log In
- Visit healthscheme.wb.gov.in.
- Click on the “Online Claim” menu and select “Government Beneficiary.”
- Log in using your Employee/Pensioner User ID and password. If you’re not registered, complete the enrollment process first (details in the eligibility section).
- Step 2: Access the Claim Reimbursement Option
- After logging in, go to the “My Claim” section.
- Select “Claim Reimbursement” to start the process.
- Step 3: Fill in Claim Details
- Choose the treatment type (e.g., Indoor Treatment or OPD).
- Enter the admission and discharge dates.
- Select the type of discharge (Normal, Referral, On Risk Bond, or Death).
- Specify the treatment type: Package, Non-Package, or Both.
- Enter the treatment start and end dates.
- Search for the treatment name or code (type at least three letters to get results).
- Add the treatment details and the number of vouchers (bills) for the claim.
- Step 4: Upload Documents
- Upload scanned copies of required documents (listed in the next section).
- Ensure all documents are clear and meet the specified format (e.g., PDF or JPEG).
- Step 5: Submit the Claim
- Review the entered details and uploaded documents.
- Click the “Submit” button to send the claim to the Operator.
- If you see an error like “Your claim has not been submitted” due to an untagged Head of Account, contact your Operator or Head of Office.
- Step 6: Claim Processing Workflow
- The Operator verifies the claim and forwards it to the Recommending Authority.
- The Recommending Authority checks the details and sends it to the Head of Office (HOO) or Delegated Approver.
- The HOO/Approver reviews and approves the claim.
- After approval, the bill is processed, and the reimbursement amount is transferred to the beneficiary’s account.
- Step 7: Track Claim Status
- Use the portal to check the status of your claim.
- You may also receive SMS updates about claim progress.
Additional Notes
- Claims must be submitted within six months of discharge, as per Memo No. 67-F(MED) WB dated 25/06/2020.
- For treatments in non-empanelled hospitals, reimbursement is limited to 60% of the approved cost or the actual amount paid, whichever is lower.
- For treatment outside West Bengal, prior permission from the WBHS Authority is required.
The online process reduces paperwork and speeds up claim settlement. Beneficiaries can also download forms and certificates from the portal.
Important Guidelines for Reimbursement
- Reimbursement will be made only if treated in recognized hospitals. List is available in Annexure A.
- Cost will be reimbursed as per ceiling rates mentioned in Annexure B or actual cost, whichever is lower.
- Food items, cosmetics, tonics, and telephone charges will not be reimbursed.
- Special nursing, blood transfusion, implants, and test charges will be reimbursed in full.
- If you have insurance, first claim from the insurance company. Then submit the balance claim to the health scheme authority.
Sample Case for Better Understanding
Suppose Mr. Saha, a government employee, got treated in Apollo Gleneagles Hospital, Kolkata (which is listed in Annexure A).
His total bill was ₹1,00,000.
The ceiling rate for the treatment is ₹80,000 as per Annexure B.
He also received ₹50,000 from his health insurance.
Now, as per WBHS rules:
- He can claim the balance ₹30,000 (₹80,000 – ₹50,000) under West Bengal Health Scheme.
Deadline for Claim Submission
The reimbursement claim must be submitted within 3 months from the date of completion of treatment.
Late applications may get rejected unless supported by strong reasons.
Contact Us
If you face any problem, you can contact the West Bengal Health Scheme helpdesk through the following methods:
- Website: https://healthscheme.wb.gov.in
- Helpline Email: [email protected]
- Phone Numbers (General Queries):
- 033-2254-4133
- 033-2254-4964
You can also visit your respective Head of Office or Cadre Controlling Authority for help.
Final Tips
- Keep original bills safely until your claim is fully settled.
- Always get treatment from listed hospitals only.
- Track your claim regularly after submission.
- Submit accurate details to avoid rejection.
- If using insurance, get a certificate of reimbursement from your insurance provider.
Conclusion
The West Bengal Health Scheme online claim at healthscheme.wb.gov.in is a very useful facility for state government employees and pensioners. It brings convenience, speed, and transparency to medical reimbursement.
If you are eligible, do not wait. Keep your documents ready and submit your claim online today. It is simple, fast, and secure. You can also track everything from home without going to any office.
For more help, always stay updated with the official website and your departmental notifications.