What is the West Bengal Health Scheme?
The West Bengal Health Scheme (WBHS) is a medical-benefit scheme administered by the Finance Department, Government of West Bengal.
The scheme was introduced in 2008 to provide better medical facilities to eligible West Bengal Government employees. It was subsequently extended to government pensioners, family pensioners and other eligible categories.
WBHS provides benefits such as cashless indoor treatment at empanelled hospitals, reimbursement for certain OPD treatments, specified investigations, follow-up treatment and treatment at certain hospitals outside West Bengal.
The official WBHS portal is maintained by the Government of West Bengal and provides information about enrolment, claims, hospitals, beneficiaries, circulars and approved rates.
Official website: West Bengal Health Scheme official portal
Who is eligible for WBHS?
WBHS is not a universal health insurance scheme for every resident of West Bengal.
The official portal provides enrolment facilities for categories including:
- West Bengal Government employees
- West Bengal Government pensioners
- Family pensioners
- Beneficiaries of Grant-in-Aid colleges
- Beneficiaries of Grant-in-Aid universities
- Employees of Panchayati Raj bodies covered under the scheme
- Pensioners of Panchayati Raj bodies covered under the scheme
- Other categories specifically brought under WBHS by government orders
The exact eligibility conditions can differ according to the beneficiary category.
Official enrolment portal: WBHS Online Enrolment
Is WBHS available to ordinary West Bengal residents?
No.
A person does not become eligible for WBHS merely because they live in West Bengal.
WBHS is primarily an employee/pensioner medical-benefit scheme and is different from schemes such as Swasthya Sathi and Ayushman Bharat PM-JAY.
Before applying, a person should determine whether they belong to a category covered by WBHS.
What benefits are available under WBHS?
WBHS provides several types of medical benefits.
1. Cashless indoor treatment
The official WBHS facility page states that cashless indoor treatment up to ₹2 lakh per indoor treatment is available when treatment is taken at a private empanelled hospital.
The Medical Cell processes the hospital’s admissible claim up to the applicable cashless limit. The official portal also states that reimbursement of eligible indoor treatment costs above ₹2 lakh is available through the claim process.
Therefore, readers should not interpret ₹2 lakh as meaning that WBHS can never provide reimbursement above ₹2 lakh.
Can WBHS cover treatment costing more than ₹2 lakh?
Yes, subject to the applicable rules.
The official WBHS facility page specifically states that reimbursement of indoor treatment costs beyond ₹2 lakh is available, subject to submission of the claim to the appropriate authority.
There are also special government orders concerning extension of the cashless facility beyond the existing ₹2 lakh limit for pensioners.
The official WBHS circular page lists Order No. 32-F(MED)WB dated 2 March 2026, concerning extension of the cashless facility beyond the existing ₹2 lakh limit for pensioners.
Because special limits and procedures can depend on the beneficiary category and treatment, readers should check the latest government order rather than applying a single limit to every WBHS case.
Does WBHS cover OPD treatment?
Yes, but not all ordinary OPD treatment is automatically reimbursable.
The scheme provides reimbursement for OPD treatment connected with an indoor admission.
The official facility page states that related OPD treatment costs incurred during:
- 30 days before admission, and
- 30 days after discharge
can be reimbursed subject to the applicable rules.
WBHS also provides OPD reimbursement for certain specified diseases.
Which diseases are covered under WBHS OPD reimbursement?
The official WBHS website currently lists specified diseases for which OPD treatment may be reimbursable when the applicable conditions are satisfied.
The list includes:
- Malignant diseases
- Tuberculosis
- Hepatitis B/C and other liver diseases
- Type-1 insulin-dependent diabetes
- Heart diseases
- Neurological and cerebrovascular disorders
- Malignant malaria
- Chronic kidney disease, Stage 2 onwards
- Thalassaemia, bleeding disorders and platelet disorders
- Accident injuries, including animal bites
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Crohn’s disease
- Endodontic/root canal treatment
- COPD
- Ankylosing spondylitis
- COVID
- Specified neuropsychiatric disorders
The neuropsychiatric list includes bipolar affective disorder, major depressive disorder, schizophrenia, obsessive-compulsive disorder, autism spectrum disorder and ADHD/hyperkinetic disorder.
Important: Being diagnosed with a listed disease does not by itself guarantee reimbursement. The treatment, hospital and claim must satisfy the applicable WBHS rules.
Does WBHS cover follow-up treatment?
Yes.
The official scheme provides reimbursement for follow-up medical attendance and treatment for specified diseases when the applicable conditions are satisfied.
Follow-up provisions include certain cases involving:
- Cardiac surgery and angioplasty
- Cancer surgery, chemotherapy and radiotherapy
- Renal transplant
- Hip and knee replacement
- Accident cases
- Certain neurosurgical treatment
The exact conditions should be checked against the current WBHS rules.
Does WBHS cover diagnostic tests?
Certain investigations are reimbursable under WBHS.
The official facility page states that specified investigations can be reimbursed based on an OPD prescription from a doctor consulted at a recognised hospital, provided the investigation is performed at an empanelled hospital or diagnostic centre.
The applicable investigation list and approved rates should be checked on the official WBHS portal.
Can WBHS be used at a non-empanelled hospital?
In certain circumstances, yes.
The official WBHS facility page states that indoor treatment at a non-empanelled hospital within West Bengal can be reimbursed subject to the prescribed conditions.
The reimbursement is:
- 60% of the approved cost or actual amount paid, whichever is lower, or
- 80% where the hospital has more than 80 beds, subject to the specified conditions.
The hospital must also have had a valid licence under the West Bengal Clinical Establishment Act and Rules on the date of treatment.
This does not mean that every treatment at every non-empanelled hospital is automatically reimbursed.
Can WBHS cover treatment outside West Bengal?
Yes, in specified circumstances.
The official WBHS facility page states that the actual cost of treatment, including journey expenses for one attendant, can be reimbursed when treatment is taken at certain specified speciality hospitals outside West Bengal, subject to the applicable rules.
Therefore, beneficiaries should obtain the required permission before planned treatment outside the state whenever the rules require it.
How many hospitals are under WBHS?
The official WBHS portal currently displays:
- 204 empanelled private hospitals
- 30 empanelled diagnostic centres
The number of ongoing treatments displayed on the portal can change as procedures, packages and rates are updated.
Because hospital empanelment can change, it is better to use the official portal rather than relying on an old hospital list published elsewhere.
Official WBHS portal: healthscheme.wb.gov.in
How to check the WBHS hospital list
Go to the official WBHS website and use the Hospital → Empanelled Hospitals section.
Before planned treatment, verify:
- The hospital is currently empanelled.
- The required treatment is available.
- The applicable package is approved.
- Cashless treatment is available for the particular treatment.
- Any required permission or pre-authorisation has been obtained.
Hospital empanelment and treatment packages can change, so an old list should not be treated as current.
WBHS online registration
The official WBHS portal provides separate enrolment facilities for different categories.
The portal currently provides options for:
- Government employees
- Government pensioners
- Grant-in-Aid college beneficiaries
- Grant-in-Aid university beneficiaries
- Employees of Panchayati Raj bodies
- Pensioners of Panchayati Raj bodies
Official website: WBHS Online Enrolment
Is fresh WBHS enrolment open in August 2026?
This needs particular attention.
The official portal records G.O. No. 51-F(MED)WB dated 2 June 2026, which extended fresh enrolment of government employees and pensioners until 31 July 2026.
Therefore, that particular extension has already expired.
Readers should check the official portal for a subsequent extension before assuming that fresh enrolment is currently open.
Latest WBHS updates in 2026
The official WBHS circular section currently lists several important 2026 orders.
These include:
- 32-F(MED)WB — 2 March 2026: Extension of cashless facility beyond the existing ₹2 lakh limit for pensioners
- 31-F(MED)WB — 10 March 2026: Enrolment certificate for retiring employees
- 51-F(MED)WB — 2 June 2026: Extension of enrolment
- 63-F(MED)WB — 15 July 2026: Revision of the mechanism for processing cashless claims
- 70-F(MED)WB — 14 August 2026: Revision of approved WBHS rates
This is why readers should be careful when using older WBHS articles.
Official circulars: WBHS Circulars & Memos
How to claim WBHS reimbursement
WBHS provides online claim facilities through its official portal.
The process depends on whether the treatment was:
- Cashless treatment at an empanelled hospital
- Reimbursement-based indoor treatment
- OPD treatment
- Follow-up treatment
- Treatment at a non-empanelled hospital
- Treatment at an approved speciality hospital outside West Bengal
Keep prescriptions, bills, discharge summaries, investigation reports and other required documents safely because the exact documentation depends on the claim type.
Official claim portal: WBHS Online Claim
WBHS official contact information
For questions about eligibility, claims, hospitals or enrolment, use the contact details published by the official WBHS portal.
Official contact page: WBHS Contact Us
Frequently Asked Questions
What is the WBHS cashless limit?
The official facility page states cashless indoor treatment up to ₹2 lakh per indoor treatment at private empanelled hospitals, while eligible reimbursement above ₹2 lakh is also provided through the claim mechanism. Special provisions may apply to pensioners.
Is WBHS available to everyone in West Bengal?
No. It is intended for eligible government employees, pensioners and other covered categories.
Does WBHS cover OPD?
Yes, but only under specified conditions. Related OPD treatment around an indoor admission and OPD treatment for specified diseases are covered under the applicable rules.
Can WBHS be used at a non-empanelled hospital?
Certain indoor treatment expenses may be reimbursable, subject to the conditions and percentages prescribed by the scheme.
Can WBHS be used outside West Bengal?
Certain treatment at specified speciality hospitals outside West Bengal may be reimbursed subject to the applicable permission and scheme rules.
Where can I find the latest WBHS rules?
Use the official WBHS portal and its Circulars and Memos section.
Disclaimer
Disclaimer: The information provided in this article is for general informational and educational purposes only. We make reasonable efforts to keep the information accurate and up to date using official government sources; however, government schemes, eligibility criteria, benefits, hospital empanelment, procedures, rates, deadlines and other rules may change from time to time. DailyDigiHelp does not guarantee that all information will remain current or that any individual will be eligible for a particular benefit. Before applying for a scheme, seeking treatment, or making any financial or medical decision, readers should verify the latest information with the relevant official government portal, department, hospital or authorised authority. DailyDigiHelp is not affiliated with or officially associated with the Government of West Bengal, Government of India, or any scheme mentioned in this article.
Conclusion
The West Bengal Health Scheme provides medical benefits to eligible government employees, pensioners and other covered beneficiaries. Its benefits include cashless indoor treatment, eligible reimbursement above the cashless limit, specified OPD treatment, follow-up treatment, certain investigations and treatment at specified hospitals outside West Bengal.
Because WBHS rules and approved rates can change, readers should always verify the latest information through the official government portal before taking treatment or submitting a claim.
Official source: West Bengal Health Scheme Portal