The West Bengal Health Scheme is a comprehensive healthcare initiative that provides cashless medical treatment services to state government employees, their dependents, pensioners, and their families. It covers a range of medical procedures and offers benefits such as reimbursement for outpatient treatment and cashless indoor treatment facilities.

2. Who is eligible for the West Bengal Health Scheme?

The scheme is available to state government employees, their dependents, state government pensioners, and families who have opted for medical allowance. Additionally, All India Services (AIS) pensioners and officers in West Bengal are eligible to avail of policy benefits.

3. How can one enroll in the West Bengal Health Scheme?

To enroll in the scheme, visit the West Bengal Health Scheme portal. Government employees can follow the online enrollment process, providing personal details, family information, and relevant documentation. The website offers specific forms for different categories, such as state government employees and pensioners.

4. What does the West Bengal Health Scheme cover?

The scheme provides coverage for over 1,000 medical procedures, including outpatient treatment, major surgeries, laparoscopic or endoscopic surgeries, normal deliveries, and minor surgeries. The insured individuals receive cashless cards for treatment at hospitals, and reimbursement for expenses incurred during treatment is available for certain procedures.

5. How does the cc work under the West Bengal Health Scheme?

The claim process involves presenting the cashless card at an empanelled hospital. The Health Care Organisation (HCO) then sends an authorization request to the Government Authorised Agency (GAA), which approves the request. After treatment, the hospital submits the bill, along with necessary documents, to the GAA for verification. The approved amount is then transferred to the HCO.

6. What are the exclusions under the West Bengal Health Scheme?

The scheme does not cover expenses related to cosmetic surgeries and non-medical treatments. It's essential to review the exclusions to understand the limitations of the coverage.

7. Can expenses incurred in non-empanelled hospitals be reimbursed?

If treatment is obtained from a non-empanelled hospital, reimbursement is possible. The reimbursement amount may vary based on factors like the actual cost incurred and the size of the hospital.

8. How long do beneficiaries have to claim reimbursement for indoor treatment?

Reimbursement for indoor treatment expenses should be claimed within 3 months from the date of discharge.

9. What documentation is required for the claim process?

The claim process typically involves submitting the cashless card, doctor’s certificate, medical report, and discharge summary. Ensure all necessary documents are provided for a smooth claim process.

10. Can AIS officers and their families avail coverage benefits under the West Bengal Health Scheme?

Yes, AIS officers and their families are covered under the scheme, extending its benefits to All India Services pensioners in West Bengal.