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Health & Social ProtectionOfficial Info Verified
West Bengal Health Scheme
Government of West Bengal medical benefit scheme administered by the Finance Department (Medical Cell) for State Government employees, pensioners, family pensioners, and AIS officers, offering cashless inpatient treatment up to ₹2 lakh at empanelled hospitals, OPD coverage, and reimbursement at approved rates.
Department: Finance Department (Medical Cell), Government of West Bengal
Cashless Baseline
₹2,00,000
Per claim at empanelled HCOs
2026 Budget Proposal
75% Beyond ₹2L
Proposed for pensioners in Budget
Covered Beneficiaries
Employees & Pensioners
State Govt, AIS & Dependants
Nodal Authority
Finance Medical Cell
wbhealthscheme.gov.in
Language:
Scheme Overview
What is West Bengal Health Scheme?
The West Bengal Health Scheme (WBHS), officially framed as the 'West Bengal Health Scheme, 2008', is a specialized healthcare welfare scheme administered by the Medical Cell under the Finance Department, Government of West Bengal. Unlike general public health initiatives, WBHS is specifically structured for regular State Government employees, pensioners, family pensioners, and All India Service (AIS) officers who serve or have served the affairs of West Bengal, along with their eligible dependent family members. Enrolment is conducted online via the official WBHS Portal (wbhealthscheme.gov.in) through HRMS/IFMS integration for employees and PPO/Treasury authentication for pensioners (for whom enrolment is optional and entails surrendering regular monthly medical relief). The scheme provides cashless inpatient treatment up to ₹2,00,000 (₹2 lakh) per claim at empanelled private healthcare organisations (HCOs) and autonomous institutions. Claims beyond ₹2 lakh are processed through the Claim Admissibility Report Committee (CARC) / Medical Cell. In the 2026–27 State Budget Speech, the Government proposed enhancing the cashless limit for pensioners by covering up to 75% of the additional expenditure beyond ₹2 lakh (subject to the formal departmental notification). In addition, WBHS reimburses admissible OPD expenses for specified chronic ailments and covers approved medical procedures at standard Government package rates.
Primary Purpose:To provide comprehensive, cashless inpatient healthcare up to the prescribed baseline limit (₹2 lakh) at empanelled healthcare organisations, admissible OPD medical coverage, and systematic reimbursement of medical expenses under government-approved rates for eligible West Bengal Government employees, pensioners, and their dependent family members.
Key Scheme Objectives
- Deliver cashless inpatient treatment up to the ₹2 lakh baseline at empanelled private hospitals and institutions.
- Reimburse admissible medical expenses for indoor and approved OPD treatments under standard government rate schedules.
- Enable seamless digital claim settlement and hospital empanelment via the dedicated WBHS Medical Cell portal.
- Protect state government employees, retirees, and dependent family members from catastrophic health expenses.
Financial Framework
WBHS Treatment Modes, Cashless Limits & Financial Mechanisms
WBHS operates on two primary financial pillars: (1) Cashless treatment up to ₹2 lakh at empanelled private hospitals and recognized institutions, and (2) Reimbursement of admissible medical expenses incurred in government or approved healthcare organisations as per official rate schedules.
Current Cashless Baseline
₹2,00,000 / Claim
2026 Budget Enhancement Proposal
75% Above ₹2 Lakh
Claim Approval for Claims > ₹2L
CARC / Medical Cell
Pensioner Medical Relief Rule
Surrender ₹500/mo
Cashless Limits: Current Baseline vs. 2026–27 Budget Speech Proposal
Under existing verified WBHS operational guidelines, the cashless treatment limit at empanelled healthcare organisations stands at ₹2,00,000 (₹2 lakh) per claim. In the 2026–27 State Budget Speech, the Finance Department proposed that for State Government pensioners, the cashless treatment limit will be enhanced to cover up to 75% of the additional expenditure incurred beyond ₹2 lakh. Beneficiaries must note that this enhancement is a Budget Proposal subject to the formal publication of the detailed departmental notification.
Key Differences Between WBHS, Swasthya Sathi & Ayushman Bharat:
WBHS vs. Swasthya Sathi
WBHS is an employee/pensioner service medical benefit scheme under the Finance Department with HRMS/PPO enrolment. Swasthya Sathi is a statewide universal health scheme under the Health Department providing ₹5 lakh smart-card-based cover to all eligible citizen families.
WBHS vs. Ayushman Bharat PM-JAY
WBHS is a 100% West Bengal State Government scheme for public servants. Ayushman Bharat PM-JAY is a central-state health assurance scheme targeting SECC-deprived households with ₹5 lakh annual coverage.
Cashless Treatment vs. Medical Reimbursement
Cashless treatment is available directly at empanelled private HCOs up to ₹2 lakh where the Medical Cell pays the hospital directly. Reimbursement is claimed post-treatment for government hospital expenses or approved OPD/indoor treatments at notified standard package rates.
Important Scheme Scope Note:
WBHS is exclusively for West Bengal Government employees, pensioners, AIS officers, and their eligible dependants. It is NOT Swasthya Sathi (universal public health cover) and is NOT Ayushman Bharat PM-JAY.
Finance Department Medical Cell & Portal Governance
The WBHS Medical Cell under the Finance Department manages hospital empanelment, issues rate schedules, scrutinizes CARC claims, and oversees digital claim submissions via the official WBHS portal (wbhealthscheme.gov.in).
Eligibility Guidelines
Who is Eligible to Apply?
Review standard qualifying conditions, income limits, and applicable waiver categories. Read our guide on understanding eligibility
Standard Eligibility Requirements
- Must be a regular/permanent employee of the Government of West Bengal drawing salary through HRMS/IFMS
- State Government Pensioners and Family Pensioners receiving pension through West Bengal treasuries/banks
- All India Service (AIS) officers and pensioners who serve or served the affairs of the Government of West Bengal
- Eligible dependent family members (spouse, dependent children, dependent parents subject to income/dependency rules)
Not Eligible:
- General citizens or residents of West Bengal who are not State Government employees, pensioners, or eligible dependants.
- Pensioners who have opted out of WBHS and choose to continue drawing standard monthly fixed Medical Relief.
- Family members who are gainfully employed or exceed the prescribed dependent income thresholds as per notifications.
Employee & Pensioner Welfare
Cashless Healthcare up to ₹2 Lakh at Empanelled Hospitals
Finance Department Medical Cell Scheme
Provides cashless indoor hospital treatment up to ₹2,00,000 per claim across empanelled private hospitals, diagnostic centres, and recognized medical institutions in West Bengal.
2026 Budget Proposal
Proposed Pensioner Cashless Enhancement (75% Beyond ₹2 Lakh)
The 2026–27 State Budget Speech proposed enhancing pensioner cashless coverage to include up to 75% of expenses exceeding ₹2 lakh, pending detailed departmental notification.
Required Documentation
Commonly Required Documents
Exact document requirements can depend on the application type and applicant circumstances. View our common documents checklist
Standard
HRMS Employee ID / PPO ID & Treasury Code
Official identifier to fetch authenticated service or pension records from IFMS/CTS.
Standard
WBHS Enrolment Certificate / e-Card (For Hospitalisation)
Official system-generated enrolment certificate bearing individual WBHS beneficiary ID.
Standard
Photographs & Signatures of Employee/Pensioner & Dependants
Scanned passport photos and signatures as prescribed during portal registration.
Standard
Treatment Discharge Summary, Original Bills & Vouchers (For Claims)
Required for reimbursement claims or non-cashless settlements along with doctor prescription.
Guidance: Ensure the applicant’s bank account is active and matches the beneficiary name exactly before institutional submission.
Application Process
How to Apply for West Bengal Health Scheme
Step-by-step application and verification procedure based on official guidelines. Read our official portals guide
1
Online Enrolment on Official WBHS Portal
Visit wbhealthscheme.gov.in. Employees login using HRMS ID; Pensioners use Treasury Code + PPO ID to populate basic service data.
2
Fill Dependent Details & Upload Photo/Signature
Enter family details (spouse, dependent children, parents), blood groups, and upload scanned photos/signatures.
3
Generate Printout & Physical Submission
Submit the online application, generate the system printout, sign the declaration, and physically submit it to your Head of Office (HOO) / PSA.
4
Verification & Enrolment Certificate Generation
Head of Office / Approver verifies service records and approves enrolment. Download the official WBHS Enrolment Certificate.
5
Availing Cashless Care / Filing Claims
Present the certificate at empanelled HCOs for cashless indoor care up to ₹2 lakh, or file digital reimbursement claims online.
Payment Method
For Cashless Treatment: Direct financial settlement between the WBHS Finance Department Medical Cell and the empanelled healthcare organisation up to ₹2,00,000. For Reimbursement: Approved claims are credited directly into the employee/pensioner’s salary/pension bank account via IFMS/DBT.
Scheme Inception:Notified under West Bengal Health Scheme, 2008
Important to Know
WBHS is strictly for eligible West Bengal Government employees, pensioners, AIS officers, and their dependants.
Cashless inpatient treatment is capped at ₹2,00,000 baseline per claim at empanelled private hospitals.
The 2026 Budget Speech proposed covering up to 75% beyond ₹2 lakh for pensioners, subject to departmental notification.
Enrolment is optional for pensioners and requires giving up the monthly fixed Medical Relief from the date of enrolment.
Treatment in specialty hospitals outside West Bengal requires prior sanction from the WBHS Authority/Medical Cell.
Frequently Asked Questions
West Bengal Health Scheme Frequently Asked Questions
Common questions and answers regarding eligibility, benefits, documents, and application process for West Bengal Health Scheme.
WBHS is a government medical benefit scheme administered by the Finance Department (Medical Cell) for eligible State Government employees, pensioners, family pensioners, and AIS officers to provide cashless hospitalisation and medical reimbursement.
Sources Checked
All factual information on this page has been compiled and verified against official government portals, gazettes, and departmental guidelines.
Last Verified: 2026-08-18T00:00:00Z
Independent Platform Notice:
WBScheme is an independent information platform and is not the Government of West Bengal. WBHS eligibility, enrolment, treatment coverage, cashless limits, reimbursement rules, empanelled healthcare organisations and dependent-beneficiary rules may change through Government notifications. Always verify the latest information through the West Bengal Finance Department and the official WBHS portal before seeking treatment or submitting a claim.
Healthcare & Medical Cover
