The West Bengal Health Scheme (WBHS) has recently expanded its coverage for outpatient (OPD) treatment. Under the revised guidelines, employees, pensioners, and their beneficiaries can now claim reimbursement for a wider range of diseases.
Expanded Disease Coverage:
In addition to the existing list of diseases covered under Clause 7(1), the WBHS now includes the following conditions for OPD reimbursement:
- Related Diseases: If a beneficiary suffers from any of the diseases listed in Clause 7(1) or (2), they can also claim reimbursement for treatment of related conditions.
- Chronic Obstructive Pulmonary Disease (COPD): COPD is now included as a covered condition.
Prescription Requirements:
To be eligible for reimbursement, all medications, including supplements like vitamins and calcium, must be prescribed by the treating specialist on a single prescription.
Effective Date:
The new rules are applicable from the date the order is issued.
Reimbursement Claim Forms:
The WBHS has introduced revised physical and online claim forms for different types of treatments:
- Form-C1: Reimbursement for OPD treatment in empanelled/enlisted hospitals.
- Form-C2: Reimbursement for IPD treatment in non-empanelled hospitals.
- Form-C3: Reimbursement for cashless IPD treatment in empanelled hospitals.
- Form-C4: Reimbursement for non-cashless IPD treatment in empanelled/enlisted hospitals.
Download The Forms Click Here
List of Diseases under OPD Treatment in WBHS:
These following diseases are included for WBHS OPD Treatment:
- Malignant Diseases
- Tuberculosis
- Hepatitis B/C and other Liver Diseases
- Type-1 Insulin-Dependent Diabetes
- Heart Diseases
- Neurological Disorders / Cerebrovascular Disorders
- Malignant Malaria
- Renal Failure
- Thalassaemia / Bleeding Disorders / Platelet Disorders
- Injuries Caused by Accidents (including Animal Bite)
- Rheumatoid Arthritis
- Systematic Lupus Erythematosus (LUPUS)
- Crohn’s Disease
- Endodontic Treatment (Root Canal Treatment)
- Chronic Obstructive Pulmonary Disease (COPD)
- Ankylosing Spondylitis
- COVID-19
Also Read: WBHS Cashless Hospital List
Official Source: Click Here