Kolkata – A recent decision extends cashless medical treatment benefits beyond the existing limit of ₹2 lakh for pensioners enrolled in the West Bengal Health Scheme (WBHS), an official stated on Monday.
Expanded Coverage for Pensioners
The change addresses situations where the cost of critical or complex medical care exceeds the ₹2 lakh cashless ceiling, which previously placed a financial burden on pensioners. Currently, both employees and pensioners under WBHS are eligible for up to ₹2 lakh in cashless treatment for indoor procedures at participating private healthcare organizations.
Previously, in-service employees could access medical advances beyond the ₹2 lakh limit, a benefit not extended to pensioners or family pensioners. The state government has now established a new process for pensioners receiving inpatient (IPD) treatment at empanelled hospitals to request an extension of the cashless facility.
Application and Review Process
Pensioners, or their authorized representatives, must submit a prescribed form to the hospital when treatment costs are projected to exceed ₹2 lakh. The hospital will then provide a cost estimate for up to 10 days of treatment, along with a prognosis report justifying the proposed intervention.
The Finance Department’s medical cell will review these documents to determine the necessity of the treatment and the amount of coverage allowed. This scrutiny is to be completed within 24 working hours of receiving complete documentation.
If a decision is not communicated within the 24-hour timeframe, approval is automatically granted, increasing the cashless limit to the permissible extent, up to 75% of the hospital’s estimated cost. This extension can be utilized multiple times throughout the course of treatment.
Frequently Asked Questions
What is the West Bengal Health Scheme?
The West Bengal Health Scheme (WBHS) provides cashless and reimbursable medical benefits to eligible individuals, including government employees and pensioners.
Who is eligible for the extended cashless benefit?
Pensioners enrolled under the West Bengal Health Scheme are eligible for the extended cashless treatment facility when treatment costs exceed ₹2 lakh.
What happens if the Finance Department doesn’t respond within 24 hours?
If the Finance Department does not communicate a decision within 24 working hours of receiving complete documentation, the extension of the cashless treatment limit will be automatically approved, up to 75% of the estimated cost.
Will this new framework improve access to healthcare for pensioners in West Bengal remains to be seen, but it represents a significant step toward alleviating financial burdens associated with complex medical treatments.
