The West Bengal Health Scheme (WBHS) is a healthcare benefit scheme administered by the Finance Department, Government of West Bengal for eligible State Government employees, pensioners and other covered beneficiary categories.
The scheme provides medical benefits through recognised and empanelled healthcare organisations. Depending on the beneficiary category and treatment, the scheme provides cashless inpatient treatment, reimbursement of eligible medical expenses, specified OPD treatment benefits and medical-advance facilities.
Latest WBHS Update 2026: Cashless Limit Increased to ₹5 Lakh
The biggest recent change to the West Bengal Health Scheme is the enhancement of the cashless limit for inpatient treatment.
Under Finance Department Memorandum No. 81-F(MED)WB dated 17 September 2026, the cashless limit for eligible IPD treatment at private empanelled hospitals within West Bengal has been increased:
₹2 lakh → ₹5 lakh per hospitalisation
The revised limit applies to eligible IPD treatments where the date of admission is on or after 1 October 2026.
The memorandum states that the enhancement applies to employees and pensioners enrolled under WBHS and their eligible beneficiaries, subject to the existing terms and conditions of the scheme.
This is an important distinction: ₹5 lakh is the revised cashless IPD limit per hospitalisation; it should not be described as an unrestricted ₹5 lakh insurance policy or an automatic reimbursement of every medical bill.
West Bengal Health Scheme 2026 – Overview
| Particular | Details |
|---|---|
| Scheme Name | West Bengal Health Scheme (WBHS) |
| Administering Department | Finance Department, Government of West Bengal |
| Scheme | West Bengal Health Scheme, 2008 |
| Major 2026 cashless limit | Up to ₹5 lakh per eligible IPD hospitalisation |
| ₹5 lakh limit effective from | 1 October 2026 |
| Applicable hospital | Private empanelled hospitals within West Bengal |
| Beneficiaries | Eligible Government employees, pensioners and eligible beneficiaries |
| Other medical benefits | Eligible reimbursement, specified OPD treatment and medical advance facilities |
| Application/claims | Through the WBHS Portal and prescribed authorities |
| Official authority | Medical Cell, Finance Department, Government of West Bengal |
The official WBHS Portal currently provides separate facilities for Government employees, Government pensioners, beneficiaries of Grant-in-Aid colleges and universities, and covered Panchayati Raj bodies.
What Is the West Bengal Health Scheme?
The West Bengal Health Scheme 2008 is a Government of West Bengal healthcare benefit programme administered by the Medical Cell under the Finance Department.
The Medical Cell is responsible for administering the scheme, issuing operational guidelines and clarifications, fixing approved rates for medical procedures and investigations, and empanelling eligible private hospitals, nursing homes, clinics, laboratories and diagnostic centres.
The scheme can provide:
- Cashless inpatient treatment at eligible private empanelled hospitals
- Reimbursement of eligible indoor treatment expenses
- Reimbursement for specified OPD treatment
- Medical advances for eligible treatment
- Treatment through recognised healthcare organisations
- Treatment at certain approved speciality hospitals outside West Bengal, subject to the applicable approval procedure
- Medical benefits for eligible dependent beneficiaries
The exact benefit depends on the beneficiary’s category, treatment, hospital and the applicable WBHS rules.
What Is the New ₹5 Lakh Cashless Treatment Limit?
From 1 October 2026, the cashless ceiling for eligible IPD treatment has been increased to:
₹5,00,000 per hospitalisation
The new limit applies when:
- The beneficiary is enrolled under WBHS;
- The treatment is eligible under the scheme;
- The treatment is provided at a private empanelled hospital within West Bengal; and
- The date of admission is 1 October 2026 or later.
The enhancement was notified through Memo No. 81-F(MED)WB dated 17 September 2026. The memorandum states that the earlier ₹2 lakh ceiling is enhanced to ₹5 lakh and that the other terms and conditions governing cashless treatment remain unchanged.
Important
The ₹5 lakh figure should not be understood as:
- ₹5 lakh annual insurance cover;
- ₹5 lakh automatically payable for every illness;
- ₹5 lakh reimbursement for treatment at any hospital; or
- unlimited coverage regardless of WBHS approved rates.
It is the cashless IPD ceiling for each eligible hospitalisation in a private empanelled hospital within West Bengal.
What If Treatment Costs More Than ₹5 Lakh?
The ₹5 lakh figure is the cashless ceiling.
It does not mean that WBHS suddenly stops recognising all treatment expenses above ₹5 lakh. The scheme has separate provisions concerning admissible reimbursement and treatment costs above the cashless ceiling.
The amount admissible depends on:
- Whether the treatment is covered;
- The applicable WBHS approved rate;
- Whether the hospital is empanelled;
- The type of treatment;
- Any required prior permission; and
- The applicable claim and reimbursement procedure.
Therefore, beneficiaries should not assume that the entire amount above ₹5 lakh will automatically be reimbursed.
Who Can Get Benefits Under WBHS?
The WBHS framework covers eligible categories of Government employees, pensioners and other beneficiaries covered by the scheme.
The official portal currently provides enrolment facilities for:
- Government employees
- Government pensioners
- Beneficiaries of Grant-in-Aid colleges
- Beneficiaries of Grant-in-Aid universities
- Employees of Panchayati Raj bodies
- Pensioners of Panchayati Raj bodies
Eligibility is subject to the relevant Government orders and scheme conditions.
West Bengal Government Employees
Eligible regular West Bengal Government employees can enrol in WBHS according to the prescribed procedure.
Employee participation is subject to the applicable scheme conditions.
An enrolled employee is required to give up the regular Medical Allowance as prescribed under the scheme.
The scheme also contains conditions relating to continuation and withdrawal after benefits have been availed.
Pensioners and Family Pensioners
Eligible Government pensioners and family pensioners can enrol in WBHS through the prescribed pensioner enrolment procedure.
The applicable Medical Relief has to be surrendered as required under the scheme.
Pensioners should use the dedicated pensioner enrolment and claim facilities provided through the WBHS Portal or follow the applicable prescribed offline procedure where permitted.
All India Service Officers
Eligible All India Service officers serving in the West Bengal cadre can be covered under the applicable WBHS provisions.
The scheme also contains provisions for eligible retired AIS officers, subject to the relevant conditions, including the applicable relationship with CGHS benefits.
Grant-in-Aid Institutions and Panchayati Raj Bodies
The current WBHS Portal provides separate facilities for covered beneficiaries associated with:
- Grant-in-Aid colleges;
- Grant-in-Aid universities; and
- Panchayati Raj bodies.
These categories should follow the specific enrolment and claim procedure applicable to their organisation.
Eligibility of Dependent Family Members
Eligible dependent family members can receive WBHS benefits when they satisfy the applicable relationship, income and dependency conditions.
The categories covered under the applicable provisions include spouses, parents, children and certain other dependent family members.
Spouse
The spouse can be eligible without the usual dependency-income condition applicable to certain other family members, subject to the scheme’s requirements.
Parents
The applicable rules provide an income condition for dependent parents.
Under the provisions reflected in your source material, the gross monthly income from all sources must not exceed ₹8,500.
Children
Eligible children are subject to the prescribed dependency and income conditions.
The income threshold reflected in the applicable provisions is ₹5,000 per month.
Unmarried Daughter
An unmarried daughter may qualify as a dependent subject to the applicable income and dependency conditions.
Widowed or Divorced Daughter
A dependent widowed or divorced daughter may qualify subject to the prescribed conditions.
Minor Brother or Sister
A minor brother or sister can qualify subject to the prescribed age and income conditions.
Dependent Sister
An unmarried, widowed or divorced sister may qualify as a dependent when the prescribed conditions are satisfied.
Major Son
A major son can remain a dependent until he starts earning ₹5,000 or more per month or reaches 25 years of age, whichever occurs earlier, subject to the applicable provisions.
Son With Permanent Disability
A son having more than 40% permanent physical or mental disability can remain a dependent irrespective of age, subject to the prescribed conditions and submission of the required Disability Certificate.
Income Declaration for Dependent Beneficiaries
Dependent eligibility can require periodic income verification.
For working or retired dependent beneficiaries, the prescribed income certificate may be required from the concerned Head of Office.
For non-working dependent beneficiaries aged 18 years or above, the prescribed Self Declaration of Income (Annexure-V) may be required.
Where applicable, the self-declaration has to be renewed according to the prescribed schedule.
A Disability Certificate for a dependent beneficiary covered because of permanent disability may also require periodic review.
New Non-Pecuniary Beneficiary Provision in 2026
One of the important WBHS developments listed on the official portal in 2026 is the introduction of the Non-Pecuniary Beneficiary category through Memo No. 78-F(MED)WB.
This category should not be confused with normal WBHS financial coverage.
A person qualifying under the non-pecuniary beneficiary provisions does not receive the normal financial benefits of WBHS simply by being placed in this category.
The applicable 2026 order and portal instructions should be followed for:
- Eligibility;
- Enrolment;
- Treatment;
- Applicable rates; and
- Payment responsibilities.
Because this is a new provision, readers should always check the latest official order rather than relying on older WBHS articles.
West Bengal Health Scheme Benefits
1. Cashless IPD Treatment
The most significant current benefit is cashless inpatient treatment at private empanelled hospitals within West Bengal.
From 1 October 2026, the applicable ceiling is ₹5 lakh per hospitalisation for eligible IPD treatment.
2. Reimbursement of Eligible Indoor Treatment
WBHS also provides reimbursement for eligible indoor treatment according to the scheme’s rules and approved rates.
The Medical Cell fixes approved rates for surgical procedures and investigations from time to time.
Therefore, the amount actually admissible is not necessarily identical to the amount charged by the hospital.
3. OPD Treatment
WBHS provides OPD reimbursement under specified conditions.
This does not mean that every ordinary OPD consultation or medicine purchase is automatically reimbursable.
The scheme contains a specified list of eligible diseases/treatments.
The official portal currently lists 2026 updates concerning:
- Inclusion of six additional diseases in the OPD list under the relevant WBHS provision; and
- Clarification regarding OPD treatment.
The latest applicable OPD list and notification should therefore be checked before submitting a claim.
4. OPD Expenses Related to Indoor Treatment
The official WBHS facilities page also provides for reimbursement of certain OPD expenses related to indoor treatment.
It states that eligible related OPD treatment expenses incurred during the prescribed period before admission and after discharge can be reimbursed under the applicable rules.
This is separate from the reimbursement available for specified standalone OPD diseases.
Medical Advance Under WBHS
Eligible employees can obtain a medical advance for qualifying treatment according to the prescribed procedure.
The advance is generally linked to the estimated treatment cost and the applicable WBHS provisions.
The employee must submit the prescribed hospital estimate and other supporting documents.
The amount sanctioned is subject to the scheme’s rules and is not an unconditional advance for every medical treatment.
Pensioners have separate provisions for medical advances, particularly for specified major treatments.
Which Treatments Require Prior Permission?
Certain specialised procedures require approval from the West Bengal Health Scheme Authority (WBHSA).
The official Medical Cell page specifically identifies procedures including:
- More than two procedures where the total cost exceeds ₹50,000;
- More than two Drug-Eluting Stents;
- AICD implantation;
- CRT with AICD;
- Deep Brain Stimulator implantation;
- Intrathecal pump implantation;
- Cochlear implantation;
- Spinal Cord Stimulator implantation;
- Chemotherapy or immunotherapy where medicine cost exceeds ₹50,000 per cycle;
- Certain high-value non-package treatments.
For non-package treatment, the current Medical Cell information specifies a threshold of:
- ₹5 lakh for Tata Medical Center, Rajarhat, and
- ₹3.5 lakh for other private empanelled hospitals.
Successive permission requirements can also apply to continuing non-package treatment.
Because these thresholds and procedures are highly specific, patients should ask the hospital’s WBHS desk to confirm whether prior permission is required before the treatment is performed.
Treatment Outside West Bengal
Treatment at speciality hospitals outside West Bengal can be permitted under WBHS subject to the applicable approval procedure.
The Medical Cell states that the West Bengal Health Scheme Authority is ordinarily required to be consulted before permission is granted for treatment at speciality hospitals outside the State, subject to specified exceptions.
Therefore, beneficiaries should not assume that treatment at an outside-state hospital will automatically qualify for reimbursement.
Prior approval and the prescribed referral/medical documentation may be required.
Documents Required for WBHS
The exact documents depend on the purpose of the application.
For Enrolment
The prescribed documents can include:
- Enrolment application;
- Family particulars;
- Details of eligible beneficiaries;
- Aadhaar details;
- Photograph;
- Signature;
- Blood-group information;
- Required undertaking/declaration;
- Documents supporting dependent eligibility.
Employees generally use the prescribed employee enrolment form, while pensioners follow the pensioner enrolment procedure.
For Adding Dependent Beneficiaries
Depending on the beneficiary, documents can include:
- Income certificate;
- Self Declaration of Income;
- Disability Certificate;
- Proof of relationship;
- Other documents required by the authority.
For Medical Reimbursement
Depending on the claim, the beneficiary may need:
- Prescribed claim form;
- Original medical bills;
- Original vouchers;
- Hospital documents;
- Medical records;
- Essentiality Certificate, where applicable;
- Copy of the beneficiary Identity Card;
- Other documents prescribed for the particular claim.
For Medical Advance
The documents can include:
- Hospital cost estimate;
- Required annexures;
- Prescribed advance application;
- Medical reports;
- Treatment details;
- Other supporting documents.
The hospital and concerned authority should be consulted for the exact document set because requirements can vary by treatment and beneficiary category.
How to Apply for WBHS Online?
The official WBHS Portal provides separate online facilities for different beneficiary categories.
Government Employees
The general process is:
Step 1: Open the Official WBHS Portal
Visit the official West Bengal Health Scheme Portal maintained by the Finance Department.
Step 2: Select Employee Enrolment
Choose the Government Employee enrolment option.
Step 3: Submit the Prescribed Application
Enter the employee and family details and complete the prescribed enrolment application.
Step 4: Add Eligible Beneficiaries
Enter the details of eligible dependent family members.
Step 5: Provide Required Documents
Submit the prescribed photographs, signatures, Aadhaar information and other required details.
Step 6: Office Verification
The concerned authority examines the application.
Step 7: Enrolment Certificate
After approval, the prescribed enrolment certificate is generated.
The official portal provides the current online enrolment facilities and should be used instead of relying on screenshots or instructions from old third-party websites.
How Can Pensioners Apply?
Eligible pensioners and family pensioners should use the pensioner enrolment facility available through the WBHS Portal.
The application is processed through the prescribed Pension Sanctioning Authority or other competent authority as applicable.
Pensioners who face difficulties because they reside away from their relevant authority may use the applicable offline mechanism where permitted.
The exact authority depends on the pensioner’s circumstances and the current WBHS procedure.
How to Claim WBHS Reimbursement?
For an eligible reimbursement claim, the beneficiary should submit the prescribed claim form and supporting documents through the applicable online or departmental procedure.
Depending on the treatment, documentation may include:
- Medical bills;
- Vouchers;
- Discharge summary;
- Prescriptions;
- Investigation reports;
- Essentiality Certificate;
- Identity documents;
- Other treatment records.
Claims are scrutinised by the competent authority before the admissible amount is determined.
Is There a Time Limit for Filing a Claim?
The applicable claim must be submitted within the prescribed period.
Your source material specifies:
- IPD reimbursement: generally within six months from hospital discharge;
- Eligible OPD reimbursement: generally within six months from consultation.
Because claim-processing rules can be amended, beneficiaries should check the current applicable notification/portal instructions before relying on the six-month period for a particular claim.
WBHS Empanelled Hospitals
Cashless treatment depends on the hospital being an eligible private empanelled hospital under WBHS.
The official WBHS Portal provides a dedicated section for:
- Private empanelled hospitals;
- State-aided hospitals;
- Outside-state hospitals;
- Beneficiary authentication; and
- Permission status.
The portal currently displays 205 empanelled private hospitals and 30 empanelled diagnostic centres, although these figures can change as empanelment is updated.
Therefore, it is better to check the official hospital list immediately before admission instead of relying on a static list published in an article.
Important Things to Know Before Using WBHS
The ₹5 lakh limit is not a blanket insurance policy
The new ₹5 lakh limit specifically concerns eligible cashless IPD treatment in private empanelled hospitals within West Bengal.
Hospital empanelment matters
A private hospital is not automatically covered merely because it is a large or recognised hospital.
Check its current WBHS empanelment status.
Approved rates matter
The Government fixes approved rates for procedures and investigations. The admissible amount can therefore differ from the hospital’s ordinary retail bill.
Some treatments require prior approval
Do not wait until after a specialised procedure to discover that permission was required.
Keep medical documents
Bills, prescriptions, discharge summaries, investigation reports and other supporting records may be required for reimbursement or verification.
Check the latest notification
WBHS rules have changed several times during 2026. The official portal currently lists new orders relating to:
- Cashless claim processing;
- Revision of approved rates;
- OPD disease coverage;
- OPD clarification; and
- Non-Pecuniary Beneficiaries.
West Bengal Health Scheme 2026 – Frequently Asked Questions
What is the West Bengal Health Scheme?
WBHS is a healthcare benefit scheme administered by the Finance Department of the Government of West Bengal for eligible Government employees, pensioners and other covered beneficiaries.
What is the new WBHS cashless limit in 2026?
The cashless IPD limit is ₹5 lakh per hospitalisation at private empanelled hospitals within West Bengal for eligible admissions from 1 October 2026.
Was the earlier limit ₹2 lakh?
Yes. The earlier cashless IPD ceiling was ₹2 lakh under the previous provisions. The September 2026 memorandum enhanced it to ₹5 lakh from 1 October 2026.
Does the ₹5 lakh limit apply to every hospital?
No. The new ceiling applies to eligible IPD treatment at private empanelled hospitals within West Bengal.
Does WBHS cover all medical expenses up to ₹5 lakh?
No. Treatment remains subject to WBHS eligibility, approved rates, admissibility rules and other applicable conditions.
Who can enrol in WBHS?
Eligible Government employees, pensioners and other categories covered by the scheme can enrol subject to the applicable conditions.
Can dependent family members receive WBHS benefits?
Yes, where they satisfy the applicable relationship, income and dependency requirements.
Does WBHS cover OPD treatment?
Yes, but OPD reimbursement is subject to specified diseases, treatments and conditions. It is not a blanket reimbursement for every OPD expense.
Can WBHS beneficiaries receive treatment outside West Bengal?
Treatment outside West Bengal may be permitted at certain speciality hospitals subject to the prescribed approval procedure and exceptions.
Does WBHS have a new beneficiary category in 2026?
Yes. The official portal lists the introduction of a Non-Pecuniary Beneficiary category under Memo No. 78-F(MED)WB.
Where can I check the latest WBHS rules?
The safest source is the official West Bengal Health Scheme Portal and the Finance Department’s latest circulars and memoranda.
Official West Bengal Health Scheme Portal
The West Bengal Health Scheme Portal is operated by the Finance Department, Government of West Bengal, and hosted/maintained through NIC.
It provides current information relating to:
- Enrolment
- Claims
- Empanelled hospitals
- Approved rates
- Circulars and memoranda
- Beneficiary authentication
- Treatment permissions
- Forms
- Contact information
Official portal: West Bengal Health Scheme Portal
The Finance Department’s official circular database should also be checked whenever a major WBHS rule is being relied upon.
Key 2026 WBHS Updates at a Glance
| Date | Update |
|---|---|
| 14 August 2026 | Notification No. 70-F(MED)WB revised approved WBHS rates |
| 1 September 2026 | Revised approved rates became effective |
| 11 September 2026 | 78-F(MED)WB introduced the Non-Pecuniary Beneficiary provision |
| 17 September 2026 | Memo No. 81-F(MED)WB enhanced the cashless IPD ceiling |
| 1 October 2026 | ₹5 lakh cashless IPD limit became applicable to eligible admissions |
The official WBHS Portal currently lists the 2026 orders concerning revised rates, cashless claim processing, OPD changes and the Non-Pecuniary Beneficiary category.
The West Bengal Health Scheme 2026 remains an important healthcare benefit for eligible West Bengal Government employees, pensioners and covered beneficiaries.
The most important current change is that the cashless IPD limit has been increased to ₹5 lakh per hospitalisation, effective for admissions from 1 October 2026, at eligible private empanelled hospitals within West Bengal.
However, beneficiaries should remember that the ₹5 lakh figure is a cashless treatment ceiling, not an unrestricted insurance policy. Treatment eligibility, approved WBHS rates, hospital empanelment, prior permissions and claim conditions continue to apply.
Because WBHS rules are being updated during 2026, beneficiaries should always verify the latest notification and hospital status through the official portal before making a medical or financial decision.