WBHS Cashless Limit Extended Beyond 2 Lakhs for West Bengal Pensioners

WBHS Cashless Limit: The Government of West Bengal has introduced a significant policy shift aimed at providing financial relief to retired state government employees under the West Bengal Health Scheme (WBHS). In a move to ensure better healthcare accessibility, the Finance Department (Medical Cell) has issued a memorandum extending the cashless medical treatment facility for pensioners beyond the existing limit of Rs 2 Lakhs.

Breaking the 2 Lakh Barrier

Previously, while in-service employees could avail medical advances for high-cost treatments, pensioners and family pensioners were restricted to a cashless cap of Rs 2 Lakhs at empanelled Private Healthcare Organisations (HCOs). Any amount exceeding this limit had to be paid out-of-pocket and claimed later as reimbursement. Recognizing the financial strain this caused during critical or complex illnesses, the state has now enabled a mechanism to extend cashless benefits beyond this threshold.

The Application Procedure: Form C-7

To access this enhanced facility, beneficiaries need to follow a specific protocol during their In-Patient Department (IPD) treatment:

• Initiation: When the treatment cost is projected to exceed Rs 2 Lakhs, the pensioner or their representative must submit an application via Form C-7 to the hospital.
• HCO’s Responsibility: The hospital is required to generate a cost estimate for the next 10 days, accompanied by a Prognosis Report justifying the medical necessity. These documents are then uploaded to the WBHS portal for government review.

Fast-Track Approval System

The most pensioner-friendly aspect of this order is the strict timeline for approval:

• 24-Hour Review: The Medical Cell of the Finance Department is mandated to review the uploaded documents within 24 working hours.
• Deemed Approval: If the department fails to provide a decision within this timeframe, the request is automatically considered approved.
• Sanctioned Amount: Upon approval, the cashless limit is enhanced by 75% of the estimated cost submitted by the hospital (rounded off to the nearest Rs 1000).

Key Terms and Conditions

Beneficiaries should be aware of the following operational guidelines:

• Incremental Extension: The extension is valid for a maximum period of 10 days at a time. However, multiple requests can be made consecutively if the treatment continues.
• Timing: Estimates issued before the commencement of the treatment will not be accepted; the facility is for ongoing IPD cases.
• Liability: While the government covers the major portion, the pensioner remains liable for any inadmissible items or costs exceeding the sanctioned extension.

This order comes into effect immediately from March 2, 2026, marking a progressive step in elder care for former state employees.