WBHS OPD Diseases: The list of conditions covered under Out-Patient Department (OPD) treatment reimbursement in the West Bengal Health Scheme has grown from 18 to 24 diseases. The Medical Cell of the Finance Department issued Notification No. 76-F(MED)WB dated September 7, 2026, adding six new conditions to the existing list.
Table of Contents
Which Six Diseases Got Added?
Under Clause 7(1) of WBHS 2008, only 18 specified diseases were earlier eligible for OPD medicine reimbursement. The Governor has now approved six additional conditions, listed as items 19 to 24.
| Sl. No. | New Disease Added |
|---|---|
| 19 | Pancreatitis |
| 20 | Osteoarthritis |
| 21 | Ulcerative Colitis |
| 22 | Glaucoma |
| 23 | Idiopathic Pulmonary Fibrosis (IPF) |
| 24 | Connective Tissue Diseases (CTD): Systemic Sclerosis, CTD-associated ILD, Sjögren’s Syndrome, Dermatomyositis/Polymyositis |
Full List of 24 Diseases at a Glance
Combining the earlier 18 with the six new additions, here is the complete picture. If you’re a serving employee or pensioner, check whether your condition now falls under this list.
| Sl. Range | Diseases/Conditions |
|---|---|
| i-x | Malignant diseases, Tuberculosis, Hepatitis B/C & liver diseases, Type-1 Diabetes, Heart diseases, Neurological/Cerebrovascular disorders, Malignant malaria, CKD Stage 2 onwards, Thalassaemia/bleeding disorders, Accident injuries |
| xi-xviii | Rheumatoid Arthritis, Lupus, Crohn’s Disease, Root Canal Treatment, COPD, Ankylosing Spondylitis, Covid-19, Neuropsychiatric Disorders (Bipolar, MDD, Schizophrenia, OCD, ASD, ADHD) |
| xix-xxiv | Pancreatitis, Osteoarthritis, Ulcerative Colitis, Glaucoma, IPF, CTD |
Claim Process and Conditions
As per the source, medicine costs for the six new diseases will be admissible under the same rates, limits and provisions applicable to existing OPD reimbursements. No new claim procedure has been created, only the disease list has expanded.
- Diagnosis must follow standard, clinically accepted protocols
- Other requirements prescribed under the Scheme from time to time must also be met
- Specialist’s prescription and diagnostic reports need to accompany the claim
New Fraud Control Mechanism
Beyond expanding the disease list, this notification also introduces an internal control mechanism to check fraudulent claims. Here’s what happens if misuse is suspected.
| Situation | Possible Action |
|---|---|
| Reasonable suspicion of fraud | Temporary suspension of Enrolment Certificate, enquiry initiated |
| Before final decision | Hearing opportunity mandatory |
| Fraud proven | Certificate cancelled via reasoned order |
| Reimbursement obtained falsely | Full amount recovered from beneficiary |
| For serving government employees | Disciplinary action under service rules may also follow |
Impact
If you suffer from a long-term condition like osteoarthritis, glaucoma or ulcerative colitis, you can now claim monthly medicine costs under OPD reimbursement. Earlier, since these six diseases weren’t on the list, you had to bear the medicine expenses out of pocket, and the scheme’s benefit was available only for hospitalisation-based treatment.
Consider a pensioner spending Rs 1,500 a month on glaucoma medication. Earlier this entire amount came from personal savings; now, subject to the prescribed rates and conditions, it can be claimed back. But keeping diagnosis reports and prescriptions accurate and complete matters more now, since the new control mechanism can lead to card cancellation if a false or incomplete claim is detected.
Effective From When
This notification takes effect from its date of issuance, that is September 7, 2026. It has been signed by Finance Secretary Khalid A. Anwar, IAS.
Department: Finance
Source: https://healthscheme.wb.gov.in/
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