WBHS Revision of Approved Medical Treatment Rates and Guidelines Order 2026

Government of West Bengal

Medical Cell, Finance Department

2nd Floor, Khadya Bhavan,

11A, Mirza Ghalib Street, Kolkata-700087

No.70-F(MED)WB Date: 14.08.2026

NOTIFICATION

The West Bengal Health Scheme (WBHS) was introduced in 2009 to provide healthcare facilities to serving as well as retired Government employees and their dependent beneficiaries. Subsequently, the cashless IPD (In-Patient Department) treatment facility was introduced in 2014. However, the approved rates under WBHS were last revised more than a decade ago and have remained unchanged since then despite significant escalation in healthcare costs.

Due to the prolonged non-revision of approved rates, beneficiaries are facing difficulties in availing IPD & OPD treatment from empanelled Healthcare Organizations (HCOs) at the prevailing rates. It is felt that, in order to ensure continuity of the Scheme in the interest of serving & retired employees, a rational revision of WBHS approved rates in line with prevailing healthcare costs and comparable benchmarks such as Central Government Health Scheme (CGHS) is necessary.

Accordingly, in view of the above and after careful consideration of the matter, the Governor is pleased to notify the revised approved rates for various services, procedures, investigations etc. required in connection with medical attendance and treatment of a beneficiary under WBHS subject to the following terms & conditions and associated guidelines:

1. Structure of Differential Rates:
The empanelled HCOs are classified into three categories based on geographical locations, viz. X (Tier-I), Y (Tier-II), and Z (Tier-III). Revised approved rates have been rationalised based on such classification and the existing HCO class under the scheme:

1. The approved rates applicable to HCOs located in Y (Tier-II) cities shall be 10% lower, and those applicable to HCOs located in Z (Tier-III) cities shall be 20% lower than the approved rates applicable to HCOs located in X (Tier-I) cities.
2. HCOs classified as Class-I shall be entitled to 100% of the approved rates notified for their respective city classification, while HCOs classified as Class-II shall be entitled to 80% of the approved rates notified for their respective city classification.
3. In cases where treatment is received in non-empanelled HCOs, the existing provision for reimbursement at 80% or 60% of the approved rate, as applicable, shall continue to apply. The approved rate shall be determined based on the city classification applicable to the regional location of the concerned HCO.

Note: X (Tier-I) cities include the Kolkata Metropolitan Area as defined in the Calcutta Metropolitan Planning Area (Use and Development of Land) Control Act, 1965, along with subsequent amendment if any; Y (Tier-II) cities include Asansol, Durgapur and Siliguri; and Z (Tier-III) comprises the rest of West Bengal, or as may be determined by the competent authority from time to time. The existing guidelines regarding the classification of HCOs as Class-I or Class-II shall continue to be followed.

2. Adaptation of CGHS Rates for Procedures, Investigations and Implants under WBHS:
The latest CGHS rates, as notified from time to time, for procedures, investigations and implants have been adapted under WBHS. Accordingly, the existing WBHS approved rates have been revised, and new procedures, investigations and implants available under CGHS have also been incorporated into the WBHS maximum approved rates. The revised approved rates are specified in Annexure-I, appended to this notification, and are also available on the WBHS website: https://healthscheme.wb.gov.in.

The WBHS approved rates shall, as a general rule, be revised from time to time to remain at par with the corresponding CGHS rates, subject to the following exceptions:

1. Where the existing WBHS approved rate in respect of any category viz procedure, investigation or implant is higher than the corresponding CGHS rate, such higher WBHS approved rate shall continue to apply, and shall not be reduced to align with the lower CGHS rate.
2. In respect of Tata Medical Centre, Rajarhat; Chittaranjan National Cancer Institute (CNCI), Rajarhat; and Woodburn Ward, IPGME&R-SSKM, Kolkata — being institutions governed by separate Memoranda of Agreement (MoA), the approved rates applicable shall be as per the respective MoA, and not the CGHS-linked rates notified herein.

3. Adaptation of CGHS Guidelines and Definitions under WBHS:
The Supporting Guidelines and Definitions for implementation of the revised approved rates and newly introduced rates under the West Bengal Health Scheme are specified in Annexure – II, III and IV appended to this notification.

4. Implementation of revised and newly added rates:
The revised approved rates shall come into effect from the 1st day of September, 2026, and shall apply to all IPD treatments where the date of admission is on or after the said date, and to all OPD consultations/investigations etc. undertaken on or after the said date.

OPD consultations and reimbursement thereof shall be confined to the diseases as currently allowed under WBHS, subject to any future amendment in this regard.

The revised approved rates of WBHS shall apply to all Healthcare Organisations (HCOs) and all Diagnostic Centres empanelled under the WBHS, excluding the institutions specified in clause – 2 (ii) above, viz. Tata Medical Centre, Rajarhat; Chittaranjan National Cancer Institute (CNCI), Rajarhat; and Woodburn Ward, IPGME&R-SSKM, Kolkata, which shall continue to be governed by their respective Memoranda of Agreement.

All earlier orders, notifications, guidelines, instructions, or clarifications issued on the subject shall stand modified to the extent they are inconsistent with the provisions of this Notification.

This issues with the approval of the Competent Authority vide UO No. CMO/26/JS-1/F-D/230 dated 01.07.2026.

By Order of the Governor

(K.A. Anwar, IAS)
Secretary to the
Government of West Bengal

Source: https://healthscheme.wb.gov.in/