The eco-health assessment of regional reservoirs is important for ensuring the sustainable utilization of water resources and maintenance of water security, particularly in regions facing water scarcity. The present study aimed to construct a B-IBI based on the community characteristics of macrobenthos in ten large and medium-sized reservoirs across four major river basins in Henan Province, China. The results revealed the identification of 92 species belonging to 3 phyla, 6 classes, 18 orders, 47 families. The B-IBI was established based on five key metrics, namely the number of crustacean and mollusca taxa (M6), Intolerant % (M15), the BI index (M17), the BMWP index (M18), and the Shannon-Wiener index (M27). The total B-IBI score of the 44 sites in ten reservoirs ranged from 0.35 to 3.99. The assessment results indicated two reservoirs (QTH and HKC in the Yellow River basin) were classified as poor, whereas only one reservoir (QP in Huai River basin) was classified as excellent. The B-IBI index demonstrates a strong capability to distinguish the impaired sites from the reference sites, thereby indicating its suitability for assessing regional reservoirs in Henan Province.