Swasthya Sathi Scheme

Swasthya Sathi Scheme was launched on December 30th, 2016 by the Chief Minister of West Bengal. Every family and every citizen can be covered in the scheme irrespective of their age group will be included in this scheme. This is a basic health cover for tertiary and secondary healthcare up to Rs 5 lakh per year per family. The scheme is completely funded by the state government and is completely cashless, paperless, and Smart Card based.

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    Swasthya Sathi Scheme Highlights:

    Families Covered

    2 Crores + 

    Hospital Empanelled

    2260 +

    Sum Insured

    Rs 5 lakh

    Pre-existing Diseases

    Covered

    Eligibility Criteria of the Swasthya Sathi Scheme

    The West Bengal’s government has decided to extend the benefit of this Scheme to all the residents of the State apart from those who are already insured under any Government Sponsored Health Insurance Scheme. Also, those how receive medical allowance in their salary are excluded to get the coverage benefits under the Scheme. 

    Swasth Smart Card

    Every beneficiary family receives an Online Swathya Sathi Smart card on the day of Enrolment. In this Smart Card all the details of the insured family members are captured including the biometric, photographs, mobile number, and SECC ID. The management of the scheme is completely paperless and based on IT platform.

    Key Features of the Swasthya Sathi Scheme:

    The coverage features and benefits under the Scheme by the West Bengal Government are given below:

      • Transparent Hospital Gradation: The Empanelment committee approves the grade and empanels the hospital under Swasthya Sathi 
      • Compulsory Pre-Authorization for Treatment:  All the medical treatments and procedures of the beneficiaries are 100% pre-authorized within 24-hours
      • Real-time Updation- There is real-time uploading of the beneficiaries’ e-health record once he/she gets discharged from the hospital  
      • Swasthya Sathi Mobile App- Assistance is provided to the beneficiaries through Android based 
      • SMS Alerts- SMS alerts are provided to the beneficiaries if their health card gets blocked
      • Toll Free Call Centre- The beneficiaries can call on 24*7 toll free helpline number at 1800-345-5384 with feedback option

    • Online Grievance Monitoring Mechanism- The beneficiaries can share their grievances through the Swastha Sathi online portal 

    • Quick Claim Reimbursement- Claim reimbursement to the hospital are settled within 30 days 

    Coverage Benefits of the Swasthya Sathi Scheme:

    Benefits offered under the scheme are given below:

    • Coverage up to Rs 5 Lakh- Basic health insurance cover up to Rs 5 lakh is provided for both tertiary and secondary medical care for each  family
    • Pre-existing Disease Cover- All the pre-existing diseases of the beneficiaries are covered under the scheme
    • Family Cover- There is no capping on the family size. Coverage is available to in-laws and nay dependent physically challenged family member 
    • Premium- The premium is paid by the State Government and no financial burden is put on the beneficiary
    • Cashless Hospitalization- Swasthya Sathi Scheme covers the expenses incurred on doctor’s consultation, diagnostic tests and medicines that are incurred 1 day before the hospital admission. Post treatment expenses incurred on medicines is covered for up to 5 days for the same treatment or surgery.  

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    Written By: PolicyBazaar - Updated: 19 August 2021

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