Swasthya Sathi Scheme: Apply Card Online, Eligibility, Benefits

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.

FAQs

Q1. Is there a list of hospitals where the beneficiaries under the Swasthya Sathi scheme can visit for the treatment?

A list of both the public and private hospitals is provided at the time of enrolment. You can check it from the hospital booklet. You can also call the helpline number that is provided along with the smart card.

Moreover, you can use the Swasthya Sathi Mobile App to search the hospitals or visit the official website.
Q2. What kinds of hospitals are qualified under the Swasthya Sathi scheme?

Both public and private hospitals are empanelled as per the qualifying criteria. They are further graded based on the facilities they offer and the available medical infrastructure available. And the beneficiary can choose any of these panel hospitals to avail the treatment. You can easily find the facilities provided in the hospitals through their Mobile App or online on their Website.
Q3. Do beneficiaries under the Swasthya Sathi scheme need to pay anything to the hospital for treatment?

Swasthya Sathi scheme provides cashless hospitalization benefit up to Rs 5 lakh per year to each family. The amount is paid to the hospital through the Smart card that is issued to them at the time of enrollment. No payment needs to be made by the beneficiary under the Swasthya Sathi Scheme by the West Bengal government.
Q4. Can both OPD & IPD expenses be covered under Swasthya Sathi Scheme?

The scheme does not cover OPD consultation charges but if the OPD is converted IPD, then it is payable under the scheme.
Q5. Whose fingerprint is required at the time of hospital admission under the Swasthya Sathi Scheme ?

Under the Swasthya Sathi Scheme you can provide fingerprint of any enrolled member of the family.