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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: 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
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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.
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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.
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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.
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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.
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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.
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*We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30- minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881.
*Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. Policybazaar does not provide any medical or surgical advice or diagnosis and is not responsible for your interactions / treatment by a medical practitioner/hospital. Please consult a registered medical practitioner for any medical or surgical advice. The Information that you obtain or receive from Policybazaar, and its employees, or otherwise on the Website is for informational purposes only. As per the Insurance guidelines, you are allowed to cancel the policy with-in 30 days from the date of Issuance of policy.This option is available incase of policies with a term of one year or more.
*All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.
**All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.
*₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.
*₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases
*₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.
*₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.
*No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.
*The values taken for effective cost calculation are indicative values and may change as per the selected plan.
*Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.
*Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.
*The scope of coverage may vary from plan to plan.
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Tax Benefits are subject to changes in tax laws. GST Exemption depends on fulfilment of qualification criteria and submission of relevant documents as required by the insurers. For more details on risk factors, terms and conditions, please read the sales brochure and applicable rules and regulation carefully before concluding a sale.
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