Swasthya Sathi Health Insurance Scheme

Swasthya Sathi is the Governmental health insurance scheme that covers the health scheme of the entire population of West Bengal. Swasthya Sathi Prokolpo is entirely paperless, cashless and is Smart card based. This scheme was launched on December 30, 2016. To monitor the scheme, a registered society was formed named Swasthya Sathi Samithi under the State level Implementation Committee (SLIC).

Scope of the Swasthya Sathi Scheme

Under this Swasthya Sathi Prokolpo, approximately 50 Lakh families and 2.5 crore population are getting coverage. The members from Self Help Group, ASHA workers, Civic Volunteer Force, ICDS Workers, and Helpers, Civil Defence Volunteers, and also the certain group of contractual workers included under the scheme until November 2020. Total eligible families under the Swasthya Sathi Prokolpo are getting coverage of 142 lakhs.

However, since December 01, 2020, all people in West Bengal irrespective of caste and religious affiliation, have been getting coverage under the Swasthya Sathi Prokolpo.

If you want to know more about the scheme, then call the Toll free number- 1800-345-5384.

Swasth Smart Card

On the enrollment day, every beneficiary family would receive an Online Swasthya Sathi Smart card. In this smart card, the details of the insured family members would be mentioned, such as photographs, biometric, SECC ID, mobile number. The entire functioning of this scheme is completely paperless and hence, the performance of the management is based on the IT platform.

Key Features of the Swasthya Sathi Scheme

In the following section, the key features of the Swasthya Sathi Scheme are highlighted:

• Transparent Hospital Gradation: The Empanelment committee takes the decision of approving the grade and empanels the hospitals under the Swasthya Sathi Scheme.
• Real-time Updation: Once the family members would be discharged from the hospital, there would be real-time uploading of the e-health record beneficiaries.
• SMS Alerts: If the health card will block, then the beneficiaries will receive the SMS Alerts.
• Online Grievance Monitoring Mechanism: Using Swasthya Sathi online portal, the beneficiaries are eligible to share their grievances.
• Mandatory Pre-Authorization for Treatment: Within 24 hours, the medical treatments of the beneficiaries are 100% pre-authorized.
• Swasthya Sathi App: Through the Android-based Swasthya Sathi app, the beneficiaries receive assistance.
• Toll-Free Call Centre: If required the beneficiaries can connect at 1800-345-5384 on 24*7, this is a toll-free number.
• Quick Claim Reimbursement: Within 30 days, the claim reimbursement to the hospital will be fixed.

Swasthya Sathi Scheme Coverage Benefits

The beneficiaries are eligible to get the below-mentioned coverage of the Swasthya Sathi Scheme:

• Cashless Hospitalization: The beneficiaries will get the expenses incurred on doctor’s fees, medicines and diagnostic tests under the Swasthya Sathi Scheme, which can be incurred before one day of the hospital admission. Post-treatment incurred on the medicines will be after 5 days for the same treatment or surgery.
• Family Cover: No limitation on the size of the family.
• Coverage up to 5 Lakh: Each family member will be eligible to avail of the basic health insurance up to 5 Lakh for both the tertiary and secondary medical treatment.
• Coverage of Pre-existing Disease: Under the Swasthya Sathi Prokolpo, all the pre-existing diseases of the beneficiaries will be covered.
• Premium: The beneficiaries would not face any burden of paying the premium of the scheme. It is paid for by the West Bengal Government.