Swasthya Sathi Scheme

Swasthya Sathi Scheme by West Bengal Government

The Swasthya Sathi Coverage was launched by the West Bengal Government on December 30, 2016, as a comprehensive health insurance plan for residents. It offers cashless, paperless, and Swasthya Sathi card benefits to ensure citizens receive quality medical treatment without financial stress. The scheme covers the entire family with an annual sum insured of up to Rs 5 lakh per family, targeting secondary and tertiary healthcare needs. The scheme is fully funded by the state government, providing much-needed financial relief to the beneficiaries. Whether for consultations, diagnostics, or treatment, the Swasthya Sathi Scheme stands out for its inclusiveness and wide coverage across various medical procedures.

Objective of Swasthya Sathi Scheme 

The primary objective of the Swasthya Sathi Coverage is to offer cashless healthcare services to every resident of West Bengal, focusing on reducing the burden of medical expenses for families. With rising healthcare costs, the Swasthya Sathi Scheme aims to enhance accessibility to quality healthcare, particularly for secondary and tertiary care. By empanelling hospitals and extending healthcare infrastructure in semi-urban and rural areas, the scheme ensures that quality medical services are within reach for all. The initiative addresses the need for affordable healthcare by eliminating citizens' out-of-pocket expenses.

Features of the Swasthya Sathi Scheme 

Swasthya Sathi brings a variety of features that make it a robust health insurance plan:

●      Transparent Hospital Grading: Hospitals are graded based on their services, and the empanelment committee approves them accordingly.

●      Mandatory Pre-Authorisation: All treatments and medical procedures require pre-authorisation, which is processed within 24 hours.

●      Real-Time Updates: Beneficiary health records are updated in real-time after hospital discharge, ensuring accurate data management.

●      Swasthya Sathi Mobile App: The app provides easy access to information regarding hospitals, health packages, and e-health records.

●      SMS Alerts: Beneficiaries receive SMS notifications if their health card is blocked or if there are any updates.

●      Toll-Free Support: A 24-x7 toll-free helpline (1800-345-5384) is available for assistance.

●      Quick Claim Settlements: Claims are processed within 30 days, reducing financial stress on beneficiaries and hospitals.

Benefits of the Swasthya Sathi Scheme

The Swasthya Sathi Scheme offers comprehensive benefits that cater to the healthcare needs of the beneficiaries:

●      Health Coverage up to Rs 5 Lakh: Coverage is provided for both secondary and tertiary care, ensuring extensive medical support.

●      Pre-existing Disease Coverage: The scheme covers all pre-existing conditions from day one, which is beneficial for those with ongoing health issues.

●      No Cap on Family Size: The scheme covers the entire family, including in-laws and dependent physically challenged members, without restricting family size.

●      Cashless Hospitalisation: The scheme covers expenses for doctor consultations, diagnostic tests, and medicines incurred one day before hospitalisation and up to five days post-treatment.

●      Zero Premium Cost: The West Bengal Government fully bears the premium, making the coverage completely free for beneficiaries.

Eligibility Criteria of the Swasthya Sathi Scheme 

The Swasthya Sathi Card eligibility is as follows:

●      You must be a permanent resident of West Bengal.

●      You should not be covered under any other government-sponsored health insurance scheme.

●      The health card is issued in the name of the eldest female member of the family.

●      The scheme covers all family members, including parents of both spouses, unmarried daughters (up to 21 years), and dependent physically challenged members.

Documents Required to Apply for the Scheme

To apply for the Swasthya Sathi Mediclaim Policy, you will require the following documents:

●      Proof of Identity (Aadhaar Card, Voter ID)

●      Residential Proof

●      Mobile Number

●      Recent Photograph

How to Apply for the Swasthya Sathi Health Scheme?

The process to apply for the Swasthya Sathi Scheme is simple:

●      Visit the official website of the Swasthya Sathi Scheme.

●      Click on the ‘Apply Online’ option and select ‘Form B for Registration.’

●      Fill in the required details and submit the form along with the necessary documents.

Key Functionalities of Swasthya Sathi Prokolpo

The Swasthya Sathi Prokolpo comes with a host of functionalities aimed at making healthcare accessible and affordable:

Comprehensive Hospital Network

The scheme has empanelled more than 2,290 hospitals, providing beneficiaries access to a wide range of medical facilities across the state.

Real-Time Health Record Management

Beneficiary records are updated instantly, ensuring that all medical histories are accurately documented.

Grievance Monitoring System

An online platform allows beneficiaries to lodge complaints and track resolutions, making the system transparent.

Transparent Treatment Authorisation

Treatments under the scheme are pre-authorised online within 24 hours, streamlining the process and avoiding delays.

Monthly Analytical Reports

The scheme generates monthly reports accessible to the public for review and suggestions, promoting accountability.

Cashless Treatment Across Hospitals

The scheme covers diagnostic and treatment costs across empanelled hospitals, ensuring that beneficiaries face no out-of-pocket expenses.

Transportation Allowance

Patients are provided a transport allowance post-discharge, ensuring seamless transitions back home.

Process for Swasthya Sathi Hospital Registration

Hospitals can register under the Swasthya Sathi Scheme by following these steps:

●      Visit the official Swasthya Sathi portal.

●      Click on the ‘Apply Online’ option and select ‘Hospital Registration.’

●      Fill in the required details, such as hospital name, contact details, and category.

●      Attach the necessary documents and apply for review.

How to Check Swasthya Sathi Hospital Registration Status?

To check the registration status of a hospital under the Swasthya Sathi Scheme:

Visit the official Swasthya Sathi portal.

Click on the ‘Check Hospital Reg. Status’ option.

Enter your registered mobile number to view the status.

How to Register for Treatment Outside West Bengal Under the Swasthya Sathi Scheme? H2

If you need treatment outside West Bengal under the Swasthya Sathi Scheme:

Go to the official portal.

●      Select the ‘Registration Outside of West Bengal’ option.

●      Enter your URN number and complete the registration by providing the necessary details and documents.

Swasthya Sathi Scheme Health Card

The Swasthya Sathi Health Card is issued in the name of the eldest female family member. This card contains all essential details, including family biometrics, photographs, and contact information. It is auto-renewed annually and has lifetime validity, allowing beneficiaries to receive cashless treatment across empanelled hospitals.

Steps to View Hospital Details Under Swasthya Sathi Scheme

To view details about hospitals under the Swasthya Sathi Scheme:

●      Visit the official portal and select ‘Hospital Information.’

●      You can view relevant information by selecting from options such as Active Hospital List or Hospital HR Details and submitting the form.