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Published on:

February 26, 2025

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Govt. Schemes

Swasthya Sathi Scheme: Health Insurance for Residents of West Bengal

Swasthya Sathi Scheme was set in motion by the Hon'ble Chief Minister of West Bengal on 30 December 2016 to supply healthcare-related benefits. This medical initiative, made by the West Bengal Government, seeks to make its citizens obtain full health coverage, making readily affordable and available medical care accessible during emergencies.

What is the Swasthya Sathi Scheme?

A Smart Card – Swasthya Sathi Card is a cashless and paperless scheme through which people can avail the benefits of state-run health insurance. This program is fully funded by the state government.

AIM: To provide free treatment to all those families in need and help cover expensive medical bills.

You must be a permanent resident of the West Bengal state to be eligible for the scheme. Several medical interventions and services are delivered under this program so that individuals get time-specific and right care without paying heavy hospital expenses and others.

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The Swasthya Sathi Scheme is aimed at improving the healthcare system by lowering the cost of treatment, especially in rural and semi-urban areas. The program includes:

1. Super Specialty Hospitals

2. Fair Price Diagnostic Centres

3. Fair Price Medicine Shops

3. Critical Care Units

All these facilities are available within a 50 km radius to ensure good-quality care at affordable prices for everyone.

Highlights of the Swasthya Sathi Scheme

Launched On	30th December 2016
Families Covered	2.4 Crores
Hospitals Empanelled	2600 +
Hospitalization	85 Lakhs +
Insurance Amount	5 Lakhs
Pre – Existing Disease	Covered

Coverage Benefits of the Swasthya Sathi Scheme

1. Comprehensive Coverage: Basic health cover for secondary and tertiary care up to Rs. 5 Lakh per annum per family under the WB health scheme.

2. Cashless Treatment: It is a paperless, cashless, and smart card-based scheme.

3. Pre-existing Disease Cover: All pre-existing diseases of the beneficiaries are covered here.

4. Family Cover: All the dependent physically challenged persons in the family are covered. There is no cap on the family size, and Parents from both Spouses are included.

5. Premium paid by the Government: The patients are required only to pay a minimum amount of Rs. 2 for visiting the doctor in the OPD other than that, the entire cost is borne by the State Government, and no contribution from the beneficiary.

Important Features of the Swasthya Sathi Scheme

1. Online Grievance Monitoring: Beneficiaries facing issues and complaints can give feedback through the Swasthya Sathi website.

2. Digital Application: The Swasthya Sathi mobile app (Android-based) helps beneficiaries get assistance easily.

3. SMS Alerts: One will receive an SMS alert if a beneficiary’s health card is suspended.

4. Mandatory Pre-Authorisation for Treatment: Within 24 hours for the beneficiaries, all treatments and procedures are pre-authorized.

5. Quick Claim Payment: Within 30 days, hospital reimbursement claims are paid and processed.

6. Toll-free Call Centre: People facing issues can call the Swasthya Sathi call center at 1800-345-5384. It is a 24/7 open helpline number, always there to help those in need.

Who is eligible for the Swasthya Sathi Scheme?

You must meet the following criteria to be eligible for a Swasthya Sathi card

1. You must be a permanent resident of West Bengal

2. You should not be enrolled in any other government-sponsored health insurance scheme

3. You should not receive a medical allowance in your salary

Key Functionalities of the Scheme

Swasthya Sathi Card

On enrolment, the beneficiaries are provided with a Swasthya Sathi card, which is a health insurance coverage card. The card has vital details like the identification number, name, and photo of the beneficiary. It can be checked by its owner online with ease from the official website of the Swasthya Sathi card

Empanelled Hospitals

There is a huge chain of impanelled clinics, hospitals, and diagnostic centres in West Bengal, which comes under the state-sponsored Swasthya sathi scheme. Beneficiaries can avail of the services of any of these medical centers, making it convenient for them to avail quality medical care.

How to apply for a Swasthya Sathi Scheme Online?

Follow the respective steps below to register:

1. Visit the official Swasthya Sathi Scheme website at https://swasthyasathi.gov.in.

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2. An Apply Online button can be found on the home page. Click on the same.

3. Fill out the online application form with accurate personal and family details, including income information.

4. Upload the necessary supporting documents, such as identification proof, address proof, and income certificates.

5. Submit the application form online.

Documents required: Aadhaar card number, Khadya Sathi ration card number, Registered mobile number, Employment status, and Legal domicile documents.

After the submission, a verification process will take place to verify the provided information. Once the application is approved, beneficiaries will receive their Swasthya Sathi Card by mail.

Programs run by The West Bengal government for the facilitation of Schemes like Swasthya Sathi.

DUARE SARKAR

Started on 1st December 2020 by the Hon’ble Chief Minister of West Bengal, Duare Sarkar is an initiative of the Government of West Bengal for the delivery of services and welfare schemes at the doorsteps of the people through outreach camps.

These camps are organized at the gram panchayat and municipal ward level. These camps act as service providers of specific services and nodes for the issuance and collection of applications for welfare schemes.

Swasthya Sathi on Duare Sarkar – VI

1. Total 84,060 Swasthya Sathi Camps organized till the 10 Apr 2023 of Duare Sarkar- VI.

2. A total 4,52,071 applications were received in the Swasthya Sathi Camps.

3. The Service delivered is 4,45,883, which is 98.63 % till 30 April 2023.

Conclusion

The Swasthya Sathi Scheme has turned out to be very beneficial in West Bengal, empowering families with end-to-end health insurance coverage. With its emphasis on affordability and accessibility, the scheme offers the chance for individuals of any economic status to undergo quality medical care without concern about the expense. With its key features and advantages of cashless treatment, family coverage, and no limit on family size, the scheme has completely overhauled the health scenario in the state, providing a cushion to thousands of families. The Swasthya Sathi Scheme is an indication of the government's seriousness towards giving its people priority in terms of their well-being and is a model to be replicated for similar healthcare schemes across the country.

To know more about various Government Health Schemes, explore our curated and detailed blogs.

Frequently Asked Questions:

1. How is West Bengal Health Scheme different from Swasthya Sathi?

a. Swasthya Sathi has an upper limit of 5 Lakh (for patients with critical illness)

b. WB Health Scheme is for Government Employees.

c. Swasthya Sathi is meant for the unorganized sector

d. All OPD expenses are paid in the WB Health Scheme.

2. Is Swasthya Sathi valid outside West Bengal?

The Vellore facility is the only hospital outside Bengal where people can avail of the Swasthya Sathi scheme.

3. How do I check whether my Swasthya Sathi card is valid or not?

Care should be taken to ensure that the Swasthya Sathi card has accurate information. It can be checked online according to the official website of the scheme.

4. Does the Swasthya Sathi Scheme include both OPD and IPD charges?

Yes, the Swasthya Sathi Scheme is a complete health cover scheme as it also covers the charges of the Outpatient Department (OPD) and Inpatient Department (IPD). The scheme covers doctor charges, diagnostic investigations, pre-hospitalization charges, and post-hospitalization charges, and there is no monetary cap for the whole treatment.

5. Is there any payment to be made by the beneficiary to the hospital for treatment under the Swasthya Sathi Scheme?

No, Swasthya Sathi Scheme holders enjoy absolute cashless and paymentless facilities. From consultation to operation, the entire medical charges are fully covered by the scheme. The patient does not have to spend a single rupee from their pocket, and they are treated by all the eligible residents.

6. Is Swasthya Sathi promoting cashless payment?

Yes, Swasthya Sathi Scheme offers 100% cashless transactions in all impanelled hospitals. The beneficiaries have no worries regarding bill payment because the process is paperless and hassle-free, and payment is directly between healthcare providers and the state government.