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 and 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. 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 and will be included in this scheme.
The scheme is completely funded by the state government and is completely cashless, paperless, and Smart Card based. The Swasthya Sathi Health scheme’s main objective is to help West Bengal residents get cashless treatments.
Let us understand a bit more about this scheme further in this article
1. Basic health cover for tertiary and secondary care up to Rs.5 lakh p.a. per family
2. Cashless, paperless, and smart card-based medical claim
3. Coverage of all pre-existing diseases
4. No cap on the family size and both spouse’s parents are included
5. A dependent physically challenged member is also covered
6. The state government bears the entire premium with no contribution from the beneficiary
7. Management of the scheme is on a paperless IT platform
8. Online empanelment and gradation of hospitals based on the infrastructure and services
9. Online pre-authorization with a turnaround time of 24 hours.
10. Real-time uploading of e-health records of the beneficiaries upon discharge
The following are the benefits of Swasthya Sathi
1. Coverage of up to Rs.5 lakh The Swasthya Sathi scheme provides basic health insurance for all families up to Rs.5 lakh for tertiary and secondary medical care. It is a cashless scheme, and the treatment cost of up to Rs.5 lakh per family is paid to the hospital from the smart card. The state government pays the premium on behalf of beneficiaries. Thus, there is no financial burden on the beneficiaries.
2. Scope of Coverage
The scheme covers all the pre-existing diseases of the beneficiaries. There is no cap on the family size. Coverage is available to parents, in-laws, and dependent physically challenged family members.
3. Treatment expenses
The Swasthya Sathi scheme covers both pre and post-treatment expenses. The expenses incurred on diagnostic tests, doctor’s consultations, and medicines incurred one day before the hospital admission are covered. Post-treatment expenses incurred on medicines are covered for up to five days for the treatment or surgery.
4. Transport allowance
Swasthya Sathi beneficiaries receive payment for transport up to Rs.200 per hospitalization and up to Rs.2000 in a policy year. However, when the treatment is done in a government hospital through the Swasthya Sathi Smart card, an additional transport allowance of Rs.400 to Rs.700 is provided to the beneficiary as a transport allowance.
The West Bengal Government decided to extend the benefits of the Swasthya Sathi scheme to all the state’s residents except those who are already insured under any other government-sponsored health insurance scheme. Also, residents who receive a medical allowance in their salaries are excluded from this scheme.
The eligible persons should download and fill the Form-B (Application for enrolment under Swasthya Sathi) and submit it to the nearest government hospital. They can also obtain Form-B from the nearest government hospital. Applicants can register for this scheme through agents at the nearby ward office, Gram Panchayat, or village medical centers.
After submission of the application form (Form-B), the beneficiary will get an SMS with an ID district code or serial number. The smart card is delivered within a week with a Unique Registration Number (URN). The smart card is issued in the name of the woman head of the family.
1. Legal domicile documents
2. Aadhaar card as proof of identity
3. When an Aadhaar card is not available, any photo ID card issued by the government
Every beneficiary receives a Swasthya Sathi Smart card upon enrolment. Every detail of the insured family members is captured in the smart card, including the photographs, biometrics, SECC ID, address, and mobile number. The insured family can enjoy the health services provided under this scheme in private and public hospitals. They need to deposit the smart card within 24 hours from hospitalization for cashless payments, or else they will have to bear the cost of hospitalization expenses.
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.
The scheme does not cover OPD consultation charges but if the OPD is converted into IPD, then it is payable under the scheme.
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