Swasthya Sathi is a Group Health Insurance scheme of the Government of West Bengal. The Scheme was launched in December 2016.
Scope of the scheme
All the districts of West Bengal are covered under the scheme.
50 Lakh families covering nearly 2.5 Crore population are being covered under the scheme. Families of the Self Help Group Members, ICDS Workers & Helpers, ASHA workers, Civic Volunteer Force, Civil defence Volunteers and certain categories of contractual employees included under the scheme until November 2020. All RSBY beneficiaries and other beneficiaries based on SECC deprivation criteria are also brought under the scheme. Total families eligible under the scheme at present are 142 lakhs.
From December 1, 2020 all people in the state, irrespective of their religious affiliation, caste and creed or profession will be covered under the scheme.
To know more about the scheme, call Toll free number - 1800-345-5384
Main Features of the Scheme
Basic health cover for secondary and tertiary care up to Rs 1.5 Lakh per annum through Insurance mode and Critical illness like Cancer, Neuro surgeries, cardiothoracic surgeries, liver diseases, blood disorders etc. up to Rs 5 Lakh through Assurance mode.
From 01.04.2018 Bajaj Allianz has been selected as Insurance Partner in 18 Districts and IFFCO TOKYO in 5 Districts
Paperless, Cashless, Smart Card based online Swathyasathi Smart card is provided to each family on the day of Enrolment. Smart Card captures the details of the family members, Photographs, biometric, address, Mobile Number, SECC ID, ADHAAR No ( if available). Management of the scheme is in paperless IT platform from day one.
There is no cap on the family size and Parents from both the Spouse are included. Unmarried daughter upto 21 Years and all dependent physically challenged persons in the family also covered.
All pre-existing diseases are covered.
The entire premium is borne by the State Government and no contribution from the beneficiary.
More than 500 Hospitals and Nursing Homes already registered under the scheme through online empanellement portal. Hospitals are graded according to the services available into three categories i.e. Grade-A , Grade-B and Grade-C hospitals. Online empanelment & gradation of Hospitals based on the services and infrastructure available.
100% online Pre-authorisation with turn around time of 24 Hrs.
SMS triggers and instant alerts to the beneficiaries on blocking of card.
Real-time uploading of E-health record of the beneficiaries on discharge.
Claim reimbursement to the hospital with TAT of 30 days else interest are being charged for delayed payment.
24X7 toll free Call Centre (18003455384) with feedback option
Online grievance monitoring Mechanism
Android based Swasthya Sathi Mobile app for assistance to the beneficiaries