On December 30, 2016, the Chief Minister of West Bengal introduced the Swasthya Sathi scheme. This scheme makes every family and individual, regardless of age, eligible to register under the program. This comprehensive health plan covers primary, secondary, and tertiary care expenses up to Rs. 5 lakh annually per family. The program, fully funded by the state government, operates on a cashless, paperless, and smart card-based system.
The Swasthya Sathi scheme aims to alleviate the substantial medical expenses borne by individuals, providing West Bengal residents with cashless treatment. Upon enrollment, each beneficiary family receives an Online Swasthya Sathi card, containing details of insured family members, such as biometrics, photos, mobile numbers, and SECC ID.
Swasthya Sathi Scheme: An overview
Given below are the key aspects of the West Bengal government introduced Swasthya Sathi scheme:
Official launch date |
December 30, 2016 |
Family size |
No capping |
Coverage |
Up to Rs. 5 lakh |
Payment mode for treatment |
Smart card based |
Pre-existing |
Covered |
Beneficiary assistance mode |
Swasthya Sathi mobile app |
Partner insurance companies |
National Insurance Company United India Insurance Company Bajaj Allianz Health Insurance |
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Vision and mission of Swasthya Sathi scheme
The vision of the Swasthya Sathi scheme is to gradually extend healthcare coverage to a larger section of society in West Bengal, aiming for universal health protection for every resident of the state. The mission is to reduce out-of-pocket healthcare expenses for residents, particularly for secondary and tertiary care, by providing cashless, paperless treatment. The scheme targets low-earning workers and volunteers across various state-administered projects, providing them with group health protection to prevent catastrophic expenditure due to hospitalisation.
Key features and benefits of Swasthya Sathi Health Insurance Scheme
Given below are the key features of the scheme:
Coverage:
Basic health cover for secondary and tertiary care up to Rs. 5 lakh per annum per family.
Capping on members:
There is no limit on the family size, and it includes parents from both spouses. Additionally, you can get coverage for all physically challenged dependants within the family.
Pre-existing diseases:
Coverage for all pre-existing diseases.
Premium payment:
The State Government covers the entire premium, and there is no contribution required from the beneficiary.
Network hospitals:
The beneficiaries can opt for services under the Swasthya Sathi scheme in more than 1500 empanelled hospitals. Details of these hospitals are available in the public domain.
Also, read: ABHA card download
Key functions of the Swasthya Sathi Health Insurance Scheme
The scheme offers multiple functionalities. Given below are the same:
Online platforms:
The scheme operates entirely without paperwork, utilising a seamless cloud-based IT platform. Online monitoring of the program not only conserves valuable time and resources but also ensures the swift delivery of services.
Transparent hospital gradation:
The hospitals are graded based on marks obtained on the facilities and services available. These are physically verified by the IC/TPA (insurance company/third-party administrator).
Pre-authorisation:
There is 100% online pre-authorisation with turn-around time of 24 hours.
Health records:
Immediate uploading of beneficiaries' E-health records upon discharge in real time.
Also, read: Types of insurance policies in India
Eligibility for Swasthya Sathi scheme
It is important to know Swasthya Sathi card eligibility before proceeding with the enrollment process. Given below is the eligibility criteria for the Swasthya Sathi scheme, ensuring access to healthcare benefits for residents meeting specific income and household criteria in West Bengal:
- You should be a permanent resident of West Bengal.
- There is no age restriction for the dependent member with a physical disability.
- Enrolment in another government health insurance scheme is not permissible.
How to apply for the Swasthya Sathi scheme?
To apply for a Swasthya Sathi card online, visit the official website, fill out the application form, and submit the required documents. You can follow the steps given below to apply for the scheme:
Step 1: Visit the official website swasthyasathi.gov.in
Step 2: Enter your mobile number and click on ‘Get OTP’. Verify the OTP and click on ‘Submit.’
Step 3: Select the district, panchayat, and municipality name from the list that appears on the screen.
Step 4: Fill in the other details like category, department name (for employed applicants), office name and address, residential address, and PIN code.
Step 5: Further, fill in the applicant’s name, and the name of the head of the family.
Step 6: Mention if any member of the applicant’s family is enrolled under any government or private scheme.
Step 7: After filling in all the information, click on ‘Submit’ to complete the application process.
Read more: Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme
Documents required to apply for the scheme
While filling in the application process, you must keep the following documents handy:
- Aadhar card number (12 digits)
- Khadyasathi ration card number
- Registered mobile number
- Employment status of the member
- Legal Domicile documents
Contact details for Swasthya Sathi scheme
In case of any query related to the scheme, issues with the claim process, or any other information, the beneficiaries can contact using the information given below:
- The back of the smart card displays a 24x7 toll-free call center number: 1800-3455-384 for assistance.
- Beneficiaries can also seek help through various social media platforms, including Facebook, Twitter, and WhatsApp.
- You can also download the Swasthya Sathi mobile app for assistance to the beneficiaries.
Registration process for Swasthya Sathi Hospitals
Given below are the steps that can be followed for Swasthya Sathi hospital registration:
- Step 1: Navigate to the official Swasthya Sathi Scheme online portal.
- Step 2: Locate the 'Apply Online' button on the top menu bar and choose 'Hospital Registration' from the dropdown menu.
- Step 3: Provide essential details like district name, hospital category, hospital name, address, and contact number.
- Step 4: Attach the required documents and finalize the Swasthya Sathi hospital registration by clicking 'Submit'.
Also, read: Beneficiary NHA
How to download the Swasthya Sathi App?
Given below are the steps to download the Swasthya Sathi App, enabling convenient access to healthcare services and information for beneficiaries of the Swasthya Sathi scheme in West Bengal. The Swasthya Sathi card download process is also online and beneficiaries can download it through the official website:
Step 1: Search for the Swasthya Sathi app on playstore.
Step 2: Click on the app with the official logo and download the app.
Importance of health insurance for all
In today’s unpredictable world, health concerns are rising, and having financial coverage for the same has become extremely important. Given below is the significance of a health insurance policy:
- Financial protection: Shields against exorbitant medical expenses.
- Access to quality healthcare: Ensures access to advanced medical treatments.
- Preventive care: Encourages regular health check-ups and early detection.
- Risk mitigation: Guards against unexpected health crises.
- Family security: Provides comprehensive coverage for the entire family.
- Critical illness support: Offers financial aid for critical illnesses.
- Community well-being: Aids in building healthier and more resilient communities.
- Promotes healthy lifestyle: Fosters a proactive approach to personal well-being.
Being enrolled in a government or private health insurance scheme can be of utmost help to any individual. Be it the Swasthya Sathi scheme, or any other scheme as per the individual’s requirement.
Also read: Family Health Insurance
