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All you need to know about Swasthya Sathi Health Insurance Scheme
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West Bengal's Chief Minister introduced the Swasthya Sathi Scheme on December 30, 2016. No matter what age bracket they fall into, every family and every person is eligible to participate in this programme. This is a fundamental health plan that covers primary, secondary, and tertiary care costs up to Rs 5 lakh per family per year. The programme is entirely cashless, paperless, and Smart Card based with full state government funding. The Swasthya Sathi Scheme attempts to reduce the enormous medical costs that individuals bear by offering cashless treatment to West Bengal residents. With the Swasthya Sathi Scheme, the State Government is attempting to enhance the healthcare system in light of the skyrocketing costs of secondary and tertiary care. Speciality hospitals in rural and semi-urban areas, Fair price diagnostic centres, pharmacies, and critical care facilities within a 50 km radius are just a few of the initiatives that will guarantee high-quality care at reasonable prices.
Features of the Swasthya Sathi Scheme
The coverage features under the Swasthya Sathi Scheme are:
- Transparent Hospital Grading: The hospital is appointed by Swasthya Sathi once the grade has been approved by the Empanelment Committee.
- Mandatory Pre-Authorisation for Treatment: Within 24 hours, 100% of the beneficiaries' medical treatments and procedures are pre-authorised.
- Real-time Updates: Once a beneficiary is released from the hospital, their electronic health record is updated in real-time and uploaded.
- Digital Application: Assistance is given to the beneficiaries through the Android-based Swasthya Sathi mobile app.
- SMS Alerts: In the event that a beneficiary's health card is suspended, SMS alerts are sent to them.
- Toll-free Network: Beneficiaries can contact the toll-free call centre at 1800-345-5384, which is open twenty-four hours a day.
- Online Grievance Monitoring Mechanism: Through the Swastha Sathi online site, beneficiaries can express their problems.
- Quick Claim Payment: Claims for reimbursement to the hospital are processed within 30 days.
Benefits of the Swasthya Sathi Scheme
Below is a list of the advantages and benefits provided by the programme:
- Coverage Amount: For each family, basic health insurance provides coverage up to Rs 5 lakh for both tertiary and secondary medical services.
- Pre-existing Disease Coverage: The programme covers all of the recipients' pre-existing ailments.
- Family Coverage: The number of families is not capped. In-laws and any dependent physically challenged family members are eligible for coverage.
- Financial Cover: No financial strain is placed on the beneficiary because the State Government pays the premium.
- Cashless Hospitalisation: Swasthya Sathi Scheme pays for medical consultations, diagnostic tests, and medications purchased a day before admission to the hospital. For the same therapy or operation, post-treatment expenses for medications are covered for up to 5 days.
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What are the Eligibility Criteria for Swasthya Sathi Scheme?
The government of West Bengal has made the decision to make this Scheme's benefits available to all state residents, excluding those who are currently covered by another government-sponsored best health insurance plans. Additionally, persons who receive medical benefits as part of their wage are not eligible for coverage under the Scheme.
Swasthya Sathi Card Status
On the day of enrollment, an Online Swasthya Sathi card is given to each beneficiary family. All the information about the insured family members is recorded on this smart card, including the biometrics, pictures, mobile number, and SECC ID. The administration of the programme is totally paperless and computerised.
How to Apply for the Swasthya Sathi Scheme?
It is simple to apply for the Swasthya Sathi apply online programme. Simply follow the instructions below:
- Go to a credible insurance provider website like Niva Bupa.
- Select "Apply online."
- For new registration under the Swasthya Sathi Scheme, click on Form B.
- Add all necessary supporting documentation, then click "Submit."
How to Check the Status of a Hospital's Registration under the Swasthya Sathi Scheme?
Here is how you can check the status of the hospital's registration under the Swasthya Sathi Scheme:
- Go to the company's website.
- Select "Apply online."
- Check the status of your hospital registration
- The website https://helpline.swasthyasathi.gov.in/HospitalRegStatus.aspx will be opened for you
- Search by entering your mobile number
- After that, the status will be shown.
Swasthya Sathi Health Card
The purchase of a smart card is another component of the Swasthya Sathi Scheme. The citizens, who will benefit from the programme, will receive these cards. Each family in the state will receive one card as part of the campaign. Additionally, this card will be available for usage in the state's public and private hospitals. It will contain all of the information about the family, such as the number of family members, photos, phone numbers, biometric identities, addresses, and SECC IDs. Through the Swasthya Sathi website, which is the company's official one, the smart card can also be verified online.
- You need to click on the card verification link
- Your browser will take you to this address: https://helpline.swasthyasathi.gov.in/SearchURN.aspx.
- Enter the name of the district and the state
- Type in URN and press "Submit"
- After that, you will be able to see the information.
Swasthya Sathi App
You can get the Swasthya Sathi app download from the Google Playstore. The app contains the features listed below.
- Information about the hospital
- Healthcare services
- Verification of URN
- Information about the doctor and a video gallery
- Packages for Swasthya Sathi
- Hospitals, both publicly and privately appointed
- Added amenities
Frequently Asked Questions
Can the Swasthya Sathi Scheme pay both OPD and IPD costs?
Do recipients of the Swasthya Sathi programme have to pay the hospital anything in exchange for their care?
What is the Swasthya Sathi card's maximum amount?
Does Swasthya Sathi support cashless payments?
OPD consultation fees are not covered by the plan. However, if an OPD is changed to an IPD, then the plan will pay for those fees.
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