Swasthya Sathi

The Hon’ble Chief Minister of West Bengal launched the Swasthya Sathi scheme on 30 December 2016. Swasthya Sathi scheme is a group health insurance scheme for the citizens of West Bengal. It offers proper health facilities irrespective of the economic condition of a family. The Swasthya Sathi Health scheme’s main objective is to help the West Bengal residents get cashless treatments.

Features of Swasthya Sathi

• Basic health cover for tertiary and secondary care up to Rs.5 lakh p.a. per family
• Cashless, paperless and smart card-based medical claim
• Coverage of all pre-existing diseases
• No cap on the family size, and both spouse’s parents are included 
• A dependent physically challenged member is also covered
• The state government bears the entire premium with no contribution from the beneficiary
• Management of the scheme is on a paperless IT platform
• Online empanelment and gradation of hospitals based on the infrastructure and services
• Online pre-authorisation with a turnaround time of 24 hours.
• Real-time uploading of e-health records of the beneficiaries upon discharge
• Instant alerts and SMS triggers to the beneficiaries upon blocking of smart cards
• Claim reimbursement to the hospital with a turnaround time of 30 days, and interest is charged for delayed payment
• Toll-free call centre 24×7 with feedback option (18003455384)
• Online grievance monitoring mechanism
• Online alerts and triggers to detect probable frauds
• Android-based Swasthya Sathi mobile app to assist the beneficiaries

Scope of Swasthya Sathi

Each district of West Bengal state is covered under the Swasthya Sathi scheme. It covers around two crore families, including families of the Self Help Group (SHG) members, ASHA workers, ICDS workers and helpers, civil defence volunteers, civic volunteer force and certain categories of contractual employees. All Rashtriya Swasthya Bima Yojana (RSBY) beneficiaries and other beneficiaries based on SECC deprivation criteria are brought under this scheme.

Currently, there are around 142 lakh families eligible under the scheme. From 1 December 2020, the government widened the coverage to include all people in the state, irrespective of their caste, religious affiliation, creed or profession. There are more than 2290 hospitals empanelled, and above 34 lakhs people hospitalised under this scheme. 

Benefits of Swasthya Sathi

The following are the benefits provided under the Swasthya Sathi scheme:

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.

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.

Treatment expenses

The Swasthya Sathi scheme covers both pre and post-treatment expenses. The expenses incurred on diagnostic tests, doctor’s consultation, 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.  

Transport allowance

Swasthya Sathi beneficiaries receive payment for transport up to Rs.200 per hospitalisation 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.

Eligibility Criteria for Swasthya Sathi

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 under this scheme. 

Swasthya Sathi Application Process

The eligible persons should download and fill the Form-B (Application for enrollment 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, Grama Panchayat or village medical centres.

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.

Documents Required for Swasthya Sathi

• Legal domicile documents
• Aadhaar card as proof of identity
• When an Aadhaar card is not available, any photo ID card issued by the government

Swasthya Sathi Smart Card

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 hospitalisation for cashless payments, or else they will have to bear the cost of hospitalisation expense.

Swasthya Sathi App

Swasthya Sathi mobile app is available on the Google Play Store. Users can download the app on Android phones from the Google Play Store. The Swasthya Sathi mobile app involves the below features:

• Empanelled list of private and public hospitals
• Doctors information
• Hospital facility details
• Hospital services
• Swasthya Sathi packages
• URN verification
• Photo and video gallery
• Other information about the Swasthya Sathi scheme