Swasthya Sathi Scheme: West Bengal government introduced a new health coverage scheme called “Swasthya Sathi Scheme” to provide health insurance facilities to protect its citizens from heavy expenditure in case of hospitalization. This scheme was launched with an objective to provide free secondary and tertiary health care treatment to the citizens from the various empaneled hospitals. The complete package of treatment up to a ceiling of 5lakh per family for a year will be borne by the state government.
Considering the situation when citizens are not able to bear the catastrophic expenditure of hospital treatment, government decided to launch a health cover scheme for all and as a result Swasthya Sathi scheme was implemented in the state.
Update: Bengal Government has now decided to extend the health care support under this scheme to all the citizens of the state except those who are already getting benefit under any other state or central government scheme. Apart from this, families which are getting medical allowance included in their salary from Employer (Govt.) are also exempted from this scheme.
Swasthya Sathi Scheme 2021
Swasthya Sathi Scheme is a flagship scheme of West Bengal which was launched on 30th December 2016 by the Chief Minister of the state Mamata Banerjee. It was implemented by Department of Health and Family Welfare, Govt. of India. This scheme provides health insurance and assurance cover to all the eligible citizens of the state. A Smart Card/ Health card issued to each beneficiary once their application is approved. They can use the card in case of any health emergency at any of the empanelled hospital under this scheme.
In this article, you will get every information aboutSwasthya Sathi Scheme. To get information about eligibility, features, benefits, application process, login, name search and other details of this scheme, just go through this article once.
Swasthya Sathi Scheme 2021: An Overview
|Name of the scheme||Swasthya Sathi Scheme|
|Category||West Bengal Govt Scheme|
|Scheme Type||State funded health scheme|
|Official Launch Date||30th December 2016|
|Launched by||CM Mamata Banerjee|
|Implemented by||Department of Health and Family Welfare, Govt. of India|
|Insurance cover upto||5 lakh per annum per family|
|Beneficiary||All resident of West Bengal|
|Instrument issued||Smart Card|
|Validity of smart card||Lifetime|
|Mode of Application||Online/ Offline|
|Application form||Form B|
Salient Features of the Scheme
In this section you can check some of the key features of the scheme and can get an insight about it. Have a look-
- Swasthya Sathi is a health cover scheme launched in December 2016.
- Under this scheme a basic health coverage of for a year upto Rs.5 lakh per family is provided for secondary and tertiary care.
- Under this, a cover upto Rs.1.5 lakh is provided through Insurance mode and cover beyond 1.5 to 5 lakhs is provided through Assurance mode.
- Implementation under assurance mode was done in March 2018.
- Services under this scheme are extended through various companies in Insurance and Assurance mode.
- Beneficiary do not have to contribute in the treatment as entire amount under this scheme is borne by the Government of West Bengal.
- The services delivered under this scheme are cashless, paperless and are based on Smart card. It means the complete amount of health cover is borne by the state government.
- The scheme covers all the pre-existing diseases of the patient.
- Citizens do not have to pay anything from their pocket.
- There is no upper cap on the size of the family enrolled under this scheme. Parents of both the spouse (husband and wife) are covered under this scheme.
- All the physically challenged dependent persons of a family are also covered.
- Beneficiaries enrolled under the scheme are provided with a smart card which capture details such as details of family members, biometric, mobile no., photograph, address, SECC Id etc.
- The gradation and empanelment of hospitals is done online and depends of availability of infrastructure and services.
- From the inception of the scheme, it is managed through an online platform.
- Beneficiaries are provided complete pre-authorisation in online mode with worktime of 24 hours.
- In case cards are blocked, Beneficiaries are sent instant alerts and SMSs.
- Claim for reimbursement to hospital should be done with Turnaround time of 30 days. Beyond the stipulated time of 30 days, charges will be imposed for delayed payment.
- On discharge, real time uploading of beneficiary health data/record will be done.
- An android based mobile application if also available for better accessibility to the beneficiaries.
- Availability of 24*7 toll free call center for support with an option of feedback.
- Proper mechanism for monitoring grievance mechanism
- Beneficiaries are provided online alerts with escalation matric in case a fraud is detected.
Key Functions of Swasthya Sathi Scheme
You can also have a look at the key functionalities of this flagship health care scheme of West Bengal shared below-
- Covers all Pre-Existing Diseases: Scheme covers all pre-existing diseases and all the conditions from the first day.
- Zero Beneficiary Contribution: Entire cost of insurance premium and card cost is borne by the Government. Smart cards are mainly issued in the name of the eldest female member of the family as Family head.
- No restrictions on Family Size: No cap on size of the beneficiary family. Parents of both husband and wife are also included. All the family members are covered irrespective of age, gender and other factors.
- Smart Card based transactions: All the services are made available to the beneficiaries through a Smart card. This makes the process cashless and paperless. These smart cards are issued to beneficiaries at the time of enrolment which include digitally encrypted details printed on it. The validity of each smart card is for lifetime and is auto-renewed on yearly basis.
- Mandatory Pre-Authorization for Treatment: Each and every treatment or procedure of the beneficiaries under this scheme is completely pre-authorised within a turnaround time (TAT) of 24 hours.
- IT Platform: Entire Swasthya Sathi scheme system is paperless and works on cloud-based Digital Platform. It provides timely and speedy delivery of services to the users and saves resources.
- Transparent Gradation of Hospitals: The grading of hospitals is done on the basis of marks obtained in services and facilities available there. These services/ facilities are checked and verified by the designated Insurance Company Or Third party Administrator (IC/TPA). An empanelment committee is formed to prove the grade and on the basis of transparent gradation hospital is empanelled under this scheme.
- Reasonable Package Rates: There are total 2092 packages available under this scheme. The rates of packages are dynamic and are rationalised as per requirement by the Package Selection Committee.
- Fully Cashless Hospitalization: All the expenditure incurred in consultation, diagnosis, medicines up to one day before patient’s admission into the hospital and the cost incurred in test, medicines upto 5 days after discharging the patient from hospital will be covered under this scheme. Cost of food during hospitalization will not be included.
- Post Discharge Transport Allowance- Patient admitted under this scheme are provided a transport allowance of Rs.200 at the time of discharge from hospital. If it is a hospital under state govt., then an additional amount can also be provided.
- Big network of Empanelled Hospitals: There are more than 1500 hospitals in the state empaneled under this scheme from where Swasthya Sarthi services can be availed.
- SMS Alerts: Beneficiaries get SMS triggers at the time of hospitalization and discharge.
- 24*7 Support & Assistance: Each outreach for all the beneficiaries through call centers which provide assistance 24*7. Apart from this, beneficiaries can reach using various social media platforms.
- Mobile Application: Android application makes it more convenient for beneficiaries to avail services under this scheme. They can download mobile application from google play store.
- E-Health Record on Portal: The physicians upload e-health records of the beneficiaries on real-time basis using their login on the portal.
- Claim Settlement: Mandatory claims under this scheme are settled within a Turnaround time of within 30 days. After this interest will not be paid as per the policy.
- Analytical Report: Analytical report of each month is provided in public domain through the online portal for getting suggestion from all the people associated.
- Grievance Mechanism: There is an online mechanism for monitoring grievances of beneficiaries. It means, beneficiaries and other stakeholders can post their grievances on online portal of Swasthya Sathi.
Although the scheme is for all the citizens of the state but still there are some of the basic criteria which every beneficiary should fulfill. The basic eligibility requirements include-
- Applicants should be a resident of West Bengal.
- Applicant should be enrolled and availing benefit from any other health scheme of state or Central Government.
- The smart cards under this scheme are preferably issued in the name of the eldest female member of the family considered as head of the family.
How to Apply for Swasthya Sathi Scheme?
Follow the application process explained below in various steps-
- Visit the official portal of the scheme.
- Click on “Apply Online” menu given on the menu bar.
- Select Form B option from the drop-down menu.
- Application form will open.
- Download the application form and print it.
- Fill details in the application form correctly.
- Submit the application form to the concerned authority.
- Take the receipt of registration and keep it safe.
Information to be filled in Application Form
Swasthay Sathi scheme is just like the Ayushman Bharat scheme of Central Government. Every WB citizen who wishes to apply for this group health insurance scheme and for issue of Swathya Sathi Smart Card is required to submit an application form. They have to fill each and every entry correctly in the application form. Check the important details mentioned below to be filled in the application forms-
- Application No. (Camp Name, Serial No., Date)
- Name of the Applicant (Female head of the family)
- Father’s Name
- District, Block, Panchayat, Village, Residential Address
- Cast Details
- Name of all the members of the family
- Their Gender, Age, Relation
- Mobile No.
- Khadyasathi Id
- Aadhaar No.
- Signature of the Beneficiary
How to find Your Name?
Citizens those who have applied for this scheme, can find their name online through the portal by following the simple steps-
- Go to the portal first.
- Click on “Find Your Name” tab
- Enter mobile no. and Select respective for whom you want to find name.
- Click on Submit and check details.
Swasthya Sathi URN Verification
Those who register under this scheme are provided a URN which they have to keep safe for references. For URN online verification, have a look at the simple steps shared below-
- Open official website and click on “URN Verification” tab given on the menu bar.
- Select State, District and enter URN number.
- Click on Submit button to verify URN.
Swasthya Sathi Hospital Registration
Using Swasthya Sathi online portal, hospitals can also register for this scheme. They can follow the simple steps given below-
- Open Swasthya Sathi portal.
- On the homepage, click on Apply Online menu.
- A drop-down menu will open.
- Select Hospital Registration Link from the list.
- Online registration form will open.
- Fill all the fields in the application form with utmost care.
- Verify the details and click on “Submit” button.
- On successful submission of registration form a message will be delivered to the registered mobile no.
After registration, applicants can also track registration status by clicking on Hospital registration status link. They can registration status by entering registered mobile no.
Services Available on Swasthya Sathi Portal
Swasthya Sathi Online Portal provides a large number of services related to the scheme to all its stockholders which include beneficiaries, scheme administration, empanelled hospitals etc. The list of services which can be rendered through online portal are mentioned below-
- Details about the scheme
- Hospital Information (includes Active hospital list, HR details, facility detail, service details)
- Online Application service
- URN Verification
- Name search
- Covid-Request form
- Latest News
- Transaction Dashboard
- Mobile App download link
- Various other information
Swasthya Sathi Mobile App
- As it is mentioned above that, along with online portal, Swasthya Sathi services can be accessed through online portal, we have discussed a little about it in this section. Check the important features available on mobile app listed below-
- Details of Hospital Facility
- Swasthya Sathi Packages
- Information of Doctors
- Delated of private and public empanelled hospitals
- URN verification
- Hospital Facility
- Photo Gallery
- Video Gallery
- Various other information about the scheme
How to download Swasthya Sathi App?
To access scheme through app, users have to download the application on their smart phones. Check the complete process below-
- Visit the official portal first or simply visit the link given below.
- Scroll Down the homepage.
- Click on the Application link or scan QR code given on the right side at the bottom of the page
- Google Play store page will open.
- Click on the install tab.
- Open the app and login to access its feature.
|Official Portal||Click Here|
|Swasthya Sathi Application Form||Click Here|
|Portal Login||Click Here|
|Hospital Registration||Click Here|
|Find Your Name||Click Here|
|URN Verification||Click Here|
|Mobile App||Click Here|
|West Bengal Kanyashree Scheme||Click Here|
In case any assistance related to Swasthya Sathi scheme, you can contact at the helpline no. shared below-
Help Line No.- 18003455384 (Toll Free)
The aim of the scheme is to provide health benefit to all the citizens of the state.
It means that beneficiary do not have to pay any amount of insurance to the hospital. All the expenditure involved will be incurred by the government.
Registration process is completed within 7 to 10 days.
Application process for this scheme is completely free of cost.
Ration card are made available to each beneficiary on the date and time mentioned on the registration receipt provided at the time of registration.
These smart cards are auto-renewed annually. You do not have to go anywhere to renew them.