Coverage Benefits of the Swasthya Sathi Scheme
This scheme benefits all those who cannot afford to pay for private health insurance - it also has several benefits for the members covered under the policy:
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Swasthya Sathi Health Card
The Swasthya Sathi Scheme is a healthcare program in West Bengal for all residents of the state, launched by West Bengal’s Chief Minister in 2016. It provides secondary and tertiary healthcare coverage of up to Rs 5 lacs per year per family, as long as they do not fall under any other government healthcare scheme. Based on a smart card format - the paperless Swasthya Sathi scheme bears the full cost of healthcare expenses for cardholders.
Scroll on to learn everything you need to know about this government insurance program.
Eligibility Criteria of the Swasthya Sathi Scheme
01
The applicant should be a permanent resident of the State of West Bengal
02
Applicant should not be registered for any other government insurance scheme
03
The Swasthya Sathi Card will be provided in the name of the eldest female member of the family unit
04
All valid and accurate details should be provided at the time of application and when making a claim
05
There is no cap on the family size that can be covered under this policy
06
Boy children within the family unit will be covered up to 18 years
07
Girl children (unmarried) will be covered up to 21 years
08
Physically challenged family members will have no age limit on coverage
09
Both spouse’s parents will be covered without any age limit
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Pre-existing conditions are covered from day 1 of the policy
Most insurance plans have a waiting period (usually 24 months) before the policy will cover pre-existing illnesses. Unlike other insurance plans, there is no waiting period in this scheme.
Paperless and cashless process
The scheme works based on the Swasthya Sathi Card, which is a smartcard facility that contains all the biometric and relevant details of the family members. This makes it a hassle-free process during the claims process.
No contribution from the beneficiary
As a beneficiary of the scheme, no family member is required to make any contribution to the policy - the government of West Bengal bears the entire cost of the premiums under the scheme.
Rs 1.5 lacs per year per family through insurance mode
In insurance mode, the government pays the premium to a registered insurer who will then cover a cost of Rs 1.5 lacs against your medical and hospitalisation bills.
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Benefits and Features of having the Swasthya Sathi App
An Activate Hospitals List
in this list you can view all nearby active hospitals including hospital type, grade, etc.
Complete doctor detail
you can view all information regarding the doctor you wish to consult
Facilities at the hospital
all amenities and facilities provided by the hospital are listed in the app
Services at the hospital
what all services the selected hospital offers is also listed in the Swasthya Sathi app
Documents Required for Swasthya Sathi Scheme
Steps to Log in to the Swasthya Sathi Portal
To ensure that you receive your Swasthya Sathi card, you need to submit all the documents required at the time of application - these documents are mainly required to prove your identity as well as your residency status.
1
Aadhaar Card
2
Identity Proof - Passport, Voter ID, Ration Card
3
Proof of permanent residence within the state of West Bengal
4
Below Poverty Line certificate (if any)
5
Candidates may also be required to submit income proof
5 Reasons You Should opt for Swasthya Sathi
• It’s available for all citizens of West Bengal
As long as you are a citizen of West Bengal and you are not already covered under any governmental insurance for healthcare schemes, you are eligible for the Swasthya Sathi scheme. Unlike other insurance plans, there are no other strict eligibility criteria that you need to meet to get the benefits of this scheme’s coverage for you and your family.
• No premium cost
The premium cost for this insurance plan is funded fully by the government, the beneficiaries (you and your family members) do not need to pay anything for this plan. Additionally, in assurance mode, the government pays medical bills up to Rs 5 lacs per family annually for which you do not need to pay any additional premium or charges.
• If you are the sole earner in your family
As the main breadwinner in your family, if you get into an accident or experience some sickness or disease, you will need financial help to pay for your healthcare needs. As the sole earner, you may not have sufficient savings or private insurance to cover all the medical needs of your entire family. This government scheme gives you peace of mind for potentially disastrous situations.
• Not limits on family size
Unlike typical insurance plans, there is no cap on family size. The applicant, their spouse, all male children 18 years or younger, all unmarried female children 21 years or younger and both spouses' parents can be covered under one account.
• No waiting period
As soon as your application is registered, and your family unit has been enrolled on the beneficiary list, you have coverage for all pre-existing diseases from day 1 of your policy. If you have a pre-existing illness, a private insurance plan will not cover the cost of your treatment until a fixed waiting period has been completed. This is one perk that Swasthya Sathi has over other insurance plans.
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Downsides of Swasthya Sathi Scheme
• There are very few downsides to availing of this scheme if you are an eligible candidate. One of the few drawbacks is the amount of coverage provided by the scheme. Although the government assures an amount of Rs 5 lacs per family every year - this amount may not be sufficient when you are covering your entire family.
• The parents of the spouses will typically be older, requiring more serious medical intervention. Additionally, if you have two children, 2 sets of parents and a spouse - that amounts to a minimum of 8 family members. Considering this, the maximum coverage amount of Rs 5 lacs might not be sufficient for everyone. Private insurance plans will offer you a range of coverage amounts depending on the premium amount you are willing to spend.
• Another potential downside is that Swasthya Sathi covers only 1 day for pre-hospitalisation and 5 days of post-hospitalisation. This may not be sufficient for everyone. In case your pre and post-hospitalisation go beyond this timeframe, you will need to bear the added expenses yourself. Most other types of insurance plans cover much longer pre and post-hospitalisation expenses.
• Lastly, if you are already covered by any government scheme then you cannot avail of this insurance plan. This may lead to an unfortunate situation where your current government scheme is not able to completely cover the costs of your medical expenses. In this case, you will need to go through the benefits and downsides of multiple government healthcare schemes and see which one suits your needs best before choosing one.
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Swasthya Sathi Login
Search Swasthya Sathi Scheme
Go to the Swasthya Sathi Scheme website
Click Login
Click on the ‘Login’ button on the home page.
Fill details
Enter your username and password to access the Swasthya Sathi portal.
Steps to apply online for Swasthya Sathi Card
Steps to verify your Swasthya Sathi card
1
Visit the official website of Swasthya Sathi
2
Select ‘Apply Online’
3
Download ‘Form-B’ for new registration under Swasthya Sathi.
4
Print the form and fill up all the details along with the documents
5
Submit that form to your municipality office
Steps for Swasthya Sathi Hospital registration
• Go to the official website of the Swasthya Sathi Scheme
• Click on Apply Online and then on New Hospital Empanelment
• Enter all the details and upload all the required documents
• Click the 'Submit' button’ to finish the Swasthya Sathi hospital registration process
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Steps to check the status of Swasthya Sathi Scheme Hospital registration
• Visit the Swasthya Sathi Scheme's official website
• Select the ‘Apply Online’ button and select ‘Check Hospital Empanelment Status
• Enter your registered mobile number and click 'Search' in order to find out the status of your hospital registration.
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Inclusions or Functionalities under the Swasthya Sathi Insurance Scheme
• Hospitalisation for medical or surgical procedures as well as maternity and new-born care are included with insurance coverage of Rs 1.5 lacs per family per year
• Any and all pre-existing conditions will be covered from the start of the policy, with the exception of the exclusions mentioned below in the next section
• A hospital transport allowance with a maximum of Rs 2000 per policy year is included in the policy. The amount for each transport allowance is Rs 200 or Rs 300 (depending on the grade of the hospital) and this amount will be paid to the beneficiary by the hospital at the time of discharge
• 1 day of pre-hospitalisation expenses and 5 days of post-hospitalisation expenses
• Screening and follow-up expenses will also be covered but under a separate charge (day-care expenses)
• Under maternity benefits, the new-born will be covered under the policy as a beneficiary and member of the family unit until the end of the policy year
• Over 2000 packages have already been decided and fixed by the empanelled experts to ensure that the cost of common surgeries and procedures remains fixed. These fixed packages cover many factors including registration, bed charges, nursing and boarding, surgeons and other medical specialists, drugs and medicines, prosthetics and implants, X-ray scans and other diagnostic tests and any other expense incurred during the hospitalisation period.
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• Elective or unnecessary treatments - Treatments, day-care procedures and other conditions that do not require hospitalisation and those that do not require medical treatment (such as elective procedures) will not be covered by this policy
• Hospital stays purely for the purposes of diagnosis and evaluation will not be covered by this plan
• Dental treatments that are not caused by injury/accidents and which do not require hospitalisation will not be considered for coverage, this includes corrective and cosmetic dental procedures
• Illnesses, diseases and medical conditions that are caused due to the use, abuse of or addiction to substances like alcohol and illegal drugs are not considered for coverage under this scheme
• Fertility treatments, hormone replacement therapy and sex change procedures are also not covered
• Other exclusions include injuries arising from self-harm, injuries caused due to war or nuclear invasion, and any kind of vaccination or inoculation
• Maternity benefits will only be eligible for coverage if the hospitalisation time after delivery is 48 hours or more
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Exclusions with Swasthya Sathi Insurance Scheme
Although pre-existing diseases, maternity expenses and surgical/medical hospitalisation expenses are covered by this policy, here are a few notable exclusions to keep in mind:
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Frequently Asked Questions
Yes, at the time of registration you will be provided with a list of hospitals that are available under this insurance scheme. This list is constantly being updated as well. You should visit the official Swasthya Sathi website or use the official app to find out the most up-to-date list of hospitals that are part of the network.
To begin the process of Swasthya Sathi Hospital Registration, you need to follow these steps:
- Go to the official Swasthya Sathi Scheme website
- On the homepage, click on apply online button.
-, click on hospital registration button
-Fill the form that appears with all required details like hospital category, treatment specialty, type of hospital, NABH accredited, district, state, etc.
- Submit the form
Now check the status of your registration by:
-Visit the official website
-Log in and click on apply online button
-Now check hospital registration status
-A new page opens. Enter the registered mobile number
-Click on search and status will be shown
No, there are many private and public hospitals within the Swasthya Sathi network, so you do not need to only use the services of government-run hospitals.
Empanelled hospitals are graded on the basis of the services and treatments they can provide, the infrastructure and the medical facilities available at the hospital. As a beneficiary, you are free to choose from any empanelled hospital to get your treatment, you can do this by viewing a hospital's details and grading through the mobile app.
No, once you have been registered there are no fees, charges or premium amounts that need to be paid by you or any member of your family. Even the cost of generating and processing the smart Swasthya Sathi Card is covered by the government. If you need to be hospitalised, simply provide your smart card to the hospital during admission. The medical expenses incurred up to Rs 5 lacs will be covered by your Swasthya Sathi coverage.
Usually, the patient's fingerprint will be required at the time of admission to the hospital, however, in cases of emergency or accidental injury, any family member who is on the beneficiary list can submit their fingerprint during admission. In case a patient dies during hospitalisation, the same rule applies.
Visit the official Swasthya Sathi website then look for the ‘Find Your Name’ option from the menu bar at the top. Enter the registered mobile number and select either ‘Yourself’ or ‘Others’ from the dropdown menu. Click on ‘Submit’ to see the results.
Any permanent resident of West Bengal who is not covered by any other government scheme can apply for the Swasthya Sathi scheme.
If you wish to cover medical expenses that you incurred outside the state, you will need to apply for a ‘Registration for treatment of West Bengal’ from the Swasthya Sathi website. Once you submit your registration, documents and other necessary details, the decision will be made regarding whether your expenses will be approved or not.
No, the Swasthya Sathi card is valid for your entire lifetime and does not require manual renewal since it auto-renews annually.
For URN verification under the Swasthya Sathi scheme, you need to follow the below steps:
On the Swasthya Sathi Scheme website,
-Click on URN verification
-On the URN verification page, select your state and district
-Now enter your URN
-Click on submit button
To download the Swasthya Sathi app,
-Search for the Swasthya Sathi app on Google Play Store on your mobile phone
-Click on the install button to download the app
The app will be downloaded on your phone.
Go to the official Swasthya Sathi card website and on the homepage, you can click on the ‘notice’ tab and go to the notice page. Here you will find all updates regarding the scheme.
The Swasthya Sathi app offers many useful features and these are very beneficial to the user. With this app you get:
1. An Activate Hospitals List – in this list you can view all nearby active hospitals including hospital type, grade, etc.
Complete doctor detail – you can view all information regarding the doctor you wish to consult
Facilities at the hospital – all amenities and facilities provided by the hospital are listed in the app
Services at the hospital – what all services the selected hospital offers is also listed in the Swasthya Sathi app
All the scheme – you can read about all the health schemes accepted at the hospital with Swasthya Sathi app
All packages information – regarding all packages offered by Swasthya Sathi scheme. As a user, you can select a specific group and check the data to see the details of the packages.
Hospital status – you can check if your hospital registration is successful or not on the app.
Admin team and set-up information – you can view all details regarding the admin departments here.
Information on TPA, SCSP – you can view details of your insurance company, TPAs by checking type of insurance.
On the official website of Swasthya Sathi scheme portal, you will find the tenders section on the homepage itself.
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