Swasthya Sathi Scheme by West Bengal Government

Swasthya Sathi is a health insurance plan established by the Chief Minister of Bengal in 2016. The primary intention of the scheme is to cover various working groups and their families under this scheme. ICDS workers, ASHA workers, etc. and their families will get financial aid for healthcare up to INR 5 lakhs per year/family. From 2020, the government planned to include all the families of West Bengal under this plan, irrespective of their profession, caste, or religion. 

Objectives of the Swasthya Sathi Scheme:

The scheme has already covered 50 lakh families out of 142 lakh families. A total of 2.5 crore people have been brought under the scheme. Now, providing quality healthcare will no longer be a matter of hefty pocket expenses. Tertiary and secondary workers and their families can now quickly get yearly coverage. 

Features and Benefits of the Swasthya Sathi Scheme:

Swasthya Sathi Scheme provides a number of features and benefits to insured family members. Have a quick glance at the various features it offers-

1. Smart Card Based
   The scheme introduced by the government of West Bengal is absolutely paperless and cashless. Apart from this, the working of the Swasthya Sathi Card is further added for the ease of the insured people. A smart card is allocated to each insured family. This card has all the details of all the family members certified. 
   
   
2. Complete Family Coverage
   Swasthya Sathi is a much more advanced scheme that tends to include the complete family of the insured. Hence, parents of both spouses can also be insured, including physically challenged family members.
    
   
3. Zero Premium
   The best part about the Swasthya Sathi Scheme is the insured members do not have to pay any premium. The premium is charged, but the government of West Bengal is liable to pay all the premiums, not the insured people. 
   
   
4. Working Class Covered
   Tertiary and secondary workers and their families are insured under this plan with INR 5 lakh healthcare benefits per year. By 2020, the government even removed this cap to include people from all walks of life. 
   
   
5. Pre-Existing Diseases
   Unlike traditional healthcare schemes and insurance plans, the Swasthya Sathi scheme also includes pre-existing diseases. So, no matter what disease you or your family are suffering from, it will be covered under the plan. 
   
   
6. INR 5 Lakh Coverage
   One of the basic features and coverage of the Swasthya Sathi is the financial aid it provides. Up to INR 5 lakh can be used by a family in a year to get the medical treatment done at empanelled hospitals. 
   
   
7. No Limit on Family Size
   There is no limit on the family size of an insured worker. There can be any number of family members included. So, bring your spouse, children, parents from both sides, and the dependants under this one-roof of healthcare scheme. 
   
   
8. Zero Contribution
   The insured people or their family has to make no contributions. This scheme is fully financed by the government of West Bengal, and even the premiums are paid by the government. Hence, people need not make any payment. 
   
   
9. Mobile Application
   One of the easiest ways of using the features of the Swasthya Sathi Scheme is its mobile application. It can be downloaded from the Play Store, and one can easily raise a query or grievance. 
   
   
10. 24*7 Toll-Free Calling
    The government of West Bengal has also provided the facility of a 24*7 toll-free helpline number. Here, insured people can get connected to get their queries solved. It can also be accessed using the mobile application. 
    
    
11. Transport Post-Discharge
    The patient is also extended to the transportation facility upon discharge from the hospital. INR 200 is given to the patient’s family. If the patient is hospitalised in a government hospital, the actual transportation cost is provided even if it exceeds INR 200. It can go up to INR 700.
    
    
12. Empanelled Hospitals
    The West Bengal government has brought a number of hospitals under this Swasthya Sathi, known as the Empanelled Hospitals. People can get their treatment done in one of these hospitals using the Swasthya Sathi card. Day by day, more and more hospitals are coming under the scheme. 
    
    
13. 30 Days Claim Settlement
    The claim settlement process is quick when it comes to the Swasthya Sathi. Within 30 days, the claims are settled. If exceeded, the government pays the agreed interest as per the agreement. 
    
    
14. E-Health Records
    Whenever a patient gets treatment through the Swasthya Sathi Card, the E-Health record is uploaded to the server. The information on the e-health records can be viewed by physicians or patients anytime they want by logging in to the profile. 
    
    
15. Online Grievance Monitoring
    The stakeholders are provided with the facility of posting grievances. To make the process easier, the government allows the stakeholders to post their queries on the online web portal of the Swasthya Sathi Scheme. 
    
    
16. May I Help You
    On the web portal of the Swasthya Sathi, there is an option of ‘May I Help You’. In this section, a person can know about general queries like eligibility, details of enrollment, etc. 

Eligibility criteria of the Swasthya Sathi Scheme:

Read the following points to find out whether you meet the eligibility criteria of West Bengal’s Swasthya Sathi Scheme or not:

• The eligible family comprises the following beneficiaries:
  • Beneficiary, spouse, parents of both spouses, sons (maximum 18 years old), and unmarried daughters (maximum 21 years old)
• No upper or lower age limit for the physically disabled members of the family
• The family’s eldest member gets the Swasthya Sathi Scheme’s health card in his/ her name. 

But those residents of West Bengal who are already insured under any other state government’s health insurance scheme are excluded from taking advantage of the Swasthya Sathi Scheme. Furthermore, those who are getting medical allowance from the state government in their salary can’t apply for the scheme. 

What is the Swasthya Sathi Health Card?

You will be given a Swasthya Sathi smart health card on the day of enrollment. The card is issued in the name of the family’s eldest member. No paperwork is required for getting health services.

In the Swasthya Sathi smart card, all the details related to the beneficiary’s families, biometrics, photographs, mobile number, and SECC ID. The health insurance premium is also covered by the State Government of West Bengal, and hence, the expenses related to hospitalisation and other medical treatments are not borne by the beneficiaries. The card is renewed every year and is also valid for a lifetime. 

How to apply for the Swasthya Sathi Scheme?

You can get the advantage of the monetary benefits given under the Swasthya Sathi Scheme by applying in the following way:

• Step 1: Firstly, visit the official website of the Swasthya Sathi Scheme
• Step 2: On the home page, you will see the top menu bar. Select ‘Apply Online
• Step 3: A drop-down menu will appear when you tap ‘Apply Online
• Step 4: Select Form B for new registration under Swasthya Sathi
• Step 5: Download the form and take out its printout to fill in the details
• Step 6: Submit the registration form ‘Swasthya Sathi Scheme’ at Duare Sarkar Camp and the mandatory documents. 

How to check Swasthya Sathi hospital registration status?

If you want to check Swasthya Sathi hospital registration status, then follow the following procedure:

• Step 1: Go to the official website of the Swasthya Sathi Scheme. 
• Step 2: On the top menu bar, select the option ‘Apply Onlne’
• Step 3: A drop-down menu will appear. Select the option ‘check hospital registration status.’
• Step 4: You will be directed to a different page where you will be asked to enter your registered mobile number to check the status of the hospital
• Step 5: Enter the registered mobile number and search for the hospital registration status. 

How to log in to the Swasthya Sathi portal?

If you are a beneficiary of the Swasthya Sathi Scheme, you should learn the following steps that are required to log in to the Swasthya Sathi portal: 

• Step 1: Go to the website of the Swasthya Sathi Scheme or click https://swasthyasathi.gov.in/.
• Step 2: On the top right corner of the homepage, there is given an option of Login. Click on it
• Step 3: Enter your username and password to log in to the Swasthya Sathi portal. 

How to download the Swasthya Sathi application form?

If you want to download the Swasthya Sathi application form, then you should follow the following procedure:

• Step 1: Visit the Swasthya Sathi Scheme website
• Step 2: On the top menu bar, tap on the ‘Apply Online’
• Step 3: Tap on Form B for new registration under Swasthya Sathi.
• Step 4: Tap on it to view the online application form.
• Step 5: Download that application form in pdf format. 

Managing medical expenses in today’s times is not an easy task. West Bengal’s government-sponsored Swasthya Samiti scheme is considered a beneficiary scheme for the state’s residents. It greatly relieves the beneficiaries by settling their medical claims within 24 hours. Hence, the West Bengal beneficiaries can take care of their health without thinking about the medical expenses of hospitalisation, surgery, diagnostic reports, medical consultation, and medications. 

DISCLAIMER

This article is issued in the general public interest and is for educational purposes only. The blogs should not be used as a substitute for competent expert advice from a licensed professional to best suit your needs. Insurance is a subject matter of solicitation. For more details on policy terms, conditions, exclusions, and limitations, please refer/read the policy brochure before concluding a sale.