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The Swasthya Sathi Coverage was launched by the West Bengal Government on December 30, 2016, as a comprehensive health insurance plan for residents. It offers cashless, paperless, and Swasthya Sathi card benefits to ensure citizens receive quality medical treatment without financial stress. The scheme covers the entire family with an annual sum insured of up to Rs 5 lakh per family, targeting secondary and tertiary healthcare needs. The scheme is fully funded by the state government, providing much-needed financial relief to the beneficiaries. Whether for consultations, diagnostics, or treatment, the Swasthya Sathi Scheme stands out for its inclusiveness and wide coverage across various medical procedures.
The primary objective of the Swasthya Sathi Coverage is to offer cashless healthcare services to every resident of West Bengal, focusing on reducing the burden of medical expenses for families. With rising healthcare costs, the Swasthya Sathi Scheme aims to enhance accessibility to quality healthcare, particularly for secondary and tertiary care. By empanelling hospitals and extending healthcare infrastructure in semi-urban and rural areas, the scheme ensures that quality medical services are within reach for all. The initiative addresses the need for affordable healthcare by eliminating citizens' out-of-pocket expenses.
Swasthya Sathi brings a variety of features that make it a robust health insurance plan:
Hospitals are graded based on their services, and the empanelment committee approves them accordingly.
All treatments and medical procedures require pre-authorisation, which is processed within 24 hours.
Beneficiary health records are updated in real-time after hospital discharge, ensuring accurate data management.
The app provides easy access to information regarding hospitals, health packages, and e-health records.
Beneficiaries receive SMS notifications if their health card is blocked or if there are any updates.
A 24-x7 toll-free helpline (1800-345-5384) is available for assistance.
Claims are processed within 30 days, reducing financial stress on beneficiaries and hospitals.
The Swasthya Sathi Scheme offers comprehensive benefits that cater to the healthcare needs of the beneficiaries:
Coverage is provided for both secondary and tertiary care, ensuring extensive medical support.
The scheme covers all pre-existing conditions from day one, which is beneficial for those with ongoing health issues.
The scheme covers the entire family, including in-laws and dependent physically challenged members, without restricting family size.
The scheme covers expenses for doctor consultations, diagnostic tests, and medicines incurred one day before hospitalisation and up to five days post-treatment.
The West Bengal Government fully bears the premium, making the coverage completely free for beneficiaries.
The Swasthya Sathi Card eligibility is as follows:
1) You must be a permanent resident of West Bengal.
2) You should not be covered under any other government-sponsored health insurance scheme.
3) The health card is issued in the name of the eldest female member of the family.
4) The scheme covers all family members, including parents of both spouses, unmarried daughters (up to 21 years), and dependent physically challenged members.
To apply for the Swasthya Sathi Mediclaim Policy, you will require the following documents:
The process to apply for the Swasthya Sathi Scheme is simple:
1) Visit the official website of the Swasthya Sathi Scheme.
2) Click on the ‘Apply Online’ option and select ‘Form B for Registration.’
3) Fill in the required details and submit the form along with the necessary documents.
The Swasthya Sathi Prokolpo comes with a host of functionalities aimed at making healthcare accessible and affordable:
The scheme has empanelled more than 2,290 hospitals, providing beneficiaries access to a wide range of medical facilities across the state.
Beneficiary records are updated instantly, ensuring that all medical histories are accurately documented.
An online platform allows beneficiaries to lodge complaints and track resolutions, making the system transparent.
Treatments under the scheme are pre-authorised online within 24 hours, streamlining the process and avoiding delays.
The scheme generates monthly reports accessible to the public for review and suggestions, promoting accountability.
The scheme covers diagnostic and treatment costs across empanelled hospitals, ensuring that beneficiaries face no out-of-pocket expenses.
Patients are provided a transport allowance post-discharge, ensuring seamless transitions back home.
Hospitals can register under the Swasthya Sathi Scheme by following these steps:
1) Visit the official Swasthya Sathi portal.
2) Click on the ‘Apply Online’ option and select ‘Hospital Registration.’
3) Fill in the required details, such as hospital name, contact details, and category.
4) Attach the necessary documents and apply for review.
To check the registration status of a hospital under the Swasthya Sathi Scheme:
1) Visit the official Swasthya Sathi portal.
2) Click on the ‘Check Hospital Reg. Status’ option.
3) Enter your registered mobile number to view the status.
If you need treatment outside West Bengal under the Swasthya Sathi Scheme:
1) Go to the official portal.
2) Select the ‘Registration Outside of West Bengal’ option.
3) Enter your URN number and complete the registration by providing the necessary details and documents.
The Swasthya Sathi Health Card is issued in the name of the eldest female family member. This card contains all essential details, including family biometrics, photographs, and contact information. It is auto-renewed annually and has lifetime validity, allowing beneficiaries to receive cashless treatment across empanelled hospitals.
To view details about hospitals under the Swasthya Sathi Scheme:
1) Visit the official portal and select ‘Hospital Information.’
2) You can view relevant information by selecting from options such as Active Hospital List or Hospital HR Details and submitting the form.
To access the Swasthya Sathi portal:
1) Visit the official website and click on the ‘Login’ button.
2) Enter your username and password to log in.
To verify your URN under the Swasthya Sathi Scheme:
1) Visit the official portal and select ‘Card Verification.’
2) Enter your district and URN number to complete the verification.
To download the Swasthya Sathi App:
1) Visit Google Play Store and search for the Swasthya Sathi app.
2) Click on the app and download it for easy access to health-related services.
The Swasthya Sathi App provides multiple features:
For any assistance regarding the Swasthya Sathi Scheme, you can reach out to the toll-free number 1800-345-5384 or visit the official website for more details.
Yes, the Swasthya Sathi Scheme offers comprehensive healthcare coverage by including costs for both the Outpatient Department (OPD) and the Inpatient Department (IPD). Beneficiaries receive financial support for doctor consultations, diagnostic tests, pre-hospitalization, and post-hospitalisation expenses, ensuring complete medical care without financial strain.
No, under the Swasthya Sathi Scheme, treatment is entirely cashless for beneficiaries. From consultations to surgeries, all medical expenses are fully covered by the scheme. Patients don’t have to make any out-of-pocket payments, ensuring that healthcare remains accessible to all eligible residents.
When you download Swasthya Sathi Card, you can get up to Rs 5 lakh in coverage per family per year. This amount is applicable for both secondary and tertiary medical care, offering extensive financial protection against major medical expenses such as surgeries, specialised treatments, and prolonged hospitalisations..
Yes, the Swasthya Sathi Scheme supports 100% cashless payments across all empanelled hospitals. Beneficiaries do not need to worry about settling bills, as the entire process is paperless and hassle-free, with payments directly managed between the state government and healthcare providers.
Yes, beneficiaries can access a comprehensive list of hospitals through the Swasthya Sathi portal or mobile app. With over 2,290 empanelled hospitals in the network, both public and private facilities are available for treatment, ensuring accessibility to quality healthcare services.
Both public and private hospitals can qualify under the Swasthya Sathi Scheme if they meet the required empanelment criteria. The facilities are evaluated based on their service quality and infrastructure, ensuring that only capable and reliable hospitals are part of the scheme’s network.
Permanent residents of West Bengal who are not already covered under other government health schemes are eligible for the Swasthya Sathi Health Scheme. The scheme prioritises inclusivity, covering all family members, including dependent, physically challenged individuals, without any restrictions on family size.
Yes, the form for the Swasthya Sathi Scheme can be easily downloaded from the official website. This ensures that applicants have convenient access to all necessary documentation, allowing for a smooth registration process either online or through the designated enrollment centres.
No, beneficiaries under the Swasthya Sathi Scheme enjoy completely cashless treatment. All medical expenses, from diagnosis to recovery, are covered by the scheme, ensuring that financial barriers do not prevent residents from receiving the healthcare they need.
The Swasthya Sathi network includes more than 2,290 hospitals, both public and private, across West Bengal. These empanelled hospitals provide a wide range of treatments, ensuring beneficiaries can access necessary healthcare services without geographical limitations.
Yes, the Swasthya Sathi card is auto-renewed annually. Beneficiaries do not need to worry about reapplying, as the renewal process is automatic, guaranteeing continuous coverage for families year after year without any additional effort or paperwork.
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