Swasthya Sathi Scheme

Swasthya Sathi Scheme

In West Bengal, getting healthcare can be hard because a huge portion of its population is economically backward. Many of them are not even aware of available healthcare services, and some live far from medical help in rural areas. In such scenarios, the Swasthya Sathi Scheme of West Bengal emerges as a true hope to improve health care status in the state.

The scheme is specifically designed to ensure that everyone can get the medical help they need when they are sick, whether they are rich or poor. It assures that people can get help with their medical expenses, including hospitalization and treatment costs.

In this post, we will learn more about the Swasthya Sathi Scheme. We’ll talk about what it does, why it’s important, and how it helps people in West Bengal.

A Brief Historical Background

The Swasthya Sathi Scheme was launched in West Bengal in 2016 by the state government to provide health insurance coverage to all residents. At first, it covered secondary and tertiary care expenses up to a certain limit.

Over time, the scheme expanded its coverage to include outpatient treatment and diagnostics. In 2021, the government announced the further continuation of the scheme, increasing the coverage amount and including additional benefits such as maternity assistance and outpatient drug coverage.

Eligibility Criteria For Swasthya Sathi Scheme (SSS)

Here are the following parameters that one must qualify to get the benefits of the scheme:

  • The Swasthya Sathi Scheme is for everyone living in West Bengal.
  • If someone already has health insurance from another government health scheme, they can’t get benefits from this one.
  • People who get a medical allowance from their salary can’t join this scheme to get extra coverage.

Main Features & Benefits Of SSS

Some of the key features and benefits of the Swasthya Sathi Scheme are as follows:

Basic Health Cover:

The scheme offers basic protection to your family when you need it the most. Imagine if someone in your family gets really sick or hurt badly.

With this scheme, the government helps pay for their treatment, up to Rs. 5 lakh every year. So, you don’t have to worry about money when you or someone in your family needs medical care.

Highly Inclusive Cover:

No one in your family is left out of the Swasthya Sathi Scheme. It doesn’t matter if your family is big or small; everyone can be a part of it.

This includes not just your parents, siblings, and children but also grandparents and any family members who need extra care because they are sick or have special needs.

Pre-Existing Illness Cover:

Even if someone in your family already has an illness before joining the scheme, they’re still covered. This means their existing sicknesses will still be taken care of under the scheme. So, nobody is left behind when it comes to getting the medical help they need.

Smart Card System:

The scheme has a system of smart cards, which are given to beneficiaries on the day of enrollment. Instead of carrying around piles of papers, you just need to show this special card when you visit the doctor or hospital, and they’ll have all the details they need to help you.

Facilitates Quicker Help:

When you’re sick or hurt, you need help fast. With the Swasthya Sathi Scheme, you don’t have to wait long. Everything happens quickly online, so you can get the medical assistance you need without any delays.

Strong Security:

To keep your information safe, the Swasthya Sathi Scheme has special security measures in place. If something seems wrong with your card, you’ll get a message right away. This helps prevent any tricks or scams, so you can trust that your healthcare is always in good hands.

Online Pre-Authorization & 24-Hr Turnaround:

Beneficiaries can request pre-authorization for medical treatment entirely online without needing to visit the hospital physically. The process aims to approve or deny treatment requests within 24 hours, ensuring quick access to necessary medical care.

24/7 User Support:

No matter what time it is, there’s always someone ready to help you with the SSS. You can call them for free or use a special app if you have any questions or problems. It’s like having a helper by your side whenever you need them.

Timely Reimbursement & 30-Day TAT:

This benefit ensures timely reimbursement for hospitals that have provided treatment to beneficiaries under the Swasthya Sathi scheme. If the reimbursement is not processed within 30 days, the hospital may incur interest charges for the delay. This facilitates prompt payment processing and helps maintain positive relationships between hospitals and the scheme.

Real-Time E-Health Record Upload:

After a beneficiary receives treatment and is discharged from the hospital, their electronic health record (EHR) is uploaded in real-time. This ensures that accurate and up-to-date medical information is available for future reference, making it easier for healthcare providers to coordinate care and track the patient’s health history.

Swasthya Sathi Mobile App Support:

The Swasthya Sathi Mobile App helps beneficiaries by giving them easy access to scheme information, network hospitals, pre-authorization requests, and health records tracking. It makes managing healthcare needs more convenient and accessible through smartphones.

How To Apply For A Swasthya Sathi Scheme Online?

If you wish to apply for the scheme, you need to follow the below-mentioned steps:

  1. Visit the official website of Swasthya Sathi.
  1. On the top banner, hover your mouse on “Apply Online” and then click “Online Application for Swasthya Sathi Card”.
  1. Enter your mobile number in the designated field and click the “Get OTP” button.
  1. Input the OTP you receive into the appropriate field and proceed with the submission.
  1. Form B will be displayed on the screen. Fill up the following information correctly:
    • Choose your ‘District’ from the provided options.
    • For those in Panchayat Areas, select your Block, Panchayat, and Village from the dropdown menu.
    • If you reside in a Municipality Area, first choose your Municipality Name followed by your Ward Number.
    • Choose your category: SC/ST/OBC/Others.
    • If employed, specify your Department Name.
    • If applicable, provide the Office Name & Address.
    • Enter your Residential Address, including the PIN Code.
    • Provide the Name of the Applicant.
    • Fill in the Head of the Family (HoF) Name.
    • If any family member receives Govt. Sponsored Health Insurance/Assurance, select the appropriate option: YES/NO.
    • Indicate if any family member receives Medical Allowance from the Government: YES/NO.
    • Specify if any family member receives Medical Allowance from a Private Institution: YES/NO.
  1. After filling in all the important information, press the “Submit” button.

How To Check Swasthya Sathi Card Status Online?

To check the status of your SSS card online, adhere to the following steps:

  1. Visit the official website of Swasthya Sathi.
  1. On the top banner, hover your mouse on “Apply Online” and then click “Check Your Online Application Status for Swasthya Sathi Card”.
  1. Select your district and criteria and then press “Submit”.
  1. Now enter your correct Aadhaar or Khadya Sathi card number and you can now check the status of your card online.

Frequently Asked Questions

Listed below are the frequently asked questions related to Swasthya Sathi Scheme.

You can find a list of hospitals, both public and private when you enroll. Check the hospital booklet for details. You can also call the helpline number provided with your smart card.

Additionally, you can use its mobile app and search for the ‘active hospital’ tab to find network hospitals. You can also search on the official website at https://swasthyasathi.gov.in.

No, SWASTHYA SATHI is a cashless scheme. The treatment cost, up to Rs 5,00,000 per annum per family, will be paid directly to the hospital from the smart card. Beneficiaries do not need to make any payment for treatment under this scheme.

No, the cost of medicines is included in the package for all treatments under SWASTHYA SATHI.

OPD consultation is not covered, but if OPD is converted to IPD, all treatment costs will be covered under the scheme.

It’s the hospital’s responsibility to arrange all necessary medicines and tests. If the patient buys them elsewhere, they can claim reimbursement by providing the cash memo/receipt.

Regardless of the mode of transportation, payment for transport is limited to Rs. 200/- per hospitalization, and Rs. 2000/- per policy year for ‘Private Hospitals’.

You only need to take the smart card and any other government-issued identification. Provide the correct mobile number for better service.

The smart card is essential for service. In exceptional cases, the hospital may allow treatment after verification, but you must present the smart card within 24 hours.

Inform the DKM/SNA immediately through the toll-free number provided in the brochure or raise a grievance through the SSS’s mobile app.

The hospital will seek consent from the insurance company/SNA by raising a pre-authorization request within 24 hours. It depends on the type of disease.

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