Swasthya Sathi Scheme is a health insurance scheme of the Government of West Bengal, which provides financial assistance for health protection and good treatment to the common people of the state.
Under the Swasthya Sathi Card, every citizen of the state is provided medical benefits of up to ₹5 lakh per family per year for secondary or tertiary health care and tertiary or tertiary care.
This scheme is fully funded by the state government which is completely cashless and smart card based. At present around 1.5 crore families have availed this Swasthya Sathi card.
Swasthya Sathi Project
The Swasthya Sathi project was first announced on 17th February 2016. A State Level Committee chaired by the Chief Secretary was constituted to implement and monitor the scheme and it was formally launched on 30th December 2016.
At the start of the project, ‘National Insurance Company’ was the insurance partner in 9 districts and ‘United India Insurance Company’ in 11 districts, later Bajaj Allianz was chosen as the partner in 18 districts and IFFCO Tokyo as the insurance partner in 5 districts.
Again from 2020 National Insurance Company has been selected as insurance partner in 6 districts, Oriental Insurance Company in 9 districts and United India Insurance Company has been selected as insurance partner in remaining 8 districts.
The Swasthya Sathi scheme has enabled the people of the state to facilitate access to quality healthcare with improved services, which is certainly an exemplary initiative for other states in the field of health.
Swasthya Sathi Project Details
A brief description of the West Bengal Swasthya Sathi Scheme is given below:
| Scheme Name | Swasthya Sathi Card |
| Entrepreneur | West Bengal Govt |
| Project budget | ₹2,510/- crore |
| Start Time | 2016 Year |
| Responsible Department | West Bengal Government Finance Department |
| The Beneficiary | All the families of West Bengal |
| Purpose | Quality healthcare |
| Age Limit | There is no age limit |
| Grant amount | ₹5 lakh per family per annum |
| Application Procedure | Online and offline |
| Official website | swasthyasathi.gov.in |
What are the benefits of the Swasthya Sathi card?
There are several notable benefits available on the Swasthya Sathi Card, listed below:
Coverage of ₹5 lakh per annum:
Under the Swasthya Sathi Card, coverage of ₹ 5 lakh per family is provided annually for secondary and tertiary or tertiary care.
Family Capping:
There is no capping on family size in this scheme. Parents of both husband and wife are covered under the Swasthya Sathi card and physically challenged members of the family are also covered under this card. The card is issued in the name of the eldest female member of the family as the head of the family.
Premium:
It is a health insurance and its premium is paid entirely by the state government i.e. the beneficiaries do not have to pay anything.
Pre-existing Disease Cover:
The salient feature of this health insurance is that it also provides coverage for all pre-existing diseases of the beneficiary.
Total cashless hospitalization:
Under this card, the cost of doctor’s consultation, diagnostic tests and medicines are covered from 1 day before the patient’s admission to the hospital. Coverage is also provided for the cost of medicines and diagnostic tests up to 5 days after the patient’s surgery and discharge from the hospital for the same illness. However, it should be noted that the coverage does not cover the cost of the patient’s meals during hospitalization.
Transport allowance after discharge:
A transport allowance of ₹200/- is included for hospital discharge under this card and in case the patient is discharged from a State Government Hospital, an additional transport allowance of ₹400/- to ₹700/- is given over and above ₹200/-.
Listed hospitals:
Beneficiaries can choose to get services from more than 1500 listed hospitals under the Swasthya Sathi scheme and more hospitals are joining the scheme every day.
Swachh Hospital Gradation:
Hospitals belonging to the Swasthya Saathi scheme are verified by insurance companies or third party administrators and graded based on the scores obtained on the facilities and services available. So the hospitals listed under Swasthya Sathi are each eligible for enhanced services.
Pre-authorized treatment:
All treatments under the Swasthya Sathi card are 100% pre-authorized within 24 hours TAT (turnaround time) so that the beneficiaries of this card do not face any difficulty in getting treatment quickly.
Quick claim settlement:
Claims from health care providers are monitored online and settled within 30 days otherwise contractual interest is payable so the beneficiary gets special benefits using this card.
Smart card based transactions:
Beneficiaries in Swasthya Sathi scheme receive services paperless, cashless and completely on 64Kb smart card. The information is stored digitally encrypted on this card and given to the beneficiary at the time of enrolment. This Swasthya Sathi smart card is valid for lifetime and is automatically renewed every year.
Mandatory E-Health Record:
In this scheme, the patient information is stored in the e-health record server so that the doctors can consult the information later as needed.
Cloud Based System:
By making the entire system of Swasthya Sathi Card paperless and based on cloud based IT platform, online monitoring has enabled saving valuable time and faster delivery of services.
Swasthya Sathi Package:
There are 2092 packages available on the Swasthya Sathi card. The rates of these packages are variable and are reasonably fixed by the package selection committee.
Application of Machine Intelligence:
There is a system based trigger mechanism under Swasthya Saathi Card to ensure that all hospital beds are not filled by the hospital or third party administrator or any insurance, high value packages are not all blocked, claims are made but not actually performed or unnecessary surgery is performed or ICU- Under this, the same package is blocked for many patients on certain days etc.
Swasthya Sathi Mobile App:
The Swasthya Sathi mobile app can be downloaded from the Google Play Store and has the facility to submit information, complaints etc. and also has a one-touch direct connection to the 24×7 helpline.
SMS facilities:
The beneficiary of the Swasthya Sathi Card is informed on the registered mobile number through SMS during hospitalization and after discharge from the hospital.
Toll Free Call Center:
A 24×7 toll free call center 1800-3455-384 is available for assistance to the beneficiaries mentioned on the back of the smart card. Besides, the beneficiaries can also contact for assistance through Facebook, Twitter and WhatsApp.
Online Complaint Monitoring Facility:
Swasthya Sathi beneficiaries can post their grievances on the online portal.
Interactive website:
There is an interactive website for Shyath Saathi beneficiaries where common people can check their eligibility, enrollment details etc. Apart from this, there is also a ‘How Can I Help You’ i.e. help desk system for common queries
Swasthya Sathi Card Eligibility
The following eligibility criteria must be met to avail the benefits of the Swasthya Sathi Card:
- Applicant must be resident of West Bengal.
- The female head of the household, her husband, mother, father, father-in-law, mother-in-law and dependent children are eligible for coverage under this Swasthya Sathi card.
- Physically challenged dependents of the family are also covered under the Swasthya Sathi card.
- Individuals who are already covered under a government sponsored health insurance scheme are not eligible for the Swasthya Sathi scheme.
- Employees who receive a medical allowance as part of their salary are excluded from the Swasthya Sathi card coverage as they are already receiving medical benefits through their employment.
Swashtha Sathi Card Apply Online
You can apply for the Swasthya Sathi card online. You can apply online from the portal in the following ways:
- First you need to visit Swasthyasathi official portal swasthyasathi.gov.in.
- Click on ‘Online Application for Swasthya Sathi Card’ under ‘Apply Online‘ from the top menu.
- Then enter your mobile number and click on ‘Get OTP’, and enter the OTP that will be sent to your mobile and click on ‘Submit’.
- Then you will reach the main application page ‘FORM-B’, this form you have to fill completely in which you have to mention your district name, block or municipality, category etc.
- If the applicant is working in any government department, it should be mentioned, followed by full address and pin code below.
- The name of the applicant in the health spouse card should be given in the name of the female head of the family. Below the name of the head of the family should be written the name of her father or husband.
- If the applicant or any member of his family is not in government service, then there is no need to mention anything in the space of ‘OFFICE NAME & ADDRESS’. Then it should be mentioned whether the applicant has any government health insurance and receives medical allowance from any government or private company.
- Then mention whether there are both men and women in the applicant’s family and mention the name of each family member, relationship with the applicant, age, gender, Aadhaar number etc. in the ‘Member List’ below. Once the form is filled completely, re-verify and click on the ‘Submit’ button only then the application process will be completed.
Swasthya Sathi card check
After applying for Swasthya Sathi Card, you can easily check the application status from the portal.
- You need to visit Swasthyasathi’s portal swasthyasathi.gov.in.
- Click on the second sub-menu ‘Check Your Online Application Status for Swasthya Sathi Card’ in the above ‘Apply Online‘ menu.
- Then you have to select the district and submit by writing ‘Family ID’ or ‘Adhaar No’, only then you can check the status of your Swasthya Sathi card.
Swasthya Sathi scheme related Queries (FAQs):
What coverage is available on the Swasthya Sathi card?
Swasthya Sathi Hol is a health insurance, where the family gets a coverage of Rs 5 lakh per year and all pre-existing diseases are included in this insurance coverage. Stage II and III diseases are treated under this insurance and the coverage includes doctor’s consultation, diagnostic tests, and medication costs incurred from one day before hospitalization, as well as post-treatment costs up to five days after the operation.
What kind of hospital benefits are available on the Swasthya Sathi card?
Both public and private hospitals are listed based on the eligibility criteria under the Swasthya Saathi scheme. Hospitals are graded according to the facilities and infrastructure available, i.e. Grade A, Grade B, Grade C and Grade R.
Beneficiaries can check the facilities available in the hospital through the mobile app or from the official portal and select the nearest hospital according to their convenience.
Are Out Patient Department (OPD) and In Patient Department (IPD) both eligible for treatment under Swasthya Sathi?
OPD is not covered under Swasthya Sathi, but if OPD is converted to IPD, all medical expenses will be covered under the scheme.
What documents does the Swasthya Sathi beneficiary need to take to the hospital?
The beneficiary of Swasthya Sathi card only needs to visit the hospital with the smart card and any identity card issued by the government and keep the registered mobile number for the facility.
Can Swasthya Sathi card be used in case of pregnancy?
Yes, free maternity facility is available in government hospitals and M paneled hospitals under Swasthya Sathi card. Apart from childbirth, many gynecological diseases are also covered under this Swasthya Sathi card.
Is the Swasthya Sathi card benefits available even if not admitted to the hospital?
If the beneficiary of the Swasthya Sathi card is not admitted to the hospital, then no benefit will be available.
