West Bengal Swasthyasathi Health Insurance Scheme
This topic provides information about West Bengal State's free Health Insurance scheme named "Swasthysathi".
Swasthya Sathi is a Group Health Insurance scheme of the Government of West Bengal. The Scheme was launched during December 2016.
Scope of the scheme
All the district of West Bengal is covered up under the scheme and 45 Lakhs of families covering nearly 2.5 Crore population will be benefitted out of the scheme. Families of the Self Help Group Members, ICDS Workers &Helpers, ASHA Karmee, Civic Volunteer Force, Civil defence Volunteers and certain categories of contractual employees included under the scheme at present.
Main Features of the Scheme
- Basic health cover for secondary and tertiary care up to Rs 1.5 Lakh per annum through Insurance mode and Critical illness like Cancer, Neuro surgeries, cardiothoracic surgeries, liver diseases, blood disorders etc. up to Rs 5 Lakh through Assurance mode.
- From 01.04.2018 Bajaj Allianz has been selected as Insurance Partner in 18 Districts and IFFCO TOKYO in 5 Districts
- Paperless, Cashless, Smart Card based. Online Swathyasathi Smart card is provided to each family on the day of Enrolment. Smart Card captures the details of the family members, Photographs, biometric, address, Mobile Number, SECC ID, ADHAAR No ( if available). Management of the scheme is in paperless IT platform from day one.
- There is no cap on the family size and Parents from both the Spouse are included. Unmarried daughter upto 21 Years and all dependent physically challenged persons in the family also covered.
- All pre-existing diseases are covered.
- The entire premium is borne by the State Government and no contribution from the beneficiary.
- More than 500 Hospitals and Nursing Homes already registered under the scheme through online empanellement portal. Hospitals are graded according to the services available into three categories i.e. Grade-A , Grade-B and Grade-C hospitals. Online empanelment & gradation of Hospitals based on the services and infrastructure available.
- 100% online Pre-authorisation with turn around time of 24 Hrs.
- SMS triggers and instant alerts to the beneficiaries on blocking of card.
- Real-time uploading of E-health record of the beneficiaries on discharge.
- Claim reimbursement to the hospital with TAT of 30 days else interest are being charged for delayed payment.
- 24X7 toll free Call Centre (18003455384) with feedback option
- Online grievance monitoring Mechanism
- Android based Swasthya Sathi Mobile app for assistance to the beneficiaries
- List of Approved Hospitals
- Hospitals registered and their status
- Swasthaya Sathi Packages under Assurance Mode
- Expertise / Facility available in hospitals under Swasthaya Sathi
- Services available in hospitals under Swasthaya Sathi
- Online Hospital Registration for Swasthaya Sathi
- Check the status of Hospital Registration for Swasthaya Sathi
Source : Swasthaya Sathi website