Swasthya Sathi Scheme Yojana Features, Benefits, and Eligibility

The Swasthya Sathi Scheme aims to improve the healthcare system by making treatment more affordable, especially in rural and semi-urban areas. The program includes:

• 1. Specialty hospitals
• 2. Diagnostic centers
• 3. Pharmacies
• 3. Critical care facilities

All of these are available within a 50 km radius to ensure good-quality care at affordable prices for everyone.

Read this blog to get complete information regarding Swasthya Sathi Scheme.

Highlights of the Swasthya Sathi Scheme

Important Features of the Swasthya Sathi Scheme

Here are the important features of the Swasthya Sathi Scheme:

• 1. Real-time Updates : When a beneficiary is discharged from the hospital, their health record is updated instantly and uploaded.
• 2. Toll-free Call Center : Beneficiaries can contact the Swasthya Sathi call center at 1800-345-5384, available 24/7 for any assistance.
• 3. Quick Claim Payment : Claims for hospital reimbursements are processed and paid within 30 days.
• 4. SMS Alerts : If a beneficiary’s health card is suspended, they will receive an SMS alert.
• 5. Mandatory Pre-Authorisation for Treatment : All treatments and procedures are pre-authorised within 24 hours for the beneficiaries.
• 6. Digital Application : The Swasthya Sathi mobile app (Android-based) helps beneficiaries get assistance easily.
• 7. Transparent Hospital Grading : Hospitals are approved and graded by the Empanelment Committee before being included in the program.
• 8. Online Grievance Monitoring : Beneficiaries can file complaints or issues online through the Swasthya Sathi website.

Coverage Benefits of the Swasthya Sathi Scheme

The Swasthya Sathi Scheme offers the following benefits:

• 1. Coverage up to Rs 5 Lakh : Each family gets health insurance coverage of up to Rs 5 lakh for both secondary and tertiary care.
• 2. Pre-existing Disease Cover : The scheme also covers pre-existing diseases of the beneficiaries.
• 3. Family Cover : There is no limit on the number of family members. This includes in-laws and any dependent family members with physical challenges.
• 4. Premium Paid by the Government : The state government pays the premium, so beneficiaries don’t have to pay anything.
• 5. Cashless Hospitalization : The scheme covers costs like doctor consultations, diagnostic tests, and medicines starting from 1 day before hospital admission. It also covers post-treatment medicines for up to 5 days after surgery or treatment.

Eligibility Criteria for the Swasthya Sathi Scheme

The Swasthya Sathi Scheme is available to all residents of West Bengal. However, people who are already covered by another government health insurance plan or those who get medical benefits through their jobs are not eligible for this scheme.

Swasthya Sathi Card

When you enroll in the scheme, you will receive an online Swasthya Sathi card for your family. This card will have all the important details, like:

• 1. Family member information
• 2. Biometric details
• 3. Pictures
• 4. Mobile number
• 5. SECC ID

The whole process is paperless and managed digitally.

Conclusion

The Swasthya Sathi Scheme is a helpful program by the West Bengal government that provides affordable healthcare to all families. It offers up to Rs 5 lakh coverage, cashless treatment, and free medical care. The scheme aims to make healthcare accessible to everyone, especially in rural and semi-urban areas, ensuring no one is left behind.