Swasthya Sathi Scheme is a flagship health insurance scheme initiated by the West Bengal Government on December 30, 2016. The scheme offers cashless and paperless medical treatment to all the state's residents, irrespective of age, occupation, or social standing.

According to recent statistics, the Swasthya Sathi Scheme has already offered care to 2.5 crore individuals (50 lakh families) under its coverage. The government has a target to reach 1.42 crore families. It has become a lifeline for West Bengal’s families by reducing out-of-pocket spending and making quality healthcare more accessible and affordable.

Under the scheme, each WB family will get health coverage of up to ₹5 lakh per year. It offers expenses for primary, secondary, and tertiary care. Further, the entire programme is fully funded by the state government and runs through a Smart Card system. This ensures easy access to healthcare without forcing the patient to pay first.

What differentiates the scheme is that there is no maximum limit on family size, and even pre-existing conditions are insured. To strengthen healthcare access, the state has also created specialty hospitals in rural and semi-urban areas, along with affordable diagnostic centres, pharmacies, and critical care facilities.

Smart Card-Based Access

Each family receives a Swasthya Sathi Smart Card that contains the details of all members. This allows cashless transactions at registered hospitals and is renewed automatically every year.

Coverage for Entire Family

The scheme covers the entire family, including spouses, children, parents of both spouses, and even physically challenged dependents.

Zero Premium and Contribution

Beneficiaries do not have to pay anything out of pocket. The premiums and contributions are both taken care of entirely by the state government.

Health Coverage up to ₹5 Lakh

Each family gets coverage of up to ₹5 lakh every year for treatment at registered hospitals. The coverage includes all types of secondary and tertiary care, consultations, diagnostics, medicines, hospital food, and post-discharge follow-ups.

Transport Allowance

Patients also receive a transport allowance of ₹200 at discharge and up to ₹700 if treated in government hospitals.

Quick Claim and Pre-Authorisation

The authorities pre-authorise medical procedures within 24 hours and settle claims within 30 days. They pay interest for any delays.

Pre-Existing Conditions Covered

If there is any pre-existing disease, these are also covered from day one. This ensures inclusive healthcare for all beneficiaries.

Paperless Platform

The scheme operates on a completely paperless, IT-based system. This makes enrolment, treatment, and claims smooth and easy.

Mobile App and 24×7 Helpline

There is also a mobile app that beneficiaries use to raise queries or track treatment, whereas the 24×7 toll-free helpline provides round-the-clock assistance.

E-Health Records

The history of treatments is stored as E-Health records. This is accessible anytime by patients and physicians for future reference.

Online Grievance Monitoring

There is also an online grievance system that allows beneficiaries to submit complaints or queries easily. This helps to ensure quick redressal and transparency.

Extensive Package Coverage

The Swasthya Sathi Scheme offers more than 2,000 medical packages. The rates are set by the Package Selection Committee to maintain transparency.

SMS Updates

Beneficiaries can opt for timely SMS updates when they are hospitalised and after they are discharged. This helps them stay informed about treatment and coverage.

Interactive Website

There is also an online portal that provides all essential information, such as eligibility, enrollment, and benefits. This makes it easy for users to understand the scheme better.

Large Hospital Network

Treatment is available at multiple registered hospitals. You can access the full list on the official website.

• All residents of West Bengal can access the facilities of the Swasthya Sathi Scheme.
• The programme also targets specific groups such as ASHA workers, ICDS helpers and workers, members of self-help groups, certain categories of contractual employees, and existing beneficiaries of the Rashtriya Swasthya Bima Yojana (RSBY).
• Families meeting certain specific criteria under the Socio-Economic Caste Census (SECC) are also eligible.
• From 1st December 2020, the government expanded the scheme to offer universal coverage. This has helped make the scheme accessible to every resident of West Bengal regardless of their caste, religion, profession, or income.
• The government issues the Swasthya Sathi Smart Card in the name of the family’s eldest member. Families can use this card to access cashless medical treatment across all empanelled hospitals in the state.
• A beneficiary family under the scheme includes the main insured person, spouse, parents of both spouses, sons up to 18 years of age, and unmarried daughters up to 21 years of age.
• If there is a physically disabled member in the family, they have no upper or lower age limit for eligibility.

Submitting these necessary documents ensures a smooth and easy registration process:

• Ration Card: The ration card helps verify all family members to be included under the scheme.
• Aadhaar Card: This document serves as the most important proof of identity for the applicant. If an Aadhaar card is not available, as an alternative, any government-issued photo ID can be submitted.
• Mobile Number: Applicants need to provide a mobile number to receive SMS updates and notifications related to the status of the application and hospitalisation, claims, and scheme benefits post-approval.
• SECC ID: The Socio-Economic Caste Census (SECC) ID is also needed to verify eligibility under the deprivation criteria.
• Domicile Proof: These types of legal documents confirm an applicant’s residency in West Bengal. This is essential to establish eligibility.
• Passport-Size Photographs: It is essential to have recent photographs of the applicant and family members as identification proof.

You can complete the Swasthya Sathi application process online, offline, or through authorised agent channels. This makes it convenient for all residents of West Bengal.

Swasthya Sathi Card Apply Offline Process

Step 1: Go to your nearest Grama Panchayat, ward office, village medical camp or government hospital and collect the Form-B.
Step 2: Fill up the form correctly with the details of all family members.
Step 3: Attach the required documents and submit the form at the specified submission centre.
Step 4: Once you submit the form, you will get an SMS containing your serial number, district code, and URN.
Step 5: After you complete these steps to apply for the Swasthya Sathi card, it will be dispatched to you within a week of the submission date.

Swasthya Sathi Card Apply Online Process

Step 1: Go to the official Swasthya Sathi portal.
Step 2: Start the process by selecting your category (SC, OBC, ST, Others), block/municipality, and district.
Step 3: Fill in the applicant’s name, pincode, details of the HOF (Head of the family), and residential address.
Step 4: Enter your employment information.
Step 5: Mention if any of your family members are already covered under any government medical allowances or health insurance.
Step 6: Add the details of all your family members, such as employment status, ration card numbers, mobile numbers, and Aadhaar card numbers.
Step 7: Upload all the above-mentioned necessary documents and passport photographs.
Step 8: Click on the ‘Submit’ button and note the provided unique registration number (URN) for any future reference, and you are done with the Swasthya Sathi online application process.

Through Authorised Agents

Authorised agents at your village medical centres, Gram Panchayats, and ward offices can also help you with the registration process. These agents assist applicants in filling out the form and submitting it. They simplify the registration process for those who may need extra support.

Step 1: Check out the official website of the Swasthya Sathi scheme.
Step 2: On the menu bar, click on ‘Apply Online’.
Step 3: From the drop-down, select the ‘Check Your Online Status for Swastha Sathi Card’ option.
Step 4: The website will redirect you to a new page where you must select your district.
Step 5: You can search using your Aadhaar number, URN (Unique Registration Number), or Family ID.
Step 6: Enter the details accurately depending on the search criteria. Double-check all the necessary information to avoid errors.
Step 7: Navigate to the ‘Submit button and click on it, and your Swasthya Sathi status will be displayed on the screen.

Step 1: Check the official website or app for Swastha Sathi card application status.
Step 2: Check the lists of empanelled facilities.
Step 3: Go to the hospital or medical facility.
Step 4: Present your card to the hospital authorities.
Step 5: The hospital will verify your card and provide cashless treatment.

The Swasthya Sathi scheme is more than just a policy; it serves as a promise of care and protection for the people of West Bengal. Facilities such as quick claim processing and inclusive coverage ensure the scheme has set a new benchmark in public healthcare. As a model in public health insurance, Swasthya Sathi will transform lives by making quality medical care accessible to every WB family.

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