A Group Health Protection scheme named “Swasthya Sathi” is announced by the Government of West Bengal vide notification no – 1104-F (P) dated 25th February 2016, which is implemented in the state for certain categories of employees/beneficiaries.

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Swasthaya Sathi at a Glance

 

Swasthya Sathi” was announced in Cabinet No – 2625 dated 17th February, 2016, and Finance Department notification no – 1104-F (P) dated 25th February, 2016.

A State level Implementation Committee (SLIC) under the chairmanship of the Chief Secretary formed to oversee the scheme and there is a registered society named “Swasthyasathi Samiti” ( Registration no S/M/4377 OF 2016-2017 Dated 15.11.2016) for monitoring the scheme.

 

The scheme was officially launched by Hon’ble CM on 30th December 2016

Main Features of the Scheme:

•       Basic health cover for secondary and tertiary care  up to Rs 1.5 Lakh per annum through Insurance mode (PSU) and Critical illness like Cancer, Neuro surgeries, cardiothoracic surgeries, liver diseases, blood  disorders etc. up to Rs 5 Lakh through Assurance mode.

•        NIC as insurance partner in 9 District and UIIC in 11 Districts. Premium per family ranges from Rs 3549   In Kolkata to Rs 1729   in  Dakshin Dinajpur

•       Paperless, Cashless, Smart Card based.

•       There is no cap on the family size and Parents from both the Spouse are included.

•       All pre-existing diseases are covered.

•       The entire premium is borne by the State Government and no contribution from the beneficiary.

•       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.

•       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




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Website Last Update Date: Tuesday, January 2, 2018 6:18:16 PM



All Hospitals are requested to continue to Provide cashless services as usual. SNA assured to make Payments for all claims as per the guidelines of the schemes. In case any issue related to TMS, pl contact District or SNA.


Emergency contact number District wise for any Assistance:
Malda, Uttar Dinajpur:9836386475
Howrah,Kolkata,Hooghly:8116346916
Bankura,Birbhum,Bardhaman:9163110720
North 24 Parganas,Paschim Medinipur:9475886662


Dear all Hospital ,
in case all panned OT like cataract surgery , dialysis cases etc you are requested to send the patient details and contact number , doctor name date of surgery through email to swasthyasathi for speedy approval through pre authorisation. We are developing an IT tool for all such cases.