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.




 

A Group Health Protection scheme named "Swasthya Sathi" was announced by the Government of West Bengal vide Decision in Cabinet No - 2625 dated 17 th February, 2016, and notification of Finance Department vide no - 1104-F (P) dated 25th February, 2016.

 

The Scheme has been inaugurated by the Hon’ble Chief Minister of West Bengal, Smt Mamata Banerjee on 30 th December, 2016 and started its journey from 01.02.2017

 

A State level Implementation Committee was formed under the chairmanship of the Chief Secretary to the Government of West Bengal to oversee the implementation of "Swasthya Sathi" vide notification no - HF/O/Swasthya Sathi/097/2016/4032 dated 2 nd March, 2016.

 

The first meeting of State level Implementation Committee was held at Nabanna on 8th March, 2016 where it was resolved that The Scheme will have basic health coverage for Secondary and tertiary care up to Rs 1.5 lakhs per annum per family through Insurance Mode and up to 5 Lakhs for certain critical diseases like, cancer, Neuro-surgery, orthopaedic and cardio logical diseases etc through assurance mode under the umbrella of Swasthyasathi Samiti.

 

State Government vide notification number 6371-F[P1] dated 4 th October, 2018 further extended the coverage up to Rs. 5 lakh per annum irrespective of disease classifications. There is no cap on the Family size and parents of both the spouses are included under the scheme. Unmarried Girl child up to 21 years and all physically challenged dependent members in the family are covered.

All pre-existing diseases will be covered from the first day of the policy.

The second meeting of State level Implementation Committee was held at Nabanna on 5th July, 2016. State level Implementation Committee in its second meeting approved the administrative setup and proposed IT framework to make the scheme paperless, Cashless through use of Smart card.

State level Swasthya Sathi Package Selection Committee was formed for selection of different packages, package rates and categories. More than 1900 packages have been approved for the said scheme.

E-Tender was introduced for selection of group health insurance provider for Swasthya Sathi scheme, vide memo no -HF/O/SS/ Tender _ INS/74 dated 9th September 2016. Only public sector Insurance Companies were allowed to participate in the e-tender. National Insurance Company (9 Districts) and United India Insurance Company (11 Districts) were selected as insurer for respective districts. Offer letters were issued with the approval of Finance Department vide UO No. 2096 dated 2.11.16. Total estimate approved by Finance Department is Rs.1363.72 Cr for 2016-17.

Fresh E-Tender was invited on Feb’17 to select Insurance Company(both public and Private) and Bajaj Allianz General Insurance was selected for 18 Districts and IFFCO Tokyo General Insurance Company for 5 Districts since 01.04.2018.

A Society named Swasthya Sathi Samiti under thechairmanship of the Chief Secretary to the Government of west Bengal has been formed which has been registered, (No S/M/4377 of 2016-2017 dated 15th November 2016) under Registration of Societies West Bengal Act XXVI1961. First Meeting of the Governing Body of the Swasthya Sathi Samiti washeld on 8th December 2016.

All the district of West Bengal is covered up under thescheme and 50 lakhs of families covering nearly 2.5 Crorepopulation are covered in the scheme. Families of theSelf Help Group Members, ICDS Workers &Helpers, ASHAKarmee, Civic Volunteer Force, Civil defence Volunteers andcertain categories of contractual employees included under thescheme at present. All RSBY beneficiaries and other beneficiaries based on SECC deprivation criteria are also brought under the scheme. Total families eligible under the scheme at present are 142 lakhs.

A 24X7 Call Centre support (Toll free number -1800-345-5384) for Swasthya Sathi and android based Mobile app have been introduced.

More than 1300 Hospitals and Nursing Homes already registered under the scheme through online empanelmentportal. Hospitals are graded according to the services available into three categories i.e. Grade-A , Grade-B and Grade-C hospitals.

As on 31st August, 2018, 3.18 lakh beneficiaries availed cashless healthcare amounting to Rs.301.57 Crore out of the scheme.

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