Swasthya Sathi at a Glance

Main Features of the Scheme:

• Basic health cover for secondary and tertiary care up to Rs. 5 lakh per annum per family.
• Up to Rs 1.5 Lakh through Insurance Mode and beyond 1.5 lakh to 5 Lakh through Assurance Mode.
• The scheme was rolled out from 01.02.2017. NIC was insurance partner in 9 District and UIIC in 11 Districts up to 28.02.2018. The scheme was implemented under assurance mode for the month of march, 2018. From 01.04.2018 Bajaj Allianz selected as Insurance Partner in 18 Districts and IFFCO TOKYO in 5 Districts.
• Paperless, Cashless, Smart Card based.
• There is no cap on the family size and Parents from both the Spouse are included. All dependent physically challenged persons in the family are also covered.
• All pre-existing diseases are covered.
• The entire premium is borne by the State Government and no contribution from the beneficiary.
• Online Swathya Sathi 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.
• 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
• Online triggers and alerts to detect probable frauds with escalation matrix..
• Android based Swasthya Sathi Mobile app for assistance to the beneficiaries