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About the Scheme

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 “Swasthya Sathi 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. 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. National Insurance Company was insurance partner in 9 Districts and United India Insurance Company 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 to 15.01.2020, Bajaj Allianz selected as Insurance Partner in 18 Districts and from 01.04.2018 to 31.12.2019, IFFCO TOKYO selected as Insurance Partner in 5 Districts. The service of 5 districts has been extended by Swasthya Sathi Assurance Mode up to 15.01.2020.
  • The service is continued by new Insurance Company from 16.01.2020. National Insurance Company is selected as Insurance Partner in 6 Districts (Cluster-I), Oriental Insurance Company is selected as Insurance Partner in 9 Districts (Cluster-II), United India Insurance Company is selected as Insurance Partner in 8 Districts (Cluster-III).
  • 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