Swastha Sathi Key Functionality

a) All Pre Existing Diseases Covered: All the pre-existing diseases and conditions are covered in the Scheme from day one.

b) No Cap on Family Size, Parents for both Spouse included& Gender Empowerment: There is no cap in family size and parents from both the spouse are covered. Cards is issued preferably in the name of eldest women family member as Head of family.

c) No Beneficiary Contribution: No contribution is to be made towards insurance premium or card cost on the part of the beneficiary as entire premium which including cost of smart cards is borne by the Government of West Bengal.

d) All TransactionsSmart Card Based Transactions: The beneficiary avails the services in the form of Paperless, Cashless and entirely on the 64Kb Smart Card which contains digitally encrypted information printed in the card and distributed to the beneficiary during the time of enrollment. Smart card valid for lifetime and auto renewed in each year.

e) Entire System on IT Platform: The entire system of the scheme is paperless and based on hassle free cloud based IT platform. Online monitoring of the scheme saves valuable time and resources apart from speedy delivery of the services.

f) Compulsory Pre-Authorization for Treatment: All the medical procedures/treatments of Swasthya Sathi beneficiaries are 100% pre-authorized within 24hrs TAT (turnaround time).

g) Transparent Hospital Gradation: The hospitals are graded based on marks obtained on the facilities and services available which are physically verified by the IC/TPA (Insurance Company/Third Party Administrator). The Empanelment committee approves the grade and empanels the hospital under Swasthya Sathi.  

h) Complete Cashless Hospitalization: Expenses incurred for consultation, diagnostic test and medicines up to 1 day before the admission of the patient and cost of diagnostic test apart from food during hospitalization and medicine up to 5 days after discharge from the hospital for the same ailment / surgery are also provided to the beneficiary.

i) Rational PackageRates: 2092 Swasthya Sathi packages are available in the scheme. Package rates are dynamic and Package Selection committee rationalizes package rates as and when required.

j) SMS Alerts: SMS triggers to the beneficiaries during hospitalization and also after the discharge from the hospital.

k) Swasthya Sathi Mobile App: Downloadable from Google Play Store and queries can be raised for information, grievance, etc. This also includes a one-touch feature which directly connects to the 24X7 Help Line.

l) Easy Outreach for All through Toll Free Call Centre and Social Media: The 24X7 toll free Call Center (18003455384) for assistance is displayed on the back of Smart Card. The beneficiaries can also reach out through social media platform such as Facebook, Twitter, and WhatsApp

m) Transport Allowance after Discharge: Package includes cost of Transport Charges of Rs 200 payable to the patient at the time of discharge. In case of Patient admitted in State Government run Hospitals, additional transport allowance over and above the Rs 200 is also provided..

n) Large network of Empanelled Hospitals: The beneficiaries can opt for services under the Swasthya Sathi scheme in more than 1500 empanelledHospitals, details of them are available in Public domain. Every day more number of hospitals are registered in the scheme spontaneously..

o) Mandatory Claims Settlementthrough TAT of 30 Days:  The claims of the Health care providers are monitored and settled online within 30days or else interest would have to be paid as per the Agreement.

p) Compulsory E- HR (E-Health Record) uploaded on portal: The e-Health records of the patient is stored in the serverand can be consulted as andwhen required by the physicians through their login credentials.

q) Proactive Disclosure of Monthly Analytical report: This is available in public domain for perusal and suggestions from all including the stakeholders.

r) Online Grievance Monitoring Mechanism: Stakeholders can post their grievance on the Swasthya Sathi online portal.

s) Identification of Triggers and outliers through Machine Intelligence as well as Human Intervention: There are System Based Triggers against Hospital/TPA/Insurance which includes hospital with high admissions, number of high value packages blocked, higher package blocked and claimed but actually not done, unnecessary surgery done or kept under ICU, same packages blocked for many patients on particular day, etc.

t) Interactive Website: as on 30^thNovember, 2019- 34, 43,436   number of persons viewed the website. There is interactive “May I Help You” option for general queries of the viewer. Common people can also view their eligibility, enrollment details in the webportal.