April 24, 2024

What are the salient features of ‘Swasthya Sathi’ scheme of West Bengal Government?

Reading Time: 2 minutes

By neucrad health February 7, 2019

The honorable chief minister of West Bengal launched a remarkable Group Health Insurance Scheme- Swasthya Sathi’ on 30th December 2016 benefiting lakhs of people all over the State.  It rolled out across nine districts in the State on 1st February 2018 and another eleven districts from 28th February 2018. Bajaj Allianz was selected as the Insurance Partner in 18 districts of West Bengal from 1st April 2018 onwards, and IFFCO Tokyo would offer the same in another 5 districts. The policy would arrange free health treatment including diagnostic facilities, medicines, and ever bear the cost of other state-of-the-art surgical procedures like provision for implants for all the State-Government employees.

Salient Features of ‘Swasthya Sathi’ Scheme

# The group insurance policy would meet the secondary and tertiary medical treatment cost of up to INR 1.5 lakh per annum per family. In certain diseases like cancer, orthopaedics and cardiological treatment, and Neuro-surgeries medical expenses up to INR 5 lakhs would be taken into consideration under assurance mode.

# There is no cap on the total number of family members in each family, and parents of both the spouses can claim benefit from this scheme. Unmarried girls up to 21 years and physically challenged family members would get coverage.

# All pre-existing diseases would be taken into account and get coverage from the first day of the policy.

# State Government would bear the entire premium cost of Swasthya Sathi; the beneficiary would not have to contribute any charges upon enrolment.

# The entire policy is cash-less, paper-less, smart card based. The government would manage it on an IT platform since inception.

# When the family enrols for the scheme, they get an online Swasthya Sathi Smart Card on day one. This card bears the biometric details and photographs of family members. Mobile number, residential address, and Adhar card number.

# The beneficiaries also receive SMS alert upon blocking of the card.

# There is also an Android-based ‘Swastha Sathi Mobile App’ for the convenience of beneficiaries.

# A 24-hour Customer Care centre has also been set up taking care of the enquiries, feedback, and grievances of beneficiaries. The toll-free telephone number for the service is 18003455384.

# There is a provision for online triggers and alert-system for the detection of frauds featuring outstanding escalation matrix.

# Since the entire scheme gets managed on IT platform, there are real-time updates of E-health record on discharge from the hospital.

# More than 1300 top-grade hospitals and nursing homes have already registered in the Swastha Sathi Scheme with the help of online empanelment programme. There are three categories of hospitals according to the services and facilities offered by them.

In July 2018 West Bengal Government decided to integrate Central Govt’s ‘Ayushman Bharat’ Health Insurance Scheme with the hugely popular Swasthya Sathi Scheme in the state. State and Central Government would share the cost of implementing this programme in a 60:40 ratio. After this merger, Swasthya Sathi would now cover approximately six crore individuals. 

References: swasthyasathi.gov.ingovernmentyojana.in, deowb.subho.net, economictimes.indiatimes.com.

Image credited to creative commons, wikimedia