Swasthya Sathi Scheme 2023 Online Apply: Registration, Hospital List pdf Download

Swasthya Sathi Scheme 2023

Swasthya Sathi Scheme 2023 is a great initiative by the West Bengal govt to provide Swasthya Sathi insurance for all the residents of West Bengal. The main benefits of the Swasthya Sathi Scheme include a health cover of Rs.5 Lakhs and cashless hospitalization with zero premium coverage. The Swasthya Sathi Scheme was introduced by the West Bengal government in 2016 to provide health insurance coverage to the residents of the state.

The Search terms you can find here are About the Scheme: Swasthya Sathi card Apply Online, Swasthya Sathi Scheme Eligibility Criteria, Swasthya Sathi card Download.

History Behind Swasthya Sathi Insurance Scheme

“Swasthya Sathi Scheme” 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 was 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.

Overview of Swasthya Sathi Scheme 2023

Salient Features of the Swasthya Sathi Scheme

• Basic health cover for secondary and tertiary care up to Rs 1.5 Lakh per annum through Insurance mode and Critical illnesses like Cancer, Neuro surgeries, cardiothoracic surgeries, liver diseases, blood disorders etc. up to Rs 5 Lakh through Assurance mode.
• From 01.04.2018 Bajaj Allianz has been selected as Insurance Partner in 18 Districts and IFFCO TOKYO in 5 Districts
• Paperless, Cashless, smart-based online Swathyasathi Smart card is provided to each family on the day of Enrollment. Smart Card captures the details of the family members, Photographs, biometrics, address, Mobile Number, SECC ID, and ADHAAR No ( if available). Management of the scheme is in the paperless IT platform from day one.
• There is no cap on the family size and Parents from both Spouses are included. Unmarried daughters up to 21 Years and 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.
• More than 500 Hospitals and Nursing Homes are already registered under the scheme through the online empanelment portal. Hospitals are graded according to the services available into three categories i.e. Grade-A, Grade-B and Grade-C hospitals. Online empanelment & gradation of Hospitals based on the services and infrastructure available.
• 100% online Pre-authorisation with a turnaround time of 24 Hrs.
• SMS triggers and instant alerts to the beneficiaries on blocking of card.
• Real-time uploading of E-health records 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
• Android-based Swasthya Sathi Mobile app for assistance to the beneficiaries

What is the insurance of the Swasthya Sathi card?

Basic health insurance cover up to Rs 5 lakh is provided for both tertiary and secondary medical care for each family. The scheme provides coverage for all pre-existing diseases of the beneficiaries. There are no restrictions on the size of the eligible family under the scheme.

Swasthya Sathi Scheme Eligibility Criteria

1. This scheme exclusively caters to residents of West Bengal.
2. All state residents are eligible to participate in this program.
3. Beneficiaries should not have prior registration under any other health insurance scheme.
4. Applicants must also possess all the necessary supporting documents when registering.
5. You should not be enrolled under any other government health insurance scheme.
6. The beneficiary family will comprise the beneficiary, the spouse, parents of both spouses, sons of up to 18 years of age, and unmarried daughters of up to 21 years of age.
7. No age limit applies to the dependent physically challenged member.

Benefits of the Swasthya Sathi Scheme

• All Pre-Existing Diseases Covered: All the pre-existing diseases and conditions are covered in the Scheme from day one.
• No Cap on Family Size, Parents for both Spouse Included & Gender Empowerment: There is no cap on family size, and parents from both spouses are covered. Cards are issued preferably in the name of the eldest woman’s family member as Head of the family.
• No Beneficiary Contribution: No contribution is to be made towards insurance premiums or card costs on the part of the beneficiary as the entire premium which includes the cost of smart cards is borne by the Government of West Bengal.
• 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 a lifetime and auto-renewed each year.
• 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.
• Compulsory Pre-Authorization for Treatment: All the medical procedures/treatments of Swasthya Sathi beneficiaries are 100% pre-authorized within 24hrs TAT (turnaround time).
• 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.  
• 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.
• Rational PackageRates: 2092 Swasthya Sathi packages are available in the scheme. Package rates are dynamic and the Package Selection committee rationalizes package rates as and when required.
• SMS Alerts: SMS triggers to the beneficiaries during hospitalization and also after discharge from the hospital.
• Swasthya Sathi Mobile App: Downloadable from Google Play Store and queries can be raised for information, grievances, etc. This also includes a one-touch feature that directly connects to the 24/7 Help Line.
• 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 the Smart Card. The beneficiaries can also reach out through social media platforms such as Facebook, Twitter, and WhatsApp
• Transport Allowance after Discharge: The package includes the cost of Transport Charges of Rs 200 payable to the patient at the time of discharge. In the case of Patients admitted to State Government Hospitals, additional transport allowance over and above Rs 200 is also provided.
• Large network of Empanelled Hospitals: The beneficiaries can opt for services under the Swasthya Sathi scheme in more than 1,500 impanelled hospitals, details of them are available in the Public domain. Every day more hospitals are registered in the scheme spontaneously.
• Mandatory Claims Settlementthrough TAT of 30 Days:  The claims of the Health care providers are monitored and settled online within 30 days or else interest would have to be paid as per the Agreement.
• Compulsory E-HR (E-Health Record) uploaded on the portal: The e-Health records of the patient are stored in the server and can be consulted as and when required by the physicians through their login credentials.
• Proactive Disclosure of Monthly Analytical Report: This is available in the public domain for perusal and suggestions from all including the stakeholders.
• Online Grievance Monitoring Mechanism: Stakeholders can post their grievances on the Swasthya Sathi online portal.

How to apply for Swasthya Sathi Scheme?

Before we go to check out how to apply for a Swasthya Sathi card online we have to know the different types of forms used for the Swasthya Sathi card.

 Swasthya Sathi Scheme Application Forms

The type of Form used for the Swasthya Sathi Card is as Follows

• Form A for new member addition after receiving card
• Form B for new registration under Swasthya Sathi
• Form C for member name correction after receiving card
• Form D for member deletion after receiving card

Want to Know Swasthya Sathi Hospital List Then Click Here

How to apply for Swasthya Sathi Card Online

1. Visit the Swasthya Sathi Scheme official website
2. From Drop down menu click Apply Online
3. Click Online Application for Swasthya Sathi Card
4. Provide your Mobile Number in the appropriate place and click the get OTP button
   • Put the OTP received in the proper place and submit.
5. Select the appropriate District from the list
   • If you belong to the Panchayat Area, choose your Block, Panchayat and village name from the list
   • If you belong to Municipality Area, choose your Municipality Name then choose your Ward Number
   • Choose the proper category you belong to from the list, SC / ST / OBC / Others
   • Fill up your Department Name If Employed
   • Fill up the Office Name and address If the Applicant / Member is Employed
   • Fill up your Residential Address with a PIN Code
   • Fill up the Name of the Applicant
   • Fill up the Head of the Family (HoF) Name
   • If Any Member of the family receives Govt. Sponsored Health Insurance / Assurance, choose the option from the list YES/ NO
   • If Any Member of the family receives Medical Allowance from Govt., choose the option from the list YES / NO
   • If Any Member of the family receives Medical Allowance from a Private Institution, choose the option from the list YES /NO
6. Next Step
   • Member Name: Fill up the full name of the member as per the AADHAR Card
   • Relationship: The First relationship is always the Beneficiary, the subsequent are: Spouse, Mother, Father, Child, and Others
   • Age: Fill up the correct age as per records
   • Gender: Fill up the correct gender as per records
   • AADHAR Number: Fill up the correct AADHAR Number as per records
   • KHADYASATHI Ration Card Number: Fill up the correct Ration Card Number as per records
   • Employment Status of the Member: Fill up the correct Employment Status as per records
   • Mobile Number: Fill up the Working Mobile number for each member

a) Please USE the EDIT button to update/change any of the information entered

b) Please USE the DELETE button to delete entire information for any member EXCEPT the Beneficiary

c) Please USE the ADD NEW MEMBER to enter the details for a new member addition

d) Note: All star-marked entries are mandatory to proceed further in filling the FORM

How to check Swasthya Sathi Card Status online

1. Visit Swasthya Sathi’ official website
2. From Drop down menu click Apply Online
3. Click on “Check your Online Application Status for Swasthya Sathi Card”
4. Fill up the Desired Box like a) District b) Search Criteria
5. Click Submit

How to Find Your Name in Swasthya Sathi Portal

• Visit Swasthya sathi’s official website
  From Drop down menu click Find Your Name
  Put your mobile no.
• Select option
• click submit
• Follow the next instruction

How to Register for Treatment Outside West Bengal Under the Swasthya Sathi Scheme

• Go to the official Swasthya Sathi online portal.
• Click on ‘Apply Online’ present on the top menu bar and select the ‘Registration Outside of West Bengal’ option from the drop-down menu.
• Enter your Swasthya Sathi URN number and mobile number to proceed.
• Enter the required details on the page and submit the form.
• Attach the necessary documents like proof of ID, investigation report, etc., and upload it.
• You can now keep checking the registration status to find out if your case has been approved.
• An acknowledgement receipt shall be available in case of approved registration.

How to check Swasthya Sathi Card balance online?

To know Swasthya Sathi Card Balance you have to go to the official website and find the option Then there is an option called URN Verification.

1. Begin by choosing your state, then input the district you wish to view. Next, enter the URN and proceed by clicking the submit button below.
2. After clicking, you will see a list of all the members in your family.
3. At the bottom, you will find an option labeled “View balance.” Click on it, and you will be able to see the current balance on your card.

How to use Swasthya Sathi Card in Vellore CMC

• Visit the official Swasthya Sathi online portal. 
• Select ‘Registration for Vellore CMC’ and follow the process similar to registering for treatment outside West Bengal. 
• Enter your Swasthya Sathi URN number and mobile number to proceed.
• Enter the required details on the page and submit the form. 
• Attach the documents and upload them. 
• You can now check the registration status to know if your case has been approved.
• An acknowledgement receipt shall be available in case of approved registration for Vellore CMC.

For Treatment Outside West Bengal Under the Swasthya Sathi Scheme follow below mentioned manual

Swasthya Sathi Scheme Manual for outside hospital

List of Swasthya Sathi Insurance Company and TPA

List of Swasthya Sathi Mediclaim Policymaker Company under Assurance Mode

How to Check Active Hospital List Under Swasthya Sathi Scheme 2023

• Visit the official Swasthya Sathi Scheme online portal
• Hover your mouse in the main menu and click “Hospital Information”
• From the Dropdown menu Choose “Active Hospital List”
• A page open and fill up the following
  • Select State
  • Select District
  • Select Subdivision
  • Hospital Type
  • Hospital Grade
• Click Submit to see the list or click download

For More Details About Active Hospital Under Swasthya Sathi Scheme

How to Check Package Details Under Swasthya Sathi Scheme 2023

• Visit the official Swasthya Sathi Scheme online portal
• Hover your mouse in the Left side main menu and click “Hospital “
• From the menu Choose “Package Details”
• Swasthya Sathi package Search Page will open
• Choose Grade
• Choose Procedure
• Click on Show data

List of Packages under West Bengal Swasthya Sathi Scheme 2023

Important Links Related to Swasthya Sathi Scheme 2023

• West Bengal Swasthya Sathi Scheme Portal.
• West Bengal Swasthya Sathi Scheme Online Application.
• West Bengal Swasthya Sathi Scheme Application Status.
• West Bengal Swasthya Sathi Scheme Guidelines.
• West Bengal Swasthya Sathi Scheme Standard Operating Procedure.
• West Bengal Swasthya Sathi Scheme Mobile App Download.
• West Bengal Swasthya Sathi Scheme Frequently Asked Questions.

Latest Govt order Related to the Swasthya Sathi Scheme

• 03 Aug, 2023, Notification i.c.w Intravitreal Injection for Grade-A Super-speciality eye hospital
• 03 Jul 2023, Standard Operative Procedure (SOP) for Subdivision-wise Post Discharge Medical Audit and Trigger Management
• 15 May, 2023, Revision of Price Ceiling in respect of Coronary Stents
• 10 May, 2023, Order related to Oncology packages
• 18 Apr, 2023, Notification-Intravitreal Injection
• 12 Apr, 2023, Advisory Coordinated efforts to reduce the over use of Chemotherapy Drugs under Swasthya Sathi
• 14 Mar, 2023, Post Discharge Medical Audit and Trigger Management
• 20 Feb, 2023, Memorandum related to Implant Cost
• 20 Feb, 2023, Gatekeeping of Orthopaedic procedures
• 20 Feb, 2023, Medical Management cases not covered under specific package
• 15 Feb, 2023, Post Discharge Medical Audit
• 28 Dec, 2022, Amendment Rate capping for Spinal fixation Package under Orthopaedic and Neurosurgery
• 22 Dec, 2022, Standard Operative Protocol (SOP) for blocking & payment of Swasthya Sathi packages in special situations/exceptional cases
• 19 Oct, 2022, Gazette Notification for WBRTPS – Swasthya Sathi
• 29 Sep, 2022, Restriction on blocking of Oncosurgery packages under Swasthya Sathi
• 09 Sep, 2022, Capturing of Swasthya Sathi card number during all IPD cases in Government Hospitals
• 08 Sep, 2022, Restriction on appendectomy procedures as an additional package under Swasthya Sathi
• 08 Sep, 2022, Gate Keeping of Hydrocele/Hernia Surgery Cases and Common Dental procedures
• 06 Sep, 2022, Notification: Swasthya Sathi RTPS
• 06 Sep, 2022, Notification: Swasthya Sathi EoDB
• 22 Aug, 2022, Advisory related to treating doctor under Swasthya Sathi scheme
• 30 Jul, 2022, Notification_revision_of_Swasthya_Sathi_Packages_30.07.2022
• 09 Jun, 2022, Swasthya Sathi Treatment at Christian Medical College (CMC), Vellore
• 07 Jun, 2022, Revision of Price Ceiling in respect of Coronary Stents Ref: S.O. 1502(E) dated 30″March, 2022
• 19 May, 2022, Advisory related penalty for gradation issue
• 10 Feb, 2021, State Surveillance Team
• 10 Feb, 2021, District Surveillance Team
• 25 Oct, 2021, Restriction on Unspecified Package
• 25 Oct, 2021, Mandatory production of Swasthya Sathi Card or any other Government issued Health card during IPD in Government Hospital.
• 25 Oct, 2021, Gate Keeping for LUCS and Fissurectomy
• 22 Jul, 2021, Advisory on District Surveillance Team (DST) and State Surveillance Team (SST)
• 13 Jul, 2021, Guideline related to utilization of Swasthya Sathi fund of Government Hospital
• 23 Feb, 2021, Notification Regarding the Hospital Empanelment Under Swasthya Sathi Scheme Dated 23.02.2021
• 17 Dec, 2020, Advisory on Universal Health Protection Scheme Maximization of enrollment kit 17-12-2020
• 10 Dec, 2020, Advisory on Universal Health Protection Scheme Utilization of enrollment kit 10-12-2020
• 04 Dec, 2020, Advisory on Universal Health Protection Scheme Swasthya Sathi Enrolement Duare Sarkar 04-12-2020
• 02 Dec, 2020, Notification on Universal Health Protection Scheme Swasthya Sathi Dated 02-12-2020
• 10 Jan, 2020, Order related to refusal of treatment to Swasthya Sathi Beneficiaries
• 08 Aug, 2019, Swasthya Sathi Eligible Category List Along with Order Number
• 31 Aug, 2016, Swasthya Sathi Clarified notification of Finance Department
• 15 Nov, 2016, Societies Registration Certificate of Swasthya Sathi Samity
• 20 Jun, 2016, Second SLIC meeting resolution
• 11 Sep, 2017, Resolution 1st Annual General Meeting
• 26 Jul, 2018, Order Related to Gate Keeping
• 23 Jun, 2016, Order of Technical Director
• 15 Nov, 2016, Order of Swasthya Sathi Hospital Empanelment Committee
• 21 Jun, 2016, Order of Swasthya Sathi Package selection committee member
• 20 Jan, 2017, Order of Swasthya Sathi for Government hospitals
• 17 Apr, 2017, Order of Expert Committee Formation under Assurance Mode of Swasthyasathi
• 07 May, 2018, Order Number 2899-F(P) for Cable Operator
• 25 Feb, 2016, NOTIFICATION0001 Swasthya Sathi
• 02 Mar, 2016, Notification of State Level Implementation Committee members
• 16 Sep, 2016, Model Swasthya Sathi Agreement between Insurance and SNA
• 16 Sep, 2016, Model Swasthya Sathi Agreement between Insurance and Hospital
• 15 Sep, 2016, Gadget Notification for Swasthya Sathi Samity
• 08 Mar, 2016, Fraud Control Mechanism in Swasthysathi
• 08 Mar, 2016, First SLIC meeting resolution
• 26 Dec, 2016, First governing body meeting resolution of Samity
• 02 Aug, 2017, Financial Bid Opening of ISA for Swasthya Sathi
• 06 Sep, 2017, Extension of Coverage of Swasthya Sathi Scheme
• 23 Aug, 2016, DO LETTER OF SECRETARY on DATA PREPARATION
• 02 Sep, 2016, DO letter of Principal Secretary for data preparation
• 19 Jul, 2016, DO letter for formation of District monitoring committee by CHIEF SECRETARY
• 11 May, 2017, Data preparation and Monotoring of Swasthya Sathi Scheme
• 15 Nov, 2016, CERTIFIED COPY OF SWASTHYA SATHI SAMITY
• 17 Feb, 2016, Cabinet decision for introduction of Swasthya Sathi no -2625

You can also see :