A Group Health Protection scheme named “Swasthya Sathi” was announced by the Government of West Bengal. As on 31st August, 2018, 3.18 lakh beneficiaries availed cashless healthcare amounting to Rs.301.57 Crore out of the scheme.
A 24X7 Call Centre support (Toll free number -1800-345-5384) for Swasthya Sathi and android based Mobile app have been introduced. More than 1300 Hospitals and Nursing Homes already registered under the scheme through online empanelmentportal. Hospitals are graded according to the services available into three categories i.e. Grade-A , Grade-B and Grade-C hospitals.
West Bengal Swasthya Sathi Scheme Features
• 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
