What is the Swastha Sathi Scheme?
Swasthya Sathi Vision and Mission
Even though many people get free treatment in public hospitals, lots still go to private hospitals and end up spending a lot of money for higher-level care. The Government of West Bengal is trying hard to improve health conditions and reduce the risk of people falling into poverty because of health expenses. They’ve also formed a Clinical Establishment Regulatory Commission to ensure people get quality service at a fair cost.
The Government of West Bengal is also thinking about providing health coverage to protect residents from spending too much money when they’re in the hospital. That’s why they introduced the group health protection scheme called Swasthya Sathi. This scheme aims to cover low-earning workers and volunteers associated with various State Government projects and programs. The Finance Department identifies and approves these individuals for the Swasthya Sathi Scheme.
Main Features of the Swasthya Sathi Scheme
- Health Coverage: Get health coverage for secondary and tertiary care up to Rs. 5 lakh per year per family.
- Pre-Existing Conditions Covered: All pre-existing diseases and conditions are covered from the beginning of the scheme.
- No Family Size Cap: There’s no limit on family size, and both spouses’ parents are included. The card is preferably issued in the name of the eldest female family member as the head.
- No Contribution Required: Beneficiaries don’t need to contribute to the insurance premium or card cost; the entire expense is covered by the Government of West Bengal.
- Smart Card Transactions: All transactions are smart card-based, offering paperless, cashless services on a 64Kb smart card issued during enrollment. The card is valid for a lifetime and automatically renewed each year.
- IT-Based System: The scheme operates on a paperless, hassle-free cloud-based IT platform, enabling online monitoring for efficient service delivery.
- Pre-Authorization for Treatment: All medical procedures for Swasthya Sathi beneficiaries are 100% pre-authorized within 24 hours.
- Transparent Hospital Gradation: Hospitals are graded based on facilities and services, approved by an empanelment committee.
- Cashless Hospitalization: Complete cashless coverage for consultation, diagnostic tests, medicines, food during hospitalization, and post-discharge medicine for the same ailment/surgery.
- Rational Package Rates: The scheme offers 2092 packages with dynamic rates adjusted by the Package Selection Committee.
- SMS Triggers: Beneficiaries receive SMS updates during hospitalization and after discharge.
- Mobile App: The scheme is accessible via a downloadable mobile app, allowing queries and information sharing, including a one-touch feature for a 24/7 helpline.
- Toll-Free Call Centre: Beneficiaries can reach out through a 24X7 toll-free call center, offering assistance and feedback options.
- Transport Allowance: A transport allowance of Rs. 200 is provided at the time of discharge, with additional allowances for patients admitted to state government-run hospitals.
- Empanelled Hospitals: The scheme includes a vast network of over 1500 empanelled hospitals, with ongoing additions.
- Claims Settlement: Claims are settled online within 30 days, with interest payable if delayed.
- E-Health Record: Real-time uploading of E-health records on discharge, accessible to physicians for consultation.
- Monthly Analytical Report: A monthly analytical report is proactively disclosed in the public domain for review and suggestions from stakeholders.
- Online Grievance Monitoring Mechanism: People involved can share their complaints on the Swasthya Sathi online platform.
- Identification of Triggers and Outliers: Using machine intelligence and human intervention, the system spots unusual patterns like high admissions, blocked high-value packages, claimed but not performed procedures, unnecessary surgeries, repetitive packages on a particular day, etc.
- Interactive Website: By November 30, 2019, more than 34 Lakh individuals had visited the website. It features a “May I Help You” option for general queries. People can check their eligibility and enrolment details online.
- Coverage of Pre-existing Diseases: All pre-existing medical conditions are included in the scheme.
- State-Borne Premium: The State Government covers the entire premium; beneficiaries don’t need to contribute.
- Swasthya Sathi Smart Card: Families receive an online Swasthya Sathi Smart card at the time of enrolment, containing family details, photographs, biometrics, address, mobile number, and SECC ID.
- Paperless IT Platform: The scheme’s management operates on a paperless IT platform from its initiation.
- Online Empanelment & Gradation of Hospitals: Hospitals are empanelled and graded based on available services and infrastructure through an online process.
- 100% Online Pre-authorization: Pre-authorizations for medical services are entirely online with a quick turnaround time of 24 hours.
- SMS Triggers and Alerts: Beneficiaries receive SMS triggers and instant alerts when their card is blocked.
How to Apply for the Swasthya Sathi Scheme?
To sign up for the Swasthya Sathi Scheme, follow these easy steps:
- Go to the official Swasthya Sathi Scheme website: https://swasthyasathi.gov.in.
- Look for the “Apply Now” button on the homepage and click it.
- Fill in the online form with your correct details, like your and your family’s info and income details.
- Upload your ID proof, address proof, and income certificates.
- Click submit!
After that, they’ll check the details you gave. Once everything is okay, they’ll send you your Swasthya Sathi card in the mail.
How Does a PHR App Contribute to the Swasthya Sathi Scheme?
Using a PHR app can make things easier and more convenient for people. Here’s how:
- Accessing Scheme Information: The app can show details about schemes, like what’s covered, which hospitals are included, how to make a claim, and answers to common questions. This saves time compared to searching online or calling for help.
- Managing Health Records: You can upload and keep medical records in the app, like prescriptions and test results. This makes it easy to submit documents when you need to make a claim, and you don’t have to worry about carrying physical copies.
- Pre-authorization and Cashless Claims: Some PHR apps can connect with Swasthya Sathi insurance providers or hospitals. This lets you:
- Confirm coverage before going to the hospital.
- Start cashless claims right from the app.
- Keep track of your claim and get updates.
Certain PHR apps remind you about appointments, medications, and health checkups. This helps you manage your health overall and might mean fewer claims in the future.
Some apps can help you find nearby approved hospitals and compare them based on ratings and availability.
With all these benefits and more, a PHR app like Health-e acts like a digital health locker. It securely stores all your medical records for free. You can digitize and save various documents on Health-e, like lab reports, medical records, insurance info, vaccination records, and details about any chronic illnesses you may have. With the ABHA health ID card, you can easily share your medical history with healthcare providers for a smooth claim process.
Frequently Asked Questions (FAQs):
You can find out if your card is approved by visiting their official website.
No, the card is valid for lifetime and renews by itself every year if you’re still eligible.