Organisation : West Bengal Health & Family welfare Department (e-WBHFW)
Scheme Name : Swasthya Sathi Scheme
Applicable For : West Bengal
Website : http://swasthyasathi.gov.in/
Swasthya Sathi Scheme :
Swasthya Sathi” was announced in Cabinet No – 2625 dated 17th February, 2016, and Finance Department notification no – 1104-F (P) dated 25th February, 2016.
Related : Swasthya Sathi Track Hospital Detail West Bengal : www.statusin.in/26099.html
A State level Implementation Committee (SLIC) under the chairmanship of the Chief Secretary formed to oversee the scheme and there is a registered society named “Swasthyasathi 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
Main Features of the Scheme :
** Basic health cover for secondary and tertiary care up to Rs 1.5 Lakh per annum through Insurance mode (PSU) and Critical illness like Cancer, Neuro surgeries, cardiothoracic surgeries, liver diseases, blood disorders etc. up to Rs 5 Lakh through Assurance mode.
** NIC as insurance partner in 9 District and UIIC in 11 Districts. Premium per family ranges from Rs 3549 In Kolkata to Rs 1729 in Dakshin Dinajpur
** Paperless, Cashless, Smart Card based.
** There is no cap on the family size and Parents from both the Spouse are included.
** All pre-existing diseases are covered.
** The entire premium is borne by the State Government and no contribution from the beneficiary.
** Online Swathyasathi 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, ADHAAR No ( if available)
** 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
** Android based Swasthya Sathi Mobile app for assistance to the beneficiaries
A State level Implementation Committee was formed under the chairmanship of the Chief Secretary to the Government of West Bengal to oversee the implementation of “Swasthya Sathi” vide notification no – HF/O/Swasthya Sathi/097/2016/4032 dated 2nd March, 2016.
The first meeting of State level Implementation Committee was held at Nabanna on 8th March, 2016 where it was resolved that The Scheme will have basic health coverage for Secondary and tertiary care up to Rs 1.5 lakhs per annum per family through Insurance Mode and up to 5 Lakhs for certain critical diseases like, cancer, Neuro-surgery, orthopedic and cardio logical diseases etc through assurance mode under the umbrella of Swasthyasathi samiti..
There will be no cap on the Family size and parents of both the spouses will be eligible under the scheme. All pre-existing diseases will be covered from the first day of the policy.
The second meeting of State level Implementation Committee was held at Nabanna on 5th July, 2016. State level Implementation Committee in its second meeting approved the administrative setup and proposed IT framework to make the scheme paperless, Cashless through use of Smart card.
State level Swasthya Sathi Package Selection Committee was formed for selection of different packages, package rates and categories. More than 1900 packages have been approved for the said scheme.
E – tender was introduced for selection of group health insurance provider for Swasthya Sathi scheme, vide memo no – HF/O/SS/ Tender _ INS/74 dated 9th September 2016. Only public sector Insurance Companies were allowed to participate in the e-tender.
National Insurance Company (9 Districts) and United India Insurance Company (11 Districts) were selected as insurer for respective districts.
Offer letters were issued with the approval of Finance Department vide UO No 2096 dated 2.11.16. Total estimate approved by Finance Department is Rs 1363.72 Cr for 2016-17.