West Bengal Government Swasthya Sathi Health Insurance Scheme

Swasthya Sathi scheme aims to reduce heavy medical bills by providing treatment to people without the need for cash, it also provides basic health cover for secondary and tertiary care up to Rs 5 lakh per year per family.
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3 min
10-June-2025

On December 30, 2016, the Chief Minister of West Bengal introduced the Swasthya Sathi scheme. This scheme makes every family and individual, regardless of age, eligible to register under the program. This comprehensive health plan covers primary, secondary, and tertiary care expenses up to Rs. 5 lakh annually per family. The program, fully funded by the state government, operates on a cashless, paperless, and smart card-based system.

The Swasthya Sathi scheme aims to alleviate the substantial medical expenses borne by individuals, providing West Bengal residents with cashless treatment. Upon enrollment, each beneficiary family receives an Online Swasthya Sathi card, containing details of insured family members, such as biometrics, photos, mobile numbers, and SECC ID.

What is the Swastha Sathi Scheme?

The Swasthya Sathi Scheme is a health insurance initiative launched by the Government of West Bengal on December 30, 2016. Open to individuals of all ages, the scheme provides comprehensive coverage of up to Rs. 5 lakh per family per year for various medical expenses. Fully funded by the state government, the program is cashless, paperless, and operates through a Smart Card system.

Designed to ease the burden of high healthcare costs, the Swasthya Sathi Scheme ensures that beneficiaries can access treatment without any out-of-pocket payment. The scheme also focuses on improving healthcare access by including empanelled hospitals in rural and semi-urban areas, along with affordable diagnostic centers, pharmacies, and critical care units—ensuring quality healthcare at reasonable prices across the state.

Swasthya Sathi Scheme: An overview

Given below are the key aspects of the West Bengal government introduced Swasthya Sathi scheme:

Official launch date

December 30, 2016

Family size

No capping

Coverage

Up to Rs. 5 lakh

Payment mode for treatment

Smart card based

Pre-existing

Covered

Beneficiary assistance mode

Swasthya Sathi mobile app

Partner insurance companies

National Insurance Company

United India Insurance Company

Bajaj Allianz Health Insurance

Vision and mission of Swasthya Sathi scheme

The vision of the Swasthya Sathi scheme is to gradually extend healthcare coverage to a larger section of society in West Bengal, aiming for universal health protection for every resident of the state. The mission is to reduce out-of-pocket healthcare expenses for residents, particularly for secondary and tertiary care, by providing cashless, paperless treatment. The scheme targets low-earning workers and volunteers across various state-administered projects, providing them with group health protection to prevent catastrophic expenditure due to hospitalisation.

Main features & benefits Of Swasthya Sathi Health Scheme

Given below are the key features of the scheme:

  • Health coverage: Offers comprehensive health insurance coverage of up to ₹5 lakh per family annually for secondary and tertiary care.
  • Pre-existing conditions: All pre-existing diseases are covered right from the date of enrollment—no waiting period.
  • Unlimited family size: There is no cap on the number of family members. Coverage includes both spouses’ parents. The smart card is preferably issued in the name of the eldest female as the family head.
  • No premium contribution: Beneficiaries are not required to pay any premium or card issuance fee. The Government of West Bengal bears the entire cost.
  • Smart card system: A 64Kb biometric smart card is issued during enrollment, enabling fully paperless and cashless transactions. The card remains valid for life and is auto-renewed each year.
  • Digital IT platform: The scheme functions on a seamless, cloud-based IT system, ensuring paperless operations, real-time monitoring, and transparent service delivery.
  • Pre-authorized treatments: All medical procedures under the scheme require 100% pre-authorization, granted within 24 hours to ensure timely treatment.
  • Hospital gradation: Empanelled hospitals are graded based on the quality of infrastructure and services, reviewed by an official committee.
  • Cashless hospitalisation: Covers consultation, diagnostic tests, hospitalisation, medicines, food during the stay, and post-discharge medication for the same condition—completely cashless.
  • Standardised package rates: Offers over 2,092 treatment packages with dynamic pricing adjusted by the Package Selection Committee.
  • Real-time SMS updates: Beneficiaries receive SMS notifications during admission, discharge, and in case of any critical card or treatment status updates.
  • Mobile app access: A dedicated mobile app offers scheme information, FAQs, and a one-touch 24/7 helpline feature.
  • 24x7 toll-free helpline: Round-the-clock support is available via a toll-free call centre for assistance, queries, and feedback.
  • Transport allowance: Patients receive ₹200 for transport at the time of discharge, with additional support for admissions to government-run hospitals.
  • Extensive hospital network: Over 1,500 hospitals are empanelled under the scheme, with new ones added regularly to enhance access.
  • Timely claims settlement: Claims are processed entirely online and settled within 30 days. Interest is paid in case of delays.
  • E-health records: On discharge, electronic health records are uploaded in real-time, enabling future consultations and improved care continuity.
  • Monthly public reporting: A comprehensive monthly analysis report is published publicly to maintain transparency and invite stakeholder suggestions.
  • Online grievance redressal: Beneficiaries can submit complaints and feedback through the official Swasthya Sathi portal.
  • Fraud detection mechanism: The system uses AI and human checks to flag unusual patterns such as excessive admissions, blocked packages, or unnecessary surgeries.
  • Interactive website: As of November 30, 2019, the website had over 34 lakh visitors. It offers features like “May I Help You,” eligibility checks, and enrollment status.
  • Smart card details: The Swasthya Sathi Smart Card includes family photographs, biometrics, address, mobile number, and SECC ID.
  • Fully digital management: From card issuance to hospital empanelment, all processes are managed through a paperless digital platform.
  • Online empanelment and hospital gradation: Hospitals are added and graded via an online system based on services and facilities available.
  • Complete online pre-authorization: All treatment pre-approvals are processed digitally with a quick turnaround of 24 hours.
  • Instant alerts: Beneficiaries receive real-time SMS alerts, including notifications if their card is blocked or requires action.

Pro Tip

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Key functions of the Swasthya Sathi Health Insurance Scheme

The scheme offers multiple functionalities. Given below are the same:

  • Online platforms: The scheme operates entirely without paperwork, utilising a seamless cloud-based IT platform. Online monitoring of the program not only conserves valuable time and resources but also ensures the swift delivery of services.
  • Transparent hospital gradation: The hospitals are graded based on marks obtained on the facilities and services available. These are physically verified by the IC/TPA (insurance company/third-party administrator).
  • Pre-authorisation: There is 100% online pre-authorisation with turn-around time of 24 hours.
  • Health records: Immediate uploading of beneficiaries' E-health records upon discharge in real time.

Eligibility for Swasthya Sathi scheme

Before applying for the Swasthya Sathi Smart Card, it is essential to understand the eligibility criteria to ensure you or your family qualify for the scheme. This helps streamline the enrollment process and ensures that those who truly need financial protection for medical care can access it without delay.

The Swasthya Sathi Scheme is designed to offer health coverage to economically vulnerable families in West Bengal. The eligibility guidelines have been thoughtfully crafted to include those who often lack access to affordable healthcare services.

  • You should be a permanent resident of West Bengal.
  • There is no age restriction for the dependent member with a physical disability.
  • Enrolment in another government health insurance scheme is not permissible.

How to apply for the Swasthya Sathi Card?

To apply for a Swasthya Sathi card online, visit the official website, fill out the application form, and submit the required documents. You can follow the steps given below to apply for the scheme:

Step 1: Visit the official website swasthyasathi.gov.in

Step 2: Enter your mobile number and click on ‘Get OTP’. Verify the OTP and click on ‘Submit.’

Step 3: Select the district, panchayat, and municipality name from the list that appears on the screen.

Step 4: Fill in the other details like category, department name (for employed applicants), office name and address, residential address, and PIN code.

Step 5: Further, fill in the applicant’s name, and the name of the head of the family.

Step 6: Mention if any member of the applicant’s family is enrolled under any government or private scheme.

Step 7: After filling in all the information, click on ‘Submit’ to complete the application process.

Documents required to apply for the Swasthya Sathi Card

While filling in the application process, you must keep the following documents handy. This helps ensure quick verification and smooth approval, especially if you are applying for schemes like the Sastho Sathi card, which require accurate personal and identity details.

  • Aadhar card number (12 digits)
  • Khadyasathi ration card number
  • Registered mobile number
  • Employment status of the member
  • Legal Domicile documents

Registration process for Swasthya Sathi Hospitals

Given below are the steps that can be followed for Swasthya Sathi hospital registration:

  • Step 1: Navigate to the official Swasthya Sathi Scheme online portal.
  • Step 2: Locate the 'Apply Online' button on the top menu bar and choose 'Hospital Registration' from the dropdown menu.
  • Step 3: Provide essential details like district name, hospital category, hospital name, address, and contact number.
  • Step 4: Attach the required documents and finalize the Swasthya Sathi hospital registration by clicking 'Submit'.

How to check Swasthya Sathi Hospital Registration status?

  • Visit the official Swasthya Sathi website.
  • Click on the “Hospital Registration Status” option.
  • Enter the hospital name or district to check if it’s empanelled.
  • View the status and available services online.

How to register for treatment outside West Bengal under Swasthya Sathi Health Scheme?

  • Go to the Swasthya Sathi portal or contact the helpline.
  • Select the “Outside WB Treatment Registration” option.
  • Fill in patient and treatment details.
  • Submit documents online for pre-authorization and approval.

How to download the Swasthya Sathi App?

Given below are the steps to download the Swasthya Sathi App, enabling convenient access to healthcare services and information for beneficiaries of the Swasthya Sathi scheme in West Bengal. The Swasthya Sathi card download process is also online and beneficiaries can download it through the official website:

Step 1: Search for the Swasthya Sathi app on playstore.

Step 2: Click on the app with the official logo and download the app.

How to claim benefits under the Swasthya Sathi Scheme

  • Visit any empanelled hospital under the Swasthya Sathi network.
  • Show your Swasthya Sathi card at the hospital helpdesk for verification.
  • The hospital will authenticate your details using biometric or card-based identification.
  • Choose the required treatment under the cashless facility.
  • The hospital initiates the pre-authorisation request to the insurer/TPA.
  • After approval, you receive treatment without paying upfront.
  • The hospital submits final documents, and the claim is settled directly under the scheme.

Online URN verification process for Swasthya Sathi

Beneficiaries can easily verify their Unique Registration Number (URN) online under the Swasthya Sathi scheme. To do so, visit the official Swasthya Sathi portal, click on ‘Find Your Name’, enter the URN or registered mobile number, and verify the details. This ensures eligibility and access to cashless healthcare benefits.

How does PHR app contribute to Swasthya Sathi Scheme?

The Personal Health Record (PHR) app supports the Swasthya Sathi scheme by digitising healthcare access and medical records. Key benefits include:

  • Secure storage of medical history and prescriptions

  • Real-time access to health data during hospital visits

  • Easy claim tracking and updates for Swasthya Sathi beneficiaries

  • Integration with Ayushman Bharat Digital Mission (ABDM) for seamless healthcare services

Contact details for Swasthya Sathi scheme

In case of any query related to the scheme, issues with the claim process, or any other information, the beneficiaries can contact using the information given below:

  • The back of the smart card displays a 24x7 toll-free call center number: 1800-3455-384 for assistance.

  • Beneficiaries can also seek help through various social media platforms, including Facebook, Twitter, and WhatsApp.

  • You can also download the Swasthya Sathi mobile app for assistance to the beneficiaries.

Importance of health insurance for all

In today’s unpredictable world, health concerns are rising, and having financial coverage for the same has become extremely important. Given below is the significance of a health insurance policy:

  • Financial protection: Shields against exorbitant medical expenses.
  • Access to quality healthcare: Ensures access to advanced medical treatments.
  • Preventive care: Encourages regular health check-ups and early detection.
  • Risk mitigation: Guards against unexpected health crises.
  • Family security: Provides comprehensive coverage for the entire family.
  • Critical illness support: Offers financial aid for critical illnesses.
  • Community well-being: Aids in building healthier and more resilient communities.
  • Promotes healthy lifestyle: Fosters a proactive approach to personal well-being.

Being enrolled in a government or private health insurance scheme can be of utmost help to any individual. Be it the Swasthya Sathi scheme, or any other scheme as per the individual’s requirement.

Conclusion

The Swasthya Sathi Scheme offers accessible and cashless healthcare support for families across West Bengal. By understanding the enrollment steps, claim process, and card benefits, you can make the most of this initiative. For broader protection and customised health coverage options, explore additional Insurance plans that offer enhanced financial security and peace of mind.

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Frequently asked questions

Who is eligible to apply for the Swasthya Sathi Health Scheme?

To be eligible for the Swasthya Sathi Scheme, one must be a West Bengal resident, not enrolled in another government health insurance scheme. Health cards are issued under the name of the eldest female family member.

How can I download the Swasthya Sathi Scheme form?

The Swasthya Sathi scheme form can easily be downloaded from the official website.

How to check Swasthya Sathi balance?

To check your Swasthya Sathi balance, visit the official website or use the Swasthya Sathi mobile app. Log in with your credentials and navigate to the balance inquiry section to view your available funds and transaction history.

How much money is in Swasthya Sathi card?

The amount on your Swasthya Sathi card varies based on eligibility and benefits received. Typically, it covers essential healthcare expenses, including hospitalization, diagnostics, and treatments, up to the specified limit under the scheme.

Does Swasthya Sathi cover pregnancy?

Yes, the Swasthya Sathi scheme covers pregnancy-related expenses, including prenatal care, delivery, and postnatal care. Beneficiaries can access these services at empaneled hospitals and healthcare facilities across West Bengal.

How to check Swasthya Sathi balance?

You can check the Swasthya Sathi balance using the official app, discharge slip (in case of hospitalisation), or by calling on the 24x7 customer care number.

What is the coverage for Swasthya Sathi?

The scheme provides coverage of up to Rs. 5 lakh for secondary and tertiary care per annum for each enrolled family.  

Who cannot apply for Swasthya Sathi card?

Individuals who are government employees, already covered under any government health scheme, or those with existing medical insurance provided by the employer are not eligible for the Swasthya Sathi card. Also, residents outside West Bengal typically cannot apply unless permitted under special provisions.

What is Swasthya Sathi benefit?

Swasthya Sathi offers cashless health coverage of up to ₹5 lakh per family per year for secondary and tertiary care. It covers pre- and post-hospitalisation expenses, diagnostics, and over 1,500 listed treatments. The scheme also includes free smart card issuance and paperless claim processing.

Where Can I Check if My Swasthya Sathi Card Application is Approved?

You can check the approval status of your Swasthya Sathi card application on the official portal www.swasthyasathi.gov.in. Go to the “Find Your Name” section, enter your registered mobile number or URN, and view your card status instantly.

What are key features and benefits of Swasthya Sathi Health Insurance Scheme?
  • Provides health coverage up to Rs. 5 lakh per family per year for secondary and tertiary treatments.
  • No cap on family size; covers parents of both spouses and dependent family members.
  • All pre-existing diseases are covered from day one.
  • Entire premium is paid by the Government of West Bengal—beneficiaries pay nothing.
  • Cashless, paperless treatment using a smart card.
  • 24×7 helpline, mobile app support, and real-time digital tracking available.
What is Sastho Sathi Card?

The Sastho Sathi Card, also called the Swasthya Sathi Smart Card, is a biometric-enabled health card given to eligible families. It contains family details, a photograph, and is required for availing cashless treatment at empanelled hospitals under the scheme.

What is the official website for the Sastho Sathi Scheme?

The official website is the Swasthya Sathi portal managed by the Government of West Bengal (name only, no link as requested).

How can I check Swasthya Sathi card name online?
  • Visit the official portal’s beneficiary search section.
  • Enter your registration number, smart card number, or family ID.
  • Your enrolled family members’ names will be displayed.
How to check Swasthya Sathi card online?
  • Go to the card verification section on the official portal.
  • Enter required details such as district and registration number.
  • The system will show your card details, validity, and status.
How to check Swasthya Sathi status online in West Bengal?
  • Visit the Swasthya Sathi website.
  • Select “Application Status” or “Status Check.”
  • Enter your district and registration/smart card number.
  • View whether your card is active, pending, or blocked.
What is Swasthya Sathi Coverage Details?
  • Up to ₹5 lakh per family per year.
  • Coverage includes hospitalization, surgeries, diagnostics, medicines, and follow-up care.
  • Covers pre-existing diseases.
  • Cashless treatment at empanelled hospitals.
  • Pre- and post-hospitalisation benefits are included.
Who is eligible for Swasthya Sathi?

Eligibility includes:

  • Residents of West Bengal who are not covered under a similar government health scheme.
  • Families identified through state databases, including SHG members, ASHA workers, certain contractual staff, and more.
  • No age limit; entire family is covered.
Is Swasthya Sathi Scheme available for government employees?

The scheme is not applicable to regular state government employees who already receive medical allowances or are covered under other employee medical schemes.
However, some categories like contractual staff, ASHA workers, and self-help group members may be included.

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