Su-Swastha Yojna — Sikkim Employees' Health Services Scheme

What is Su-Swastha Yojna?

Su-Swastha Yojna is the Employees' Health Services Scheme of the Government of Sikkim, run by the Department of Health and Family Welfare. It was launched in April 2021 by Chief Minister Shri Prem Singh Tamang, and it gives regular state government employees and their dependent family members cashless hospitalisation across a network of empanelled hospitals throughout India.

Su-Swastha Yojna is not an insurance policy bought from an insurer. According to the scheme's official FAQ, covered hospital charges are paid directly by the Department of Health and Family Welfare under its agreement with the empanelled hospital. The scheme runs on a healthcare fund built from employee contributions plus a government contribution, and it is administered by the Su-Swastha Facilitation Centre on the first floor of the Old STNM Hospital, near MG Marg, Gangtok – 737101.

The name is also written Su Swasthya Yojana and Suswastha Yojana in general use; the scheme's own portal spells it Su-Swastha Yojna.

The scheme's design has three distinctive features. First, pre-existing diseases are covered from the first day of enrolment; there is no waiting period, which is unusual and directly relevant to older dependants. Second, the network is deliberately national rather than state-only, so an employee referred to a hospital in Kolkata, Siliguri or Delhi stays inside the cashless system. Third, the scheme covers heads that most employer schemes exclude, including vehicular accidents and trauma, cancer chemotherapy and dialysis.

What does Su-Swastha Yojna cover?

The financial limits

• Base cover: Rs 10 lakh per family per year, irrespective of the number of dependants enrolled.
• Critical care cover, an additional Rs 10 lakh for the entire family, again irrespective of the number of dependants.
• The Rs 10 lakh base limit cannot be increased by the employee.
• If the cover is exhausted before the year ends, the beneficiary bears the extra cost personally.

What is covered

What is not covered

The exclusion list published on the portal is long, and the items that most often surprise employees are these:

• Advances of any amount are not covered; hospitals will typically charge an advance at admission for planned treatment, or within 24 hours for emergency care.
• Pre-hospitalisation expenses are not admissible unless they form part of an agreed procedure package.
• Travelling allowance for the patient, attendant or escort. Other Government of Sikkim rules may cover this; the scheme does not.
• Hospital registration, admission, record and telephone charges.
• Death or permanent total disablement claims, Su-Swastha pays healthcare expenses, not damages.
• Non-medical consumables such as diapers, toiletries, talcum powder and oral hygiene products.
• Post-operative home aids such as crutches, wheelchairs, braces, walking sticks and home oxygen cylinders.
• Bariatric surgery and obesity treatment, cosmetic and aesthetic treatment of any description, and plastic surgery other than after an accident or as part of an illness.
• Experimental and unproven therapies, stem cell therapy, platelet-rich plasma procedures and intra-articular injection therapy.
• Oral chemotherapy, immunotherapy and biologicals, except when administered as an in-patient where clinically indicated.
• Admission primarily for diagnostic purposes with no positive finding and no further treatment indicated.
• Illness arising from substance abuse, alcohol, smoking and tobacco chewing; venereal and sexually transmitted diseases; injury from war, nuclear or terrorism causes; professional sport and hazardous activities; and any loss from the beneficiary's own illegal act.

Who is eligible for Su-Swastha Yojna in Sikkim?

You can enrol as a primary member if:

• You are an employee of the Sikkim government appointed against a regular post, eligible from the date of joining the regular post; or
• You are a central government servant, or a government servant of another state, on deputation to the Government of Sikkim.

You can be added as a dependant if you are:

• A parent of the employee or of the employee's spouse. Step-parents are excluded. Parents-in-law are expressly allowed.
• The legally wedded spouse of the employee. Where both spouses are regular government employees, they may either enrol separately as primary members or one may be a dependant on the other, but nobody can be a primary member and a dependant at the same time.
• An unemployed unmarried son up to the age of 30 years.
• An unemployed unmarried daughter of any age.
• An unmarried, unemployed biological brother or sister up to the age of 30 years.
• An unmarried, unemployed child or sibling with a certified mental or physical disability preventing gainful employment, at any age, for as long as the primary member remains employed. Disability here means blindness, hearing impairment, locomotor disability, mental retardation, mental illness or any other illness or disability certified by a competent authority or medical board.

A maximum of five dependants may be enrolled per employee, in any combination from the list above.

You cannot apply, or are not eligible, in these situations.

• You are a contractual, muster roll or ad hoc employee. The official FAQ states these categories are not eligible in the current phase.
• You are a retired employee. Retirees are not eligible, and the scheme cannot be continued after retirement on a self-paid basis.
• You are a legally divorced spouse of an employee.
• You are a grandchild of the employee. Grandchildren cannot be added as dependants.
• You are a step-parent of the employee or spouse.
• You are an employed or married child or sibling, or a son over 30 who does not have a certified disability.
• You would be the sixth dependant. In no case can more than five be added.
• Your primary member has left service through death, retirement, termination or resignation, dependant cover then stops automatically.

How much do employees contribute?

The employee contribution is Rs 200 per month for the employee and a further Rs 200 per month for each dependant. An employee enrolling five dependants contributes Rs 1,000 a month for them, in addition to their own Rs 200, a total of Rs 1,200 a month, or Rs 14,400 a year, against Rs 10 lakh of base family cover plus Rs 10 lakh of critical care cover.

The remainder of the healthcare fund is contributed by the Government of Sikkim.

How to apply for Su-Swastha Yojna

Enrolment is online, through the scheme's own portal, and is routed to your department for approval.

1. Visit the official website at suswasthasikkim.com and click Enrol Now.
2. Log in using your registered mobile number and verify it with the OTP sent to that number. You are then taken to the online enrolment form.
3. Complete Part 1 of the form, which enrols you as the primary member, and submit it. Have your employee ID ready, the portal accepts only specific employee ID types, and if you do not hold one you must obtain it from your department rather than substituting another number.
4. Complete Part 2 of the form, which enrols your dependants. Fill in every mandatory field and upload the required documents in the specified format and size, including a photograph, an identity proof and a relationship proof for each dependant.
5. Agree to the self-declaration and submit. You will receive an SMS and an email confirmation. The responsibility for the truth of the dependant declaration rests on the employee, and action may be taken if the information is found untrue.
6. Wait for your departmental nodal officer to approve the application. A list of nodal officers is published on the portal.
7. Download your member e-card using the link sent by SMS and email once the application is approved. This card is required to avail any benefit.

Save both the e-card and your member ID on your phone. If a card is lost, you can download another from the website or print it on plain plain paper, and if you have noted the ID number, that number alone will usually suffice. Two numbers are issued against each enrolled employee: one policy ID per family, and a unique member ID card for every enrolled person in the family.

A dependant may be added or removed at any time during the membership, and the primary member does not need the dependant's consent to remove them.

How do I use the scheme at a hospital?

For planned or elective hospitalisation:

1. Check the list of empanelled hospitals on the portal, or call the Su-Swastha Facilitation Centre helpline on 9800347944 before planning the admission.
2. Make an appointment or visit the empanelled hospital directly. You may go straight to a private empanelled hospital.
3. The hospital raises an online pre-authorisation request, which the Facilitation Centre approves.
4. You are admitted on a cashless basis and treated.
5. On discharge you settle only the charges that are not covered. The excluded items — directly with the hospital. The hospital raises a claim for the covered charges, which the Department of Health and Family Welfare pays.

For emergency hospitalisation:

1. Go to any hospital as an emergency.
2. Inform the Su-Swastha Facilitation Centre within 24 hours of admission. This is the step that decides whether the case can be brought inside the scheme.
3. Submit the Su-Swastha approval letter to the hospital.
4. If the hospital provides cashless services, the process continues as above. If it opts out, you settle the bill directly and raise a reimbursement claim on the Su-Swastha online web portal, accessible through the website or the app.

Carry your Su-Swastha card and one photo ID; Aadhaar, Voter ID, PAN or driving licence; to every admission, inside or outside Sikkim.

Why do enrolments and claims fail, and how do you fix it?

• Wrong employee ID used at enrolment. The portal accepts only specific ID types; ask your department rather than entering a payroll or file number.
• Relationship proof missing or mismatched. For a newborn, use the hospital discharge card attested by a gazetted government official; where no government proof exists at all, an affidavit attested by a gazetted officer is accepted.
• A dependant who does not qualify, a grandchild, a step-parent, a divorced spouse, an employed sibling or a son over 30 without a certified disability.
• Attempting to enrol a sixth dependant.
• Emergency admission not reported within 24 hours, which is the condition for bringing a non-planned admission into the cashless route.
• Treatment at a non-empanelled hospital, where only the reimbursement route is available and excluded items are still never paid.
• Claiming excluded items, advances, registration and admission charges, attendant travel, home aids or consumables. These are never reimbursed, whether the care was cashless or not.
• Cover exhausted. Once the Rs 10 lakh family limit is used up in a year, the balance is the beneficiary's own cost.

Where a covered charge was paid by the patient directly to the hospital for any reason, the scheme's FAQ states that it is reimbursed to the employee by the employer, so raise it with your department rather than writing it off.

Where do I get help or complain?

• Toll free helpline to 1800-000-1234
• Helpline and WhatsApp to 9800347944
• General enquiries, info@suswasthasikkim.com
• Grievances and support, support@suswasthasikkim.com
• In person; Su-Swastha Yojna Facilitation Centre, first floor, Old STNM Hospital, near MG Marg, Gangtok, Sikkim – 737101

Complaints and feedback can also be raised directly on the suswasthasikkim.com website. For approval-stage questions about an enrolment that has not moved, the right first contact is your departmental nodal officer, whose details are in the nodal officers list published on the portal.

How to check your application status

Su-Swastha Yojna enrolment moves through two stages after you submit the online form: departmental nodal officer approval, and then card generation. There is no separate public "track application" page on suswasthasikkim.com, so status checking runs through login, SMS/email, and the nodal officer or helpline rather than a tracking number.

Check your enrolment status this way:

1. Log back in to suswasthasikkim.com with your registered mobile number and OTP. A pending enrolment shows as awaiting departmental approval; an approved one shows the option to download your member e-card.
2. Watch for the SMS and email confirmations. You get one when you first submit the form, and a second with the e-card download link once your departmental nodal officer approves it. If the second message never arrives, the application is still sitting with the nodal officer.
3. Contact your departmental nodal officer directly if approval has not come through after a reasonable wait. The nodal officer list published on the portal names the approving official for each department, and this is the correct first point of contact for an enrolment stuck at the approval stage, not the general helpline.
4. Call the helpline on the toll free number 1800-000-1234 or 9800347944 (also used for WhatsApp) if you cannot identify your nodal officer or the portal itself is not reflecting your status.
5. Visit the Su-Swastha Facilitation Centre in person (first floor, Old STNM Hospital, near MG Marg, Gangtok) if the issue needs to be resolved face to face, for example a document that was rejected without clear reason.

Checking a claim or reimbursement, as opposed to enrolment:

• For a cashless hospitalisation, the pre-authorisation status is tracked between the empanelled hospital and the Facilitation Centre; ask the hospital's insurance or billing desk for the pre-authorisation reference, and quote it if you call the helpline.
• For a reimbursement claim filed through the Su-Swastha online portal after a non-empanelled or opted-out emergency admission, log in to the same portal account used for enrolment to see whether the claim is still under review or has been settled; if the status has not changed for an extended period, email support@suswasthasikkim.com with the claim details, or call the helpline.
• For any query specifically about fund transfer or reimbursement timing, raise it with your department, since the scheme's FAQ states that amounts a patient paid directly for covered charges are reimbursed to the employee through the employer.

Keep your member ID and, where relevant, the pre-authorisation or claim reference number ready before you call; the helpline and facilitation centre staff work off these identifiers rather than your name alone.