Swasthya Sathi Scheme

What is the Swasthya Sathi Scheme?

Swasthya Sathi is the health assurance scheme of the Government of West Bengal, run by the Department of Health and Family Welfare. Swasthya Sathi gives an enrolled family cashless hospital treatment for secondary and tertiary care up to Rs 5 lakh per family per year, and the state government pays the entire premium so that the family contributes nothing at all.

Swasthya Sathi was announced in Cabinet Memorandum No. 2625 dated 17 February 2016 and Finance Department notification no. 1104-F(P) dated 25 February 2016. The scheme was formally launched by the Chief Minister of West Bengal on 30 December 2016 and rolled out from 1 February 2017. Monitoring sits with a State Level Implementation Committee chaired by the Chief Secretary, and with a registered society, the Swasthya Sathi Samiti, registered on 15 November 2016.

According to figures published on swasthyasathi.gov.in, the scheme covers 2.42 crore families, has empanelled more than 2,800 hospitals, and has funded over 107 lakh hospitalisations, with beneficiary data updated to 31 December 2025 and 98.39 per cent of claims preferred up to 30 April 2026 already settled. Those numbers make Swasthya Sathi one of the largest state health assurance programmes in the country and confirm that it is fully operational.

Key features published on the official portal

• Basic health cover for secondary and tertiary care up to Rs 5 lakh a year.
• Paperless, cashless and smart-card based from day one.
• All pre-existing diseases covered.
• No cap on family size; parents of both spouses included.
• All dependent physically challenged persons in the family covered.
• Entire premium borne by the state, zero contribution from the beneficiary.
• Online smart card issued on the day of enrolment itself.
• 100 per cent online pre-authorisation with a 24-hour turnaround.
• Claim reimbursement to hospitals within 30 days, with interest charged for delay.

Who is covered by Swasthya Sathi, and who is not?

Covered:

• Families resident in West Bengal, enrolled through the state's enrolment drives.
• Every member recorded on the card, with no upper limit on family size.
• Parents of both spouses, which means a card can cover two sets of in-laws alongside the couple and their children.
• Dependent physically challenged members of the household.
• Anyone with a pre-existing condition, from the first day of cover.

The card is issued in the name of the senior-most woman of the household, which is why the scheme is described on the portal under the heading of women's empowerment. The card carries names, photographs, biometrics, address, mobile number and SECC ID for each member.

Not covered, or not eligible to claim:

• OPD consultation is not a benefit. Only hospitalisation of 24 hours or more, and the listed day-care procedures, are covered.
• Tests and medicines with no admission must be paid for by the family.
• People who are not residents of West Bengal cannot apply.
• A member not recorded on the family's smart card cannot claim on it.

The official portal does not publish a formal exclusion list of households. A family already covered by another government-funded health scheme such as the West Bengal Health Scheme for state employees, CGHS or ESI should confirm its position with the District Key Manager before enrolling, rather than assume double cover.

How to apply for a Swasthya Sathi card

1. Find the enrolment point for your area. Swasthya Sathi enrolment is done offline through the district Swasthya Sathi machinery and at government enrolment camps. The District Key Manager for your district is the officer responsible, and the 24x7 toll free number 1800-345-5384 will tell you where the nearest active enrolment point is.
2. Take the whole family, or their details and photographs. The card records every member. The couple, children, parents of both spouses and dependent physically challenged members. Carry Aadhaar for each person.
3. Complete biometric capture at the counter. Fingerprints are recorded so that any enrolled member of the family can authenticate at a hospital later.
4. Give an active mobile number. Every alert about card blocking, amount deducted and balance left is sent by SMS to this number.
5. Collect the smart card the same day. The portal states that the online Swasthya Sathi smart card is provided to each family on the day of enrolment, along with a booklet listing empanelled hospitals.
6. Install the Android app from the Play Store and note your URN number, so you can check balance and the active hospital list yourself.

There is no fee at any step, and no premium is ever collected from the family.

How do you use the card at a hospital?

1. Choose an empanelled hospital. Both public and private hospitals are empanelled and graded A, B, C or R according to facilities and infrastructure. The list comes with the card, and is also on the portal under Active Hospital List and in the mobile app.
2. Go to the Swasthya Sathi counter. Every empanelled hospital has a dedicated counter to guide beneficiaries.
3. Produce the smart card within 24 hours of admission. This is the single hard rule. If the card is not deposited within 24 hours of hospitalisation, the cost has to be borne by the beneficiary.
4. Give a fingerprint. The fingerprint of any enrolled member of the family is acceptable; it exists to stop card misuse.
5. Let the hospital raise the pre-authorisation. If the illness is not in the package list, the hospital seeks consent from the insurer or the State Nodal Agency before blocking the amount, and that decision comes within 24 hours.

If a card reader is broken, the responsibility to arrange an alternative lies with the hospital and the insurer. Treatment cannot be refused once identity is established.

What exactly does the money cover?

Swasthya Sathi pays package rates, and a package covers everything connected with the treatment — medicines, tests, bed charges, other materials and food. The hospital cannot charge the patient separately for any of these.

• Pre-hospitalisation expenses, including tests and medicines that led to the admission, are reimbursable on production of proof.
• Post-hospitalisation support continues for five days after discharge, with the hospital providing needed medicines and assistance.
• Transport is limited to Rs 200 per hospitalisation and Rs 2,000 in a policy year at a private hospital. Treatment at a government hospital using the card carries an additional transport allowance of roughly Rs 400 to Rs 700.
• Day-care treatment of less than 24 hours is covered only for the listed procedures.

The cover is structured in two layers. Up to Rs 1.5 lakh runs through insurance mode with the insurance partner for that district cluster, and the balance up to Rs 5 lakh runs through assurance mode funded by the state. Since 16 January 2020 the partners have been National Insurance for Cluster I, Oriental Insurance for Cluster II and United India Insurance for Cluster III.

How to check your balance and your card status

1. Read the discharge slip, which shows the amount deducted after a hospitalisation.
2. Check the SMS sent to your registered mobile number after every blocking and deduction.
3. Open the Swasthya Sathi Android app and search using your URN number.
4. Call the 24x7 toll free call centre on 1800-345-5384.

What if a hospital asks you to pay?

Report it immediately. The portal is explicit that no payment is to be made for treatment under Swasthya Sathi. A beneficiary who is asked for money should call the toll free number and inform the District Key Manager or the State Nodal Agency, or raise the grievance through the mobile app.

Grievance redressal runs in two tiers:

• District Grievance Redressal Committee (DGRC), chaired by the District Magistrate or an officer of Additional District Magistrate rank or the Chief Medical Officer, with the District Key Manager as convenor and an insurance company representative as member. Complaints about enrolment, hospitals or the insurer start here.
• State Grievance Redressal Committee (SGRC), chaired by the Principal Secretary or Secretary of the department handling Swasthya Sathi. An appeal against a DGRC decision goes here, and the SGRC's decision is final. A grievance against the District Key Manager or a district authority goes straight to the SGRC.

If the hospital did not stock a medicine or could not run a test and you bought it on the hospital's written advice, keep the cash memo. Reimbursement is available against proof.

Common reasons a claim fails

• The smart card was not produced within 24 hours of admission.
• The hospital was not empanelled at the time of treatment.
• The claim was for an OPD visit with no admission.
• The member was not on the card, because the family never updated it after a marriage or a birth.
• The annual Rs 5 lakh limit for the family was already exhausted in that policy year.
• The mobile number on record was wrong, so the family never saw the alerts and missed a step.

Keeping the family record current at the district enrolment point is the cheapest insurance against all of these.