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Health Insurance
Swasthya Sathi Scheme
Key Features
This Time, Prioritise Your Health
Coverage Highlights
Comprehensive coverage for a worry-free tomorrow
Choose from Best of Plans
Choose from multiple plans to meet your requirements
Wide Sum Insured Options
Select adequate sum insured that suits you starting INR 3 lacs to INR 1 crore
Unlimited Reinstatement Benefit & Recharge
Get the option of unlimited reinstatement of sum insured even after it is exhausted after claims
Maternity & Newborn Care
Medical expenses related to delivery of baby and towards treatment of the new born baby are covered under select plans
Preventive Health Check-Up
Start receiving annual preventive health check-ups after 2/3 policy renewals as per the chosen plan
Online Discount
Get flat 5% discount when you buy a policy on our website or our Bajaj General App
Zone Discount
Avail discounts of 20% for Zone B and 30% for Zone C depending on where you live
Fitness Discount & Wellness Discount
Avail up to 12.5% wellness discount for healthy habits on renewal
Note
Please read policy wording for detailed terms and conditions
Inclusions
What’s covered?In-Patient Hospitalisation Treatment
Offers comprehensive in-patient hospitalisation cover for your planned surgery or an unexpected illness to help you focus on your recovery not on your expenses
Hospital Room Coverage
Covers the cost of standard air-conditioned room ensuring you get the best care in a comfortable setting
ICU Cover
Covers your critical care expenses while ensuring you receive the best treatment without any financial burden
Pre-Hospitalisation Medical Expenses
Provides coverage for medical expenses for 30 days leading up to your hospital stay, ensuring you're prepared for the unexpected
Post-Hospitalisation Medical Expenses
Covers your post-hospitalisation medical expenses, including follow-up treatments and consultations, for up to 60 days after discharge
Day Care Treatment
Ensures that through advanced procedures you get back on your feet in less than 24 hours
Organ donor expenses
Offers coverage for organ transplant as per the policy terms, supporting the costs involved in the treatment
AYUSH Hospitalisation Cover
Coverage for ayurvedic, yoga, Unani, Siddha, and homoeopathic (AYUSH) treatment on a doctor’s advice for treating illness or physical injury
Road Ambulance
Covers emergency ambulance services to ensure you get swift and safe transport to the nearest medical facility
Domiciliary Hospitalisation
Ensures you receive the necessary medical care in the comfort of your home
Modern Treatment Methods and Advancement in Technologies
Covers modern treatments, like robotic surgeries and stem cell therapy, ensuring you have access to the latest medical advancements
Floater & Individual Sum Insured
Option to cover your family members under shared SI in case of a floater plan or separate SI in case of an individual plan
Note
Please read policy wording for detailed inclusions
Exclusions
What’s not covered?Investigation & Evaluation
Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded even if the same requires confinement at a hospital
Cosmetic or Plastic Surgery
Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an accident, burn(s) or cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured are not covered
Hazardous or Adventure sports
Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing, scuba diving, hand gliding, sky diving, and deep-sea diving, are not covered
Dietary Supplements & Substances
Cost of supplements that are purchased without a prescription by a certified doctor as a part of treatment, including vitamins, minerals and organic substances is not covered
Treatment for Self-Inflicted Acts
Medical expenses incurred as a result of self-harm, illegal actions, hazardous activities, etc. are not covered
Refractive Error
Expenses related to the treatment for correction of eyesight due to refractive error less than 7.5 dioptres are excluded
Unproven Treatments
Expenses related to any unproven treatment, services, and supplies in connection with any procedures or supplies that lack significant medical documentation to support their effectiveness stay uncovered
Sterility and Infertility
Expenses related to sterility and infertility, including any contraception, sterilisation and advanced reproductive technologies (such as IVF, ZIFT, GIFT, and ICSI), gestational surrogacy and reversal of sterilisation are not covered
Note
Please read policy wording for detailed exclusions
Additional Covers/Optional Covers
What else can you get?Sum Insured Reinstatement
Choose one-time or unlimited reinstatements each policy year for tailored, continuous protection
Procedure-wise/Disease-wise Sublimit
Unlock your full sum insured for key procedures and diseases (with no limitations on critical care)
Super Cumulative Bonus
Choose from three flexible growth options that match your health goals, get sum insured raised up to 200% as per the policy terms
No Claim Discount
Get accumulated bonus (Cumulative Bonus/Super Cumulative Bonus) with an immediate 1.5% discount on your next Premium payment at renewal
Cashless Discount
Enjoy a 5% discount on your premium by choosing cashless claims at our network hospitals for no upfront payments. Reimbursement claims will require a 20% co-pay.
Accidental Death Shield
Get financial protection for your loved ones, ensuring they're cared for even when you can't be there due to personal accident
Health Prime Rider
Get coverage for in-person or online doctor consultation, dental wellness, emotional wellness, diet & nutrition consultations as per the chosen plan
Swasthya Sathi Scheme by West Bengal Government
The Swasthya Sathi Coverage was launched by the West Bengal Government on December 30, 2016, as a comprehensive health insurance plan for residents. It offers cashless, paperless, and Swasthya Sathi card benefits to ensure citizens receive quality medical treatment without financial stress. The scheme covers the entire family with an annual sum insured of up to Rs 5 lakh per family, targeting secondary and tertiary healthcare needs. The scheme is fully funded by the state government, providing much-needed financial relief to the beneficiaries. Whether for consultations, diagnostics, or treatment, the Swasthya Sathi Scheme stands out for its inclusiveness and wide coverage across various medical procedures.
Objective of Swasthya Sathi Scheme
The primary objective of the Swasthya Sathi Coverage is to offer cashless healthcare services to every resident of West Bengal, focusing on reducing the burden of medical expenses for families. With rising healthcare costs, the Swasthya Sathi Scheme aims to enhance accessibility to quality healthcare, particularly for secondary and tertiary care. By empanelling hospitals and extending healthcare infrastructure in semi-urban and rural areas, the scheme ensures that quality medical services are within reach for all. The initiative addresses the need for affordable healthcare by eliminating citizens' out-of-pocket expenses.
Vision and Mission of Swasthya Sathi Scheme
The Swasthya Sathi Scheme of the West Bengal Government is meant to provide cashless, paperless and easy access to healthcare facilities for all. It aims to bring the people of quality medical services within financial reach, especially for rural and semi-urban areas. The scheme works to lower out-of-pocket medical expenses by offering comprehensive secondary and tertiary care coverage. It ensures efficient and equitable healthcare delivery with features like the Swasthya Sathi card, a user-friendly mobile app, and an extensive hospital network. With over 1,500 hospitals, including the Swasthya Sathi card hospital list in West Bengal, and a focus on inclusivity, the Health Card West Bengal initiative provides complete healthcare solutions, making quality healthcare accessible to all residents.
Features of the Swasthya Sathi Scheme
Swasthya Sathi brings a variety of features that make it a robust health insurance plan:
● Transparent Hospital Grading: Hospitals are graded based on their services, and the empanelment committee approves them accordingly.
● Mandatory Pre-Authorisation: All treatments and medical procedures require pre-authorisation, which is processed within 24 hours.
● Real-Time Updates: Beneficiary health records are updated in real-time after hospital discharge, ensuring accurate data management.
● Swasthya Sathi Mobile App: The app provides easy access to information regarding hospitals, health packages, and e-health records.
● SMS Alerts: Beneficiaries receive SMS notifications if their health card is blocked or if there are any updates.
● Toll-Free Support: A 24-x7 toll-free helpline (1800-345-5384) is available for assistance.
● Quick Claim Settlements: Claims are processed within 30 days, reducing financial stress on beneficiaries and hospitals.
Benefits You Deserve
Region-Specific Premiums
Avail fair and local pricing for premiums as per the healthcare cost of 16 diffe
Walk to Win
Enjoy up to 10% discount on policy renewal by completing regular step goals
Super Cumulative Bonus
Get your Sum Insured raised by up to 50% every year up to 200% of Sum Insured
Download Policy Documents
Get instant access to policy details with a single click
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Benefits of the Swasthya Sathi Scheme
The Swasthya Sathi Scheme offers comprehensive benefits that cater to the healthcare needs of the beneficiaries:
● Health Coverage up to Rs 5 Lakh: Coverage is provided for both secondary and tertiary care, ensuring extensive medical support.
● Pre-existing Disease Coverage: The scheme covers all pre-existing conditions from day one, which is beneficial for those with ongoing health issues.
● No Cap on Family Size: The scheme covers the entire family, including in-laws and dependent physically challenged members, without restricting family size.
● Cashless Hospitalisation: The scheme covers expenses for doctor consultations, diagnostic tests, and medicines incurred one day before hospitalisation and up to five days post-treatment.
● Zero Premium Cost: The West Bengal Government fully bears the premium, making the coverage completely free for beneficiaries.
Eligibility Criteria of the Swasthya Sathi Scheme
The Swasthya Sathi Card eligibility is as follows:
● You must be a permanent resident of West Bengal.
● You should not be covered under any other government-sponsored health insurance scheme.
● The health card is issued in the name of the eldest female member of the family.
● The scheme covers all family members, including parents of both spouses, unmarried daughters (up to 21 years), and dependent physically challenged members.
Documents Required to Apply for the Scheme
To apply for the Swasthya Sathi Mediclaim Policy, you will require the following documents:
● Proof of Identity (Aadhaar Card, Voter ID)
● Residential Proof
● Mobile Number
● Recent Photograph
How to Apply for the Swasthya Sathi Health Scheme?
The process to apply for the Swasthya Sathi Scheme is simple:
● Visit the official website of the Swasthya Sathi Scheme.
● Click on the ‘Apply Online’ option and select ‘Form B for Registration.’
● Fill in the required details and submit the form along with the necessary documents.
Key Functionalities of Swasthya Sathi Prokolpo
The Swasthya Sathi Prokolpo comes with a host of functionalities aimed at making healthcare accessible and affordable:
Comprehensive Hospital Network
The scheme has empanelled more than 2,290 hospitals, providing beneficiaries access to a wide range of medical facilities across the state.
Real-Time Health Record Management
Beneficiary records are updated instantly, ensuring that all medical histories are accurately documented.
Grievance Monitoring System
An online platform allows beneficiaries to lodge complaints and track resolutions, making the system transparent.
Transparent Treatment Authorisation
Treatments under the scheme are pre-authorised online within 24 hours, streamlining the process and avoiding delays.
Monthly Analytical Reports
The scheme generates monthly reports accessible to the public for review and suggestions, promoting accountability.
Cashless Treatment Across Hospitals
The scheme covers diagnostic and treatment costs across empanelled hospitals, ensuring that beneficiaries face no out-of-pocket expenses.
Transportation Allowance
Patients are provided a transport allowance post-discharge, ensuring seamless transitions back home.
Process for Swasthya Sathi Hospital Registration
Hospitals can register under the Swasthya Sathi Scheme by following these steps:
● Visit the official Swasthya Sathi portal.
● Click on the ‘Apply Online’ option and select ‘Hospital Registration.’
● Fill in the required details, such as hospital name, contact details, and category.
● Attach the necessary documents and apply for review.
Step-by-Step Guide
To help you navigate your insurance journey
How to Buy
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Visit Bajaj General website
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Enter personal details
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Compare health insurance plans
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Select suitable coverage
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Check discounts & offers
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Add optional benefits
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Proceed to secure payment
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Receive instant policy confirmation
How to Renew
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Login to the app
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Enter your current policy details
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3
Review and update coverage if required
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4
Check for renewal offers
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5
Add or remove riders
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Confirm details and proceed
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Complete renewal payment online
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Receive instant confirmation for your policy renewal
How to Claim
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Notify Bajaj General about the claim using app
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Submit all the required documents
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Choose cashless or reimbursement mode for your claim
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Avail treatment and share required bills
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Receive claim settlement after approval
How to Port
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1
Check eligibility for porting
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Compare new policy benefits
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Apply before your current policy expires
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Provide details of your existing policy
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Undergo risk assessment by Bajaj General
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Receive approval from Bajaj General
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Pay the premium for your new policy
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8
Receive policy documents & coverage details
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How to Check Swasthya Sathi Hospital Registration Status?
To check the registration status of a hospital under the Swasthya Sathi Scheme:
- Visit the official Swasthya Sathi portal.
- Click on the ‘Check Hospital Reg. Status’ option.
- Enter your registered mobile number to view the status.
How to Register for Treatment Outside West Bengal Under the Swasthya Sathi Scheme? H2
If you need treatment outside West Bengal under the Swasthya Sathi Scheme:
Go to the official portal.
● Select the ‘Registration Outside of West Bengal’ option.
● Enter your URN number and complete the registration by providing the necessary details and documents.
Swasthya Sathi Scheme Health Card
The Swasthya Sathi Health Card is issued in the name of the eldest female family member. This card contains all essential details, including family biometrics, photographs, and contact information. It is auto-renewed annually and has lifetime validity, allowing beneficiaries to receive cashless treatment across empanelled hospitals.
Steps to View Hospital Details Under Swasthya Sathi Scheme
To view details about hospitals under the Swasthya Sathi Scheme:
● Visit the official portal and select ‘Hospital Information.’
● You can view relevant information by selecting from options such as Active Hospital List or Hospital HR Details and submitting the form.
What Our Customers Say
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27th Jul 2020
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I am extremely happy and satisfied with my claim settlement, which was approved within just two days—even in these challenging times of COVID-19.
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27th Jul 2020
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3rd Apr 2020
Outstanding Support
Excellent services during COVID-19 for your mediclaim cashless customers. You guys are COVID warriors, helping patients settle claims digitally during these challenging times.
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Mumbai
27th Jul 2020
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FAQ's
Does critical illness insurance cover stroke?
Yes, Bajaj General Insurance Limited’s critical illness insurance covers strokes that result in permanent symptoms. Once diagnosed and confirmed by a medical professional, and the policyholder survives the mandatory 30-day period post-diagnosis, a lump sum amount is paid. This payout can be used for any treatment or lifestyle-related expense, offering much-needed financial support during recovery without the burden of hospitalisation bills or reimbursement formalities.
Can I buy health insurance after having a stroke?
Yes, individuals can still purchase heart patient health insurance after experiencing a stroke, though the process involves additional health assessments. Bajaj General Insurance Limited evaluates such applications on a case-by-case basis. Premiums may be higher due to pre-existing risk, and coverage terms may vary. Nonetheless, getting insured ensures future financial protection and access to quality treatment, especially when facing potential stroke recurrence or related health complications.
What is the best insurance for heart patients with a stroke history?
The best insurance for heart patients with a stroke history is one that offers lump sum benefits, long-term renewability, and comprehensive critical illness coverage. Bajaj General Insurance Limited’s critical illness insurance is well-suited for such needs. It covers multiple heart-related and neurological conditions, ensuring that patients receive financial aid to manage treatment costs, rehabilitation, and recovery with dignity, without being restricted by in-hospital claim limits or narrow benefits.
Is stroke covered in mediclaim for heart patients?
Standard mediclaim for heart patients may not always cover stroke, especially if it's classified under pre-existing conditions or long-term complications. Even when covered, such policies typically only reimburse hospitalisation expenses. Bajaj General Insurance Limited’s critical illness insurance, however, offers broader coverage by providing a lump sum payout upon diagnosis. This makes it a more dependable option for those seeking comprehensive financial support during stroke treatment and recovery.
What is the waiting period for stroke insurance claims?
Bajaj General Insurance Limited’s critical illness insurance has a 90-day waiting period from the policy start date. If the policyholder is diagnosed with a stroke during this period, the claim will not be admissible. However, once the waiting period ends, full benefits will be applied. This clause is standard in critical illness policies, helping insurers mitigate immediate claim risks while still offering robust protection after the waiting period.
Can stroke patients get tax benefits for their insurance?
Yes, stroke patients paying for eligible health or critical illness insurance policies can claim tax deductions under Section 80d of the Income Tax Act. Bajaj General Insurance policies qualify for this benefit. Tax savings apply to premiums paid for self, spouse, children, or parents, with higher deduction limits available for senior citizens. This helps policyholders reduce their taxable income while securing high-value financial coverage against future medical emergencies.
Are rehabilitation and physiotherapy costs covered?
In most regular mediclaim policies, rehabilitation and physiotherapy may not be fully or at all covered. However, Bajaj General Insurance Limited’s critical illness insurance pays a lump sum upon diagnosis, giving policyholders the freedom to use the money as needed, including for post-treatment care such as physiotherapy, speech therapy, home care, or assistive devices. This flexibility makes it ideal for stroke patients who require long-term rehabilitation and enhancements to their quality of life.
How do I apply for stroke insurance?
Applying for stroke insurance with Bajaj General Insurance Limited is simple. You can apply online via their website or visit a local branch or insurance agent. Depending on your age and health status, you may be required to undergo a pre-policy medical examination. Once approved, you can select your sum insured, payment frequency, and policy term. Expert advisors are available to guide you through plan comparison and help with documentation.
Is stroke covered under group health insurance?
Group health insurance, typically offered by employers, may or may not cover stroke or offer adequate benefits. Often, these policies have coverage caps and limited options for critical illnesses. It’s safer to have an individual medical insurance for heart patients or a standalone critical illness insurance plan from Bajaj General Insurance Limited. This ensures uninterrupted coverage, full control over the sum insured, and protection that continues even if you switch jobs or retire.
How can I compare stroke health insurance plans?
To compare stroke insurance plans, consider factors such as covered critical illnesses, claim types (lump sum vs. reimbursement), waiting periods, hospital networks, premium costs, and policy renewability. Bajaj General Insurance Limited stands out for its transparent coverage, flexible sum insured options, and a solid reputation in the insurance sector. Evaluate how each plan addresses both emergency care and long-term recovery needs to ensure complete protection for stroke-related health issues.
How to check Swasthya Sathi's balance?
To check your Swasthya Sathi balance, visit the official portal and go to the "Card Verification" section. Enter your URN and district details to view the available balance. This simple online process ensures beneficiaries can access their health card information conveniently.
How much is the minimum money balance for Swasthya Sathi card?
The Swasthya Sathi card is a health card West Bengal introduced to provide cashless treatment. It does not require any minimum balance, as the government covers all medical expenses up to INR 5 lakh per family annually. Beneficiaries don’t need to pay anything; the card always provides full coverage within this limit.
Does Swasthya Sathi cover pregnancy?
Yes, the Swasthya Sathi scheme under West Bengal health insurance covers pregnancy-related expenses. It includes costs for prenatal care, delivery (normal or cesarean), and postnatal care. Newborns are also covered from birth under this scheme.
Does health insurance offer options for covering my whole family?
Yes, many health insurance plans offer family coverage. However, the exact definition of 'family' can differ between providers. Generally, family health insurance covers you, your spouse, and dependant children (up to 2); you may need to get seperate policies for parents.
What are the common inclusions of health insurance?
Health insurance commonly covers hospitalisation costs, medical treatments, emergency services, and expenses related to pre- and post-hospitalisation care. Coverage for daycare procedures is also frequently included in health insurance plans; however, specific policy inclusions may vary from one plan to another.
Are pre-policy medical examinations common in health insurance?
Yes, many health insurance providers asks for pre-policy medical examinations for certain age groups, when applying for higher amount of coverage, or in other scenarios. Such examinations help insurers assess your current health conditions and potential risks. The specific tests and requirements can vary based on the provider and the policy chosen.
Do health insurance providers offer discounts for healthcare workers?
Health insurance providers may offer discounts on special concessions to healthcare workers on special occasions. The availability and specific details of these discounts can vary between insurers and different policies.
Which diseases are covered under Swasthya Sathi?
The Swasthya Sathi scheme includes all pre-existing conditions and secondary and tertiary care treatments. Thereby ensuring that beneficiaries can avail themselves of any medical procedure and hospitalisation.
What is the new scheme in West Bengal 2024?
The West Bengal health scheme benefits in 2024 include the launch of the West Bengal Apprenticeship Promotion Scheme (WB-APS). This scheme helps young people in the state by providing financial support for apprenticeship training, encouraging skill development and better job opportunities.
How much amount can be claimed in Swasthya Sathi?
Swasthya Sathi scheme allows beneficiaries to claim up to INR 5 Lakhs annually. The amount includes the cost of various medical procedures, hospital admission, and treatment concerning immediate financial safety for families without facing extra expenses to ensure quality health care.
Is there any co-payment at the time of raising claims in health insurance?
If you have opted for the co-payment option in your policy, you will be required to bear part of your hospitalisation expenses based on the policy terms.
To whom should I submit claim documents, third party administration or my insurance provider?
You can submit your claim documents to the third-party administrator (TPA) managing your claim process or directly to your insurer depending on the procedure specified by your insurance provider.
Why do some health insurance policies include co-payment requirements?
Health insurance policies may include co-payment requirements to strike a balance between affordability and comprehensive coverage.
How can I raise my health insurance claim after hospitalisation?
You can file your claim after hospitalisation in case of an emergency hospitalisation. However, you must notify your insurance provider or third-party administrator (TPA) as soon as possible; the usual timeline for informing the insurer or third-party administrator is within 24 hours of being hospitalised. Make sure to gather all necessary documents, including medical bills, reports, and discharging summary for your claim. Once you are done with all of the paperwork, submit the completed claim form and supporting documents to your insurer. Remember to consult your specific policy documents for detailed procedures and deadlines.
What are the standard renewal terms for health insurance plans?
Many health insurance plans offer long-term or lifetime renewal, requiring for consistent annual renewals and adherence to policy terms. However, policy renewal might get denied in case of misrepresentation, fraud, or non-compliance. Thus, it is important to renew your insurance plan within the insurer's provided grace period. Contact your insurance provider for specific renewal details.
If there is any claim in my existing policy, is there any exclusion during renewal of my policy?
Depending on your policy teams a 60-day cooling off period may be applicable if the policy is renewed within 60 days from the date of admission of the previously paid claim. However, usually there isn't a waiting period for other listed vector-borne diseases. In case, the policy is renewed post 60 days from the date of admission of the previously paid claim, a fresh waiting period of 15 days may be applicable for all listed vector-borne diseases.
Can I enhance my sum insured during policy renewal?
You may be able to apply for sum insured enhancement during policy renewal depending on the guidelines shared by your insurance provider. You may have to submit a fresh proposal form to your insurance provider. Based on the terms and conditions you may get enhanced sum insured.
What is the process of renewing health insurance plans?
Here is a simple guide to help you in your policy renewal: 1. Login to the app 2. Enter your current policy details 3. Review and update coverage if required 4. Check for renewal offers 5. Add or remove riders 6. Confirm details and proceed 7. Complete renewal payment online 8. Receive instant confirmation for your policy renewal
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