Main Features of the Scheme :
- Basic health cover for secondary and tertiary care up to Rs. 5 lakh per annum per family.
- Up to Rs 1.5 Lakh through Insurance Mode and beyond 1.5 lakh to 5 Lakh through Assurance Mode
Paperless, Cashless, Smart Card based :
- There is no cap on the family size and Parents from both spouses are included. All dependent physically challenged persons in the family are also covered.
- 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, biometrics, addresses, Mobile Numbers, and SECC ID.
- Management of the scheme is in a paperless IT platform from day one.
- Online empanelment & gradation of Hospitals based on the services and infrastructure available
- 100% online Pre-authorisation with a turnaround time of 24 Hrs.
- SMS triggers and instant alerts to the beneficiaries on blocking of cards.
- Real-time uploading of E-health records of the beneficiaries on discharge
- Claim reimbursement to the hospital with a TAT of 30 days else interest is being charged for delayed payment.
- 24X7 toll-free Call Centre (18003455384) with feedback option
- Online grievance monitoring Mechanism
- Online triggers and alerts to detect probable frauds with an escalation matrix.
- Android-based Swasthya Sathi Mobile app for assistance to the beneficiaries.
Services Provided at Swasthya Sathi Kiosk :
- Enrollment of beneficiaries.
- Addition of dependents’ names on the beneficiaries’ cards.
- Reprint of cards (in case of lost OR damaged OR chip error).
Services Provided at Swasthya Sathi Cell :
- Arrangement of providing Swasthya Sathi cards to the beneficiaries on an urgent basis.
- Correction of name, age, aadhar number, etc in the server against Swasthya Sathi URN.
- Searching of names of eligible beneficiaries using UID, Ration Card No, and Phone number.
Arrangement of providing the duplicate re-printed cards(in case of lost OR damaged OR Chip error).