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 the Spouse 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, biometric, address, Mobile Number, SECC ID.
• Management of the scheme is in paperless IT platform from day one.
• Online empanelment & gradation of Hospitals based on the services and infrastructure available
• 100% online Pre-authorisation with turnaround time of 24 Hrs.
• SMS triggers and instant alerts to the beneficiaries on blocking of card.
• Real-time uploading of E-health record of the beneficiaries on discharge
• Claim reimbursement to the hospital with TAT of 30 days else interest are 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 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.
- Re-print 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 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, Phone number.
Arrangement of providing the duplicate re-printed cards(in case of lost OR damaged OR Chip error).