Swasthya Sathi Eligibility, Benefits and How to Apply

Overview

Swasthya Sathi is a cashless, state-funded health protection scheme launched by the Government of West Bengal. It gives eligible families access to secondary and tertiary care at empaneled government and private hospitals, with no premium contribution required from beneficiaries.

Key Features & Benefits

Coverage: Provides up to ₹5 lakh per family per year.
Family Coverage: There is no cap on family size, and parents of both spouses and dependent family members with disabilities can be included.
Pre-Existing Diseases: Pre-existing diseases are covered, subject to applicable treatment packages and scheme rules.
Cashless Care: Eligible treatment is available on a cashless and paperless basis at empaneled hospitals.
Smart Card: The scheme uses a smart card, generally issued in the name of the family’s eldest female member.

What if families in West Bengal could access cashless hospital treatment through a state-funded health scheme?

The Swasthya Sathi scheme provides eligible residents and their families with cashless secondary and tertiary care at empaneled government and private hospitals. However, the scheme comes with specific eligibility rules, treatment packages, and hospital network requirements.

This guide covers the scheme’s eligibility, benefits, application process, hospital network, and comparison with personal health insurance.

Key Features of Swasthya Sathi

Feature	Details
Coverage	Provides up to ₹5 lakh per family per year for eligible secondary and tertiary care.
Family Coverage	There is no cap on family size. Parents of both spouses and dependent family members with disabilities can also be included.
Pre-Existing Diseases	Pre-existing diseases are covered under the scheme, subject to applicable treatment packages and scheme rules.
Premium	Beneficiaries do not pay any premium. The cost is borne by the Government of West Bengal.
Cashless Hospitalization	Eligible treatment is available on a cashless and paperless basis at empaneled government and private hospitals.
Smart Card and Package-Based Treatment	The scheme uses a Swasthya Sathi smart card, generally issued in the name of the family's eldest female member. Treatment is provided through approved packages.

Eligibility and Application Process for Swasthya Sathi

Eligibility Criteria:

Should be permanent residents of West Bengal.
Should not receive medical allowance with the salary.
Should not already be covered under other government-sponsored health insurance schemes (subject to state guidelines).

Swasthya Sathi eligibility showing covered beneficiary groups, family coverage, empaneled hospitals, and claim settlement data.

Source: Swasthya Sathi Website

Online Application Process

Step 1: Go to the official Swasthya Sathi Website.

Step 2: Click on "Apply Online" and enter your mobile number to receive an OTP.

Step 3: Complete Form B (the registration form). You will need to provide:

District, Block/Municipality, and Village/Ward details.
Category (SC/ST/OBC).
Department/Office details if any member is a contractual/government employee.

Step 4: Add the required details for each family member, including their Aadhaar number, Khadyasathi ration card number, employment status, and mobile number.

Step 5: Review the information carefully before submitting the application. You can subsequently check the application status using the registration details generated during the process.

Documents Required To Apply For Swasthya Sathi

To apply for the Swasthya Sathi scheme in West Bengal, whether online or offline, you need a few key documents:

A valid Aadhaar card for identity and address proof for all family members
An additional identity proof, such as a voter ID or a ration card
Where applicable, a Khadyasathi card may be requested to confirm eligibility.
Although Aadhaar usually serves as proof of residence, some local enrollment centres may ask for additional documents, such as a domicile certificate or ration card, especially for offline applications.

Take Note: You can contact Swasthya Sathi by calling the toll-free helpline number 1800-345-5384. The helpline provides support for enrollment queries, smart card issues, hospital and package information, claim-related concerns, and other scheme-related assistance.

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Inclusions and Exclusions of Swasthya Sathi

Inclusions	Exclusions
Eligible secondary and tertiary hospitalization at empaneled hospitals	Cosmetic or plastic surgery procedures, unless medically needed
Eligible day-care procedures covered under the scheme's treatment packages	Outpatient department (OPD) consultation (unless converted into an inpatient department)

Swasthya Sathi vs. Private Insurance: Is It Enough on Its Own?

Swasthya Sathi can act as an important healthcare safety net for eligible families in West Bengal. It provides cashless treatment for eligible secondary and tertiary care without requiring beneficiaries to pay a premium. However, treatment is subject to the scheme's approved packages and empaneled hospital network.

A personal health insurance policy can provide an additional layer of protection through higher sum insured options, broader plan-specific benefits, reimbursement facilities, and greater flexibility in choosing coverage. Whether you need one alongside Swasthya Sathi depends on your healthcare needs, preferred hospitals, and the level of financial protection you want.

Aspect	Government Health Scheme	Private Health Insurers
Coverage Limit	Fixed family-level coverage under the scheme	Sum insured varies by insurer and plan, with significantly higher options available
Hospital Network	Limited to empaneled private and government hospitals	Cashless treatment at the insurer's network hospitals. Reimbursement can also be available for eligible treatment outside the network
Room Choice	Restricted or standard rooms	Choice of room based on the plan and variant
Flexibility	Limited benefits and fixed packages for medical treatments	Flexible plans with riders
Premiums	No premium contribution from beneficiaries. State Government bears the cost	The policyholder pays the premium, and it varies by factors such as age, health, coverage, and location
Claim Process	Mostly cashless at empaneled hospitals	Cashless and reimbursement options with faster service
Best For	Basic coverage and low-income households	Enhanced protection and higher protection needs

Note: You can check the list of active hospitals by visiting the official Swasthya Sathi website. Choose the required filters, such as district, sub-division, type, and grade, to view the updated list of hospitals where cashless treatment is available under the scheme.

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Conclusion

Swasthya Sathi serves as a strong healthcare safety net, offering financial protection to families at no cost to beneficiaries. It ensures access to essential medical treatment without the burden of premium payments.

However, if you are looking for a health plan from insurers with established track records, we recommend comprehensive plans, which align with your long-term goals.

Note: Ditto has no affiliation with this scheme. Our assessment here is completely independent and based solely on publicly available data and the evaluation framework we use for all insurers. If you want to understand how Ditto reviews insurers across claims, complaints, business strength, and product suitability, you can read our methodology here. The information provided is for general awareness and should not be used for financial or legal decisions.

Please refer to the Swasthya Sathi official website for the latest details.

Frequently Asked Questions

Is there any additional transport benefit for treatment at government hospitals?

Yes. Swasthya Sathi treatment packages include a ₹200 transport allowance, payable to the patient at discharge. If treatment is received at a State Government-run hospital, the patient is also eligible for an additional transport allowance over and above the standard ₹200.

What services are available on the Swasthya Sathi mobile app?

The Swasthya Sathi mobile app can be downloaded from the Google Play Store and allows beneficiaries to raise queries related to scheme information, grievances, and other assistance. It also includes a one-touch feature that directly connects users to the 24×7 Swasthya Sathi helpline, making it easier to seek support for enrollment, treatment, hospital, or card-related concerns.

How do I apply for Swasthya Sathi online?

Visit the official Swasthya Sathi website and click "Apply Online," entering a mobile number to receive an OTP. Complete Form B with district, block, category, and employment details. Add Aadhaar numbers, Khadyasathi ration card details, and mobile numbers for each family member, then review and submit the application before checking status using the generated registration details.

What documents are required to apply for Swasthya Sathi?

Applicants need a valid Aadhaar card for identity and address proof for all family members, along with an additional identity proof such as a voter ID or ration card. A Khadyasathi card may be requested where applicable. Some local enrollment centers may also ask for a domicile certificate, particularly for offline applications.

Does Swasthya Sathi cover pre-existing diseases?

Pre-existing diseases are covered under the Swasthya Sathi scheme, subject to the applicable treatment packages and scheme rules in place. This coverage allows beneficiaries with prior medical conditions to access treatment under the scheme's framework, though specific packages and conditions determine the exact scope of coverage available for each case.

Who typically holds the Swasthya Sathi smart card?

The Swasthya Sathi smart card is generally issued in the name of the family's eldest female member. Treatment under the scheme is provided through approved packages linked to this smart card, which serves as the primary identification tool for accessing cashless hospitalization at empaneled government and private hospitals across West Bengal.

What is the toll-free helpline number for Swasthya Sathi?

The Swasthya Sathi toll-free helpline number is 1800-345-5384. This helpline provides support for enrollment queries, smart card issues, hospital and package information, and claim-related concerns. Beneficiaries can contact this number for assistance with any scheme-related questions throughout the application, enrollment, or treatment process.

What treatments are excluded under the Swasthya Sathi scheme?

Swasthya Sathi excludes cosmetic or plastic surgery procedures unless medically necessary. Outpatient department consultations are also excluded, unless the treatment is converted into an inpatient department admission. These exclusions define the boundaries of the scheme's coverage, helping beneficiaries understand which treatments qualify for cashless hospitalization under approved packages.

How is cashless hospitalization processed under Swasthya Sathi?

Eligible treatment under Swasthya Sathi is available on a cashless and paperless basis at empaneled government and private hospitals. Beneficiaries do not need to pay upfront for approved treatment packages, since the scheme directly settles costs with the hospital, reducing the financial burden during medical emergencies for enrolled families across West Bengal.

Last updated on: 15 Sep, 2026