Things You Didn’t Know About Your Swasthya Sathi Card Covers

What Does the Swasthya Sathi Card Actually Cover?

The Swasthya Sathi Card is intended to make healthcare affordable and accessible for families in West Bengal by covering major hospitalisation costs without requiring out-of-pocket payments at the time of treatment. It works as a cashless, paperless smart card that lets eligible beneficiaries receive care up to the annual financial limit set by the state government.

Here’s what it actually covers:

• Cashless hospitalisation: Covers secondary and tertiary care expenses without upfront payments at empanelled hospitals statewide.
• Up to ₹5 lakh per family per year: The scheme provides financial coverage of up to ₹5,00,000 annually per beneficiary family, regardless of age or number of family members ¹.
• Pre-existing conditions included: All previously diagnosed health conditions are covered from day one of enrolment under the scheme.
• Paperless and smart card-based: The smart card stores biometric and family information, enabling seamless cashless access at any participating hospital.
• Family-wide coverage: There is no cap on family size; spouses, parents and dependent children are all included under the same card.
• State-funded premium: The entire premium is borne by the West Bengal government, so the beneficiary pays nothing for the insurance ².

The following section provides a comprehensive overview of who can use the card for their medical matters.

Who Can Use the Swasthya Sathi Card and Which Family Members Are Included?

The Swasthya Sathi Card provides financial protection against significant healthcare costs for eligible families in West Bengal. It isn’t limited to one individual; instead, the entire beneficiary family unit is under the scheme and can access cashless care at empanelled hospitals across the state.

Let’s understand who can use this card and who is included:

• Head of Family (HoF) is the primary beneficiary: The person listed as the head of the household on official records is automatically covered as the principal member.
• Spouse and dependent children: The spouse of the head of family and their dependent children are covered under the same Swasthya Sathi Card, without separate applications.
• Parents and senior dependents: Parents and elderly dependents living in the same household can also be included, provided they are documented as part of the family unit in the official registration.
• Dependent persons with disabilities: Persons with certified disabilities who are financially dependent on the head of the family and listed as part of the household qualify for coverage.
• No age limit for coverage: There is no upper age limit for included family members, meaning older adults remain covered under the family card.
• Single card for the entire family: All members listed in the family record use the same smart card, allowing cashless hospitalisation for eligible treatments up to the scheme’s ₹5 lakh annual limit per family.

Understanding the ₹5 Lakh Swasthya Sathi Card Limit (And Common Mistakes)

While the Swasthya Sathi Card offers broad financial protection, confusion often arises over how the limit applies in practice rather than the amount itself. Understanding these practical aspects helps families avoid claim rejections and last-minute surprises.

• Package-wise utilisation matters: Treatments under Swasthya Sathi are approved through fixed government packages, not itemised hospital bills. Charges outside the approved package structure may not be settled on the card, including certain general surgery procedures that fall beyond the notified package scope.
• Pre-authorisation decides coverage, not discharge billing: The payable amount is locked at the authorisation stage, based on diagnosis and procedure codes. Any change to the treatment plan without fresh approval may result in partial denial.
• Non-admissible expenses reduce perceived coverage: Costs such as personal attendants, non-medical consumables, optional room upgrades, or experimental procedures are excluded, even during covered hospitalisation.
• Multiple admissions draw from the same annual balance: Separate hospital stays across different departments or hospitals still count cumulatively, and many families don’t realise this until the balance runs low.
• Hospital empanelment status impacts claim approval: Treatment at a non-empanelled or conditionally suspended hospital may result in delayed or rejected settlement, despite eligibility under the scheme.
• Emergency admissions still require digital validation: Even in emergencies, hospitals must upload documents and obtain scheme validation within stipulated timelines, or the case may fall outside coverage.

Also read: Critical Hours in ICU: A Step-by-Step Survival Guide for Families.

How to Apply for Swasthya Sathi Card Online or Check Status’

You can apply for the Swasthya Sathi Card online or track your application status through the official state health portal using basic household and identity details.

Step 1: Visit the Official Swasthya Sathi Portal

Go to the West Bengal Health Portal and select the Swasthya Sathi section to begin an application or check your status. The portal is accessible on both mobile and desktop devices and supports Bengali and English. Always ensure you are on the official government website to avoid incorrect submissions.

Step 2: Register Using Household or Aadhaar Details

Applicants must enter Aadhaar-linked details or the head-of-family information to initiate registration. The system verifies eligibility based on state records, voter data, or existing scheme enrolments. Accurate demographic details are essential, as mismatches may delay approval.

Step 3: Upload Required Documents Digitally

You need to upload basic documents such as Aadhaar cards of family members, proof of residence, and a recent photograph. The portal accepts standard file formats and provides upload guidelines to prevent rejection. Clear, legible documents help speed up verification.

Step 4: Submit Application and Receive Acknowledgement

After reviewing all entered details, submit the application through the portal. An acknowledgement number is generated instantly, which is crucial for future tracking and communication. This number confirms that your request has entered the verification process.

Step 5: Check Application Status and Download Card

Use the acknowledgement number or registered mobile details to track the status online. Once approved, the Swasthya Sathi Card can be downloaded digitally or collected through designated enrolment centres. Hospitals can also verify card status directly at the time of admission.

Next, let’s explore the Swasthya Sathi card hospital list in Kolkata for a clear understanding.

Swasthya Sathi Card Hospital List in Kolkata: How to Verify Before Admission

Below is a selection of empanelled hospitals around Kolkata where Swasthya Sathi Card services are known to be available

Note: always verify on the official portal before visiting.

Here are some of the hospitals where you can use your Swasthya Sathi Card:

Note: The West Bengal government regularly updates its empanelled hospital list based on infrastructure and services; before admission, beneficiaries should use the scheme’s official hospital search tool or call the Swasthya Sathi helpline to confirm acceptance and available services.

Swasthya Sathi Helpline Number, Claims, and What to Do if Cashless Is Denied

You can contact the toll-free helpline at 1800-345-5384, available 24×7 across West Bengal, for grievance registration, document sharing, and real-time assistance. In addition, beneficiaries can access official updates, hospital verification, and claim-related services through the West Bengal Health Portal, which serves as the authorised digital platform for the Swasthya Sathi scheme.