Swasthya Sathi Card Claim Process 2025: Easy Guide to Avail Free ₹5 Lakh Treatment

The government of West Bengal continues to serve the people through progressive welfare programs. One of the most impactful among them is the Swasthya Sathi Scheme, a fully cashless and paperless health insurance scheme that offers ₹5 lakh per family per year. The Swasthya Sathi Card Claim process is at the heart of this initiative, enabling eligible citizens to receive critical healthcare services without paying out-of-pocket.

However, many people are still unaware of how the Swasthya Sathi Card Claim works, who can claim, and who cannot. This official style guide explains everything about the claim process for 2025 in a step-by-step, transparent manner.

Swasthya Sathi Scheme—Key Highlights

Feature	Details
Name of Scheme	Swasthya Sathi
Launched by	Government of West Bengal
Coverage Amount	₹5 lakh per family annually
Type of Coverage	Cashless and Paperless, on a family floater basis
Eligible Beneficiaries	All families of West Bengal not covered under any other health scheme
Claim Process	Initiated and handled only by empanelled hospitals
Can individuals claim directly?	No. Only hospitals can initiate the claim.
Applicable Hospitals	Government and empanelled private hospitals across West Bengal and India
Official Website	https://swasthyasathi.gov.in

Who Can Claim Under the Swasthya Sathi Card?

The Swasthya Sathi Card claim process is not open to individuals or cardholders for personal withdrawal of any money.
It is strictly designed so that

Only authorized and empanelled hospitals can initiate the claim process. The patient or cardholder cannot directly claim money.

This ensures transparency, prevents fraud, and provides completely cashless treatment to the beneficiary at the point of care. Any attempt by individuals or third parties to claim money is invalid and may be treated as fraud.

Step-by-Step: Swasthya Sathi Card Claim Process

1. Hospitalisation at an Empaneled Hospital

• Visit a Swasthya Sathi empanelled hospital (government or private).
• Carry your Swasthya Sathi Smart Card.
• At the hospital, go to the Swasthya Sathi Help Desk.
• The hospital verifies your identity using biometric Aadhaar authentication.

2. Pre-Authorization Before Treatment

• The hospital uploads the diagnosis, cost estimation, and treatment plan to the Swasthya Sathi portal.
• Pre-authorization is granted by the TPA (Third Party Administrator) within:
  • 6 hours for emergencies.
  • 24 hours for general cases.

3. Cashless Treatment and Discharge

• Once approved, the patient undergoes treatment.
• After completion, the hospital discharges the patient.
• No bills, no payment by the patient. The entire process is cashless.

4. Claim Submission by Hospital

• After discharge, the hospital submits documents, including the discharge summary, reports, and billing, to the Swasthya Sathi portal.
• The claim is processed by the TPA.
• Once verified, payment is directly made by the government to the hospital.

Important Documents Required (Submitted by Hospital)

• Patient’s Swasthya Sathi Card
• Aadhaar-based biometric verification
• Doctor’s prescription and diagnosis reports
• Pre-authorization approval copy
• Final bill and discharge summary (submitted by hospital)

The beneficiary does not need to submit any documents or pay any money.

Can You Claim Money Using Swasthya Sathi Card?

This is a common question:
“Can I claim ₹5 lakh using my Swasthya Sathi Card for previous treatment or directly into my account?”

The clear government answer is:

No, individuals cannot claim or withdraw money.
Only hospitals are allowed to claim payment under the scheme after providing treatment.

Beware of Fraud or Misleading Information

If anyone claims they can help you “withdraw money” using the card, it is false and potentially fraudulent. Always follow official procedures and contact only government-recognized health institutions.

How to Check Swasthya Sathi Card Claim Status Online

You can easily check your claim status online using the official website:

1. Visit: https://swasthyasathi.gov.in
2. Click on “Beneficiary Corner.”
3. Select “Claim Status.”
4. Enter your URN Number or mobile number.
5. View the current status of your Swasthya Sathi Card claim.

Grievance Redressal for Claim Issues

If you face any problem with claim status or hospital denial, contact

• Toll-Free Helpline: 1800-345-5384
• Email: helpdesk.swasthyasathi@gmail.com
• District Nodal Officer: Available at each district hospital
• Duare Sarkar Camps: For offline correction and query submission

Common Issues in Swasthya Sathi Card Claim

Problem Faced	Solution
The hospital is refusing cashless service	Use the online claim tracking system or contact the hospital desk
The claim status is not updated	Call the helpline and report immediately
Name/Aadhaar mismatch	The hospital refusing cashless service
Claim delay for more than 10 days	Visit the Duare Sarkar camp to correct details

Swasthya Sathi Card Claim Process for Treatment Outside West Bengal

If a patient is referred for treatment outside West Bengal:

• Referral must be issued by a West Bengal government hospital.
• The treatment must occur in an empanelled hospital in another state.
• The claim will still be initiated and settled by the hospital through the same digital process.
• No payment is required from the patient.

Upcoming Developments in Swasthya Sathi Card Claim (2025)

To improve the process further, the government is introducing

• Mobile App for real-time claim tracking
• Faster TPA approval in critical emergencies
• AI-based fraud monitoring to stop claim misuse
• More hospitals are being empanelled in rural and remote areas

Why the Swasthya Sathi Card Claim Process is Beneficial

• Completely cashless treatment up to ₹5 lakh/year
• No paperwork or manual process for the patient
• Direct benefit to hospitals—ensuring quality service
• State-funded premium—no burden on the common man
• Covers the entire family, including parents and dependents

Conclusion

The Swasthya Sathi Card Claim process reflects the West Bengal government’s commitment to universal health coverage. By ensuring that only hospitals are authorized to initiate and settle claims, the scheme maintains transparency and removes financial stress from the lives of millions of families. For 2025, the claim process remains simple, cashless, and 100% digital, empowering every resident of West Bengal to access quality healthcare with dignity.

For authentic information, claim tracking, and hospital lists, always visit the official website: https://swasthyasathi.gov.in