Su-Swastha Yojana

श्रेणियाँ: स्वास्थ्य और कल्याण

उप-श्रेणियाँ: Health care providers and access

लक्षित लाभार्थी: व्यक्तिगत, Family

टैग: Insurance, Medical, Premium, Health, Hospital, Family

• Cashless Convenience: Cashless admission and discharge across network hospitals eliminate the burden of arranging funds during hospitalization. Access to Top-Tier Healthcare: Beneficiaries gain access to best-in-class healthcare by leveraging a network of top-tier hospitals and institutes across India. Quality Assurance: The Su-Swastha Facilitation Center ensures quality of care by overseeing medical services provided to beneficiaries. Transparent Billing: Standardized tariffs with hospitals based on infrastructure and quality of care promote transparency in billing. Patient-Centric Approach: Communication with patients and their families is maintained throughout the care journey. Wide Network Coverage: Beneficiaries can avail of the scheme& 39;s benefits at over 400+ empanelled hospitals within the Su-Swastha Yojna network. Comprehensive Coverage:
• Base Cover - 10 lacs base cover
• Critical Care Coverage - 10 lacs additional critical care coverage for the entire family, regardless of the number of dependents. In-Patient Treatment: Covers hospitalization expenses exceeding 24 hours. Road Ambulance Assistance: Covers road ambulance expenses up to ₹3500per hospitalization, with a maximum of 3 claims per year. Pre-existing Disease Coverage: Covers all pre-existing diseases from the first day of enrollment. Post-Hospitalization Care: Covers medical expenses incurred within 30 days of hospital discharge. Specialized Coverage: Includes coverage for special conditions, treatments, implants, vehicular accidents, and trauma. Maternity Benefits: Covers delivery expenses up to ₹50,000,including newborn baby cover. Dental and Ophthalmic Care: Covers daycare dental and ophthalmic treatments, including implants. Organ Donor Expenses: Covers expenses incurred for organ transplantation from a donor to a Su-Swastha beneficiary, subject to claim eligibility criteria

What is the amount of contribution for the dependents for availing the scheme?

The amount is Rs 200/- per month per dependent. For example, if you have 5 dependents, you will be contributing (Rs 200 x 5= Rs 1000/-) per month for the 5 dependents. This amount is contributed to a healthcare fund to which the Government of Sikkim contributes funds as well to cover the total healthcare expenses incurred in Su-Swastha Yojna.

What is the amount I am covered for? Can I increase this amount?

Total Cover is 10 lacs (ten lacs) for the family- irrespective of number of dependents in the family. This amount is fixed and for the current year it cannot be increased by employee.

What am I covered for in the Su-Swastha cashless benefit scheme?

1. In-patient Treatment - Covers hospitalization expenses for period more than 24 hrs 2.Day care Dental and Ophthalmic treatment inclusive of implants (However, for cosmetic purpose, dental implants are excluded) 3. Maternity and child healthcare - e.g. hospitalizations related to delivery, caesarean and neonatal care 4. Road Ambulance Expenses-Expenses incurred for transportation of the Beneficiary by ambulance service from home//one hospital to another hospital. 5. Post-Hospitalization- Medical Expenses incurred up to 30 days from the date of discharge from the hospital. 6. Organ Donor Expenses-Expenses incurred for organ transplantation from the Donor to the recipient Su Swastha beneficiary person are payable provided the claim for transplantation is payable 7. Cancer chemotherapy and dialysis 8. Vehicular Accident and Trauma

Where can I avail the cashless treatment?

Cashless benefits scheme can be availed from any of the hospitals in India which have joined on the panel or network of Su-Swastha Yojna. This list is available on our website and continuously updated.

Can two or more people be admitted in the hospital under Su-Swastha Yojna at the same time to avail medical care benefits under the yojna?

Yes, provided you are within the coverage limit and in the empanelled hospital.

Who is eligible for enrolling in Su-Swastha Yojna?

All employees of the Sikkim government appointed against the regular Post from the date of joining regular post. A central government servant or a government servant of any other state while on deputation to the Government of Sikkim. Dependents of the eligible employees- a maximum of 5 eligible dependents can be added for each employee

Are contractual/MR employees eligible for enrolment in Su-Swastha Yojna?

No, not in this phase. Contractual, MR employees and ad hoc employees are not eligible in the current year of launch; there are plans to include them in subsequent phases- please check our website for notifications on same periodically.

Are retired employees eligible?

No, retired employees are not eligible in the current year of policy period; there are plans to include them in subsequent phases- please check our website for notifications on same

What is the maximum number of dependents I can add?

You can add any number of dependents between zero (0) and five (5); a maximum of five (5) dependents can be added for a primary member or employee; in no case can more than 5 dependents be added to a primary member.

What is the amount of contribution for availing the scheme?

The employee contribution is Rs 200/- per employee per month. The rest of the healthcare fund is created by government contributions.

My spouse is also a government employee. Will both of us be entitled to enrol as a primary insured?

When both spouses are government regular employees they can choose to enrol separately as primary member of Su-Swastha Yojna OR as dependent on the other spouse. However, an employee cannot be enrolled as a primary and dependent at the same time.

Form where I can enrol for Su-swastha Yojana ?

Go to https://suswasthasikkim.com/login/employee and apply

• https://www.myscheme.gov.in/schemes/su-swastha-yojana
• https://suswasthasikkim.com/pdf/Coverage-Benefits.pdf
• https://suswasthasikkim.com/pdf/Enrolment%20Process%20User%20Guide.pdf
• https://suswasthasikkim.com/faq
• https://suswasthasikkim.com/Nodal%20Officers%20List.pdf

• Guidelines
• Enrolment Guide
• FAQ
• List Of Nodal Officers