Health Insurance May 3, 2021

The second wave of COVID-19 has been damaging the lives of people across India. The unprecedented pandemic has caused massive distress, both economically and physically, among the people. Every individual’s topmost priority is quality healthcare right now. Considering this fact, Shri Prem Singh Tamang, the Chief Minister of Sikkim, formally launched the much-awaited healthcare scheme – Su-Swastha Yojana under the Health and Family Welfare Department of the state government.

Su Swastha Yojana is a flagship healthcare program of the Sikkim Government to provide quality healthcare services in a cashless manner. With this scheme, all the government employees of Sikkim can enjoy access to cashless treatment at empanelled hospitals across the country.

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Sikkim Government employees, their dependents and pensioners can get comprehensive health insurance coverage with the Su Swastha Yojana. According to an estimate, a total of 1 lakh (approximately) State Government employees, pensioners, and their dependents will get benefits from this scheme.

SWADHI Health Private Limited will act as a service provider to monitor, support and assist insured persons under the scheme. Beneficiaries will get a cashless treatment facility through this company at specified empanelled hospitals across the country.

Let’s Understand the Prominent Benefits of Su Swastha Yojana in Detail

With the Su Swastha Yojana, insured people can enjoy a wide range of benefits. We are showing them below so that you can understand them better. Please check!

Cashless Treatment

In case of a medical emergency, Su Swastha Yojana provides cashless medical treatment against expenses incurred on treatment up to INR 20 lakh per year in a renowned empanelled hospital in India.

OPD Coverage

An individual can also get coverage against Out Patient Department (OPD) expenses, up to INR 20,000 per year of the policy.

Maternity-related Expenses Coverage

Beneficiaries under this scheme can also enjoy maternity benefits up to INR 50,000 per policy year. So if a beneficiary needs hospitalization due to maternity-related reasons, this policy will provide coverage against the expenses incurred on the same.

IVF Treatment Coverage

Individuals will also get 2 terms of In-vitro fertility (IVF) treatment at any empanelled hospitals across India.

Pre-existing Disease Coverage from Day 1

Beneficiaries under this scheme will also get coverage against pre-existing diseases right from the first day of the policy. A pre-existing disease is something that an individual has even before buying a particular insurance policy.

No Waiting Period

There will be no waiting period in the Su Swastha Yojana. So, the beneficiaries will not need to wait fot the coverage under the policy.

Day Care Procedures Coverage

Procedures that do not require a 24-hour hospitalization are known as Day Care procedures. Some of them are Cataract surgery, chemotherapy, hydrocele, etc. With this scheme from the Sikkim Government, beneficiaries will also get coverage against Day Care procedures.

Pre-and Post-Hospitalization Coverage

Su Swastha Yojana also provides coverage against expenses incurred on the pre-and post-hospitalization up to 30 days before admission and 60 days after discharge, respectively.

Tertiary Illness Coverage

This government scheme also covers the expenses incurred on the treatment of tertiary illness during the policy period up to the sum insured limit.

Emergency and Trauma Cases Coverage

If a policyholder needs treatment in an emergency and trauma case, the policy will provide coverage against the expenses incurred towards the same.

Ambulance Facilities

If policyholders need to get transported to one of the nearest empanelled hospitals for due treatment, Su Swastha Yojana also provides coverage against such expenses.

Su Swastha Yojana Eligibility Criteria

Check crucial points related to the Su Swastha Yojana eligibility criteria mentioned below.

  1. The age limit for a beneficiary stands up to 100 years.
  2. The age limit for dependent children is fixed at 30 years. However, there is no age limit for physically/mentally challenged children or unmarried unemployed daughters.
  3. This scheme also provides options of addition or deletion of beneficiaries across different situations such as marriage, newborn (coverage from Day 1), Death of insured members and Divorce.

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