SWASTHYA SAHAYATA YOJANA

SWASTHYA SAHAYATA YOJANA
INDIA
…COMPOSITION OF WORKFORCE
CHARACTERSTICS OF UNORGANIZED
SECTOR WORK FORCE
Poor
 Self-Employed
 Employers not identifiable
 Illiterate
 Migratory
 Lack of skills

WHY HEALTH CARD?
Lack of financial capability amongst the poor
 Inadequate Health infrastructure

ASSY GOALS
Major insecurity for unorganized workers relates to:
Inability to deal with medical emergencies
without facing a financial crisis
 Heavy expenditure on medical care and
hospitalization
 Recourse to adequate and competent
treatment

SWASTHYA SAHAYATA YOJANA
BENEFITS
Total Coverage up to Rs 30,000 per Beneficiary*
 Pre-existing diseases to be covered
 Coverage of health services related to
hospitalization and services of surgical nature
which can be provided on a day-care basis
 Cashless coverage of all eligible health services.
 Provision of Smart Card.
 Provision of pre and post hospitalization expenses.
 Transport allowance

IMPLEMENTATION OF THE
SCHEME
Identification of Insurance agency
 Data base
 Enrollment of Beneficiaries and Delivery of Smart
Card to commence
 Empanelment of private institutions
 Payment of insurance premium to the insurance
service provider.
 Delivery of health services

WHO CAN PROVIDE HEALTH
SERVICES?
Both public, including ESI, and private health
providers could offer services
 The service providers should possess specified basic
facilities, like: Atleast 10 inpatient medical beds;
 Medical & Surgical facilities alongwith
Diagonistic facilities i.e. Pathological test,
X-Ray, ECG, etc.

FUNDING
Beneficiary to pay Rs. 50 per annum as
Registration Fee/ Renewal Fee
 Beneficiary to pay Rs. 100 per annum as Card
Activation Fee
 Administrative cost to be borne by the Company
will come from Rs 50 received from beneficiary
 Cost of Smart Card to be borne by the Company
will come from Rs 100 received from beneficiary
 If Beneficiary want extra coverage then premium
cost to be born by beneficiary as floater basis.

SMART CARD
KFO Confirmation
Photograph
of the
Beneficiary
Thumb
Impression
of members
SMART CARD REGISTRATION PROCESS
ASSY
CARD
ASSY
CARD
Go To
Hospital
Patient
Shows
Card
After Treatment
Again Show Card
And Taken
updated in
System
Go To
Doctor
Advise
Hospitalization
ASSY COUNTER
Verifies Card and
Check Limit & issue Slip
Process Card
Process Overview
Progress so far
Scheme being implemented in 6 districts viz.
Allahabad, Jaunpur, Pratapgarh, Azamgarh, Basti
and Varanasi .
 Smart Card Enrollment has commenced in Allahabad
from 1st April
 Tenders floated for remaining districts
 Nodal Agency being set up
 Process for identification of Insurance agency
completed. ICICI Lombard has been selected for
implementation in First phase 6 districts

15
………..LET US MAKE IT WORK

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