Su-Swastha Yojana, the landmark health service scheme initiated by the Government of Sikkim is set to roll out from the 1st of October, 2021. Regular Government employees of the State including various PSUs and central government establishments on deputation who have enrolled for the scheme can avail of the services.
This was informed by the Secretary, Chief Minister's Office, S.D. Dhakal in a press conference held at Tashiling Secretariat on 8th September 2021. The press conference also had the presence and participation of DG-cum-Secretary, Health, Dr. Pempa T. Bhutia, Secretary, Department of Personnel, K.C. Lepcha, and Special Secretary, DOP, Tashi Chophel.
Dhakal informed that a total of 56,280 beneficiaries have been enrolled under the scheme till date, which includes 21,062 primary memberships. Highlighting the details of the benefits of the scheme and the eligibility criteria, the Secretary stressed that the Su-Swastha Yojana has been devised by the State Government after a series of consultations with concerned stakeholders to derive the best possible health care support for the state government employees.
He added that the Scheme is offered at the lowest premium and highest coverage, with cashless treatment in over 400 reputed hospitals across the country. He explained that the implementation of the Scheme will be monitored by a Steering Committee headed by the Chief Secretary.
DG-cum-Secretary, Health, Dr. Pempa T. Bhutia informed that the scheme will cover the primary beneficiary and five other members of the family as per the criteria laid down. He urged the beneficiaries to use the services judiciously. He further explained that the scheme has two aspects - namely cashless treatment, and reimbursement.
Su-Swastha Yojana is a cashless health plan that covers 400+ top tier hospitals for all routine and critical illnesses for 1+5 dependents to the employees of the Government of Sikkim.He said that beneficiaries can avail of the cashless treatment in reputed private hospitals, while the reimbursement facility can be availed of in case of mission hospitals, semi-government and government hospitals. He stated that the Government employees who have not enrolled on the scheme will not be entitled for the reimbursement facility.
Su-Swastha Yojana is a cashless health plan that covers 400+ top tier hospitals for all routine and critical illnesses for 1+5 dependents to the employees of the Government of Sikkim. It offers Cashless Inpatient (IPD) medical treatment of up to 10 lakhs and up to 20 lakhs for critical illnesses which is the highest coverage in India.
In-Patient treatment covers hospitalization expenses for all admissions related to medical and surgical treatments for a large number of illnesses. There is no referral procedure. An employee can avail treatment from the hospital of his/her choice from a list of empanelled hospitals. There is no waiting period for coverage. Pre-existing diseases of the beneficiaries are also covered from day one for an enrolled member. It provides healthcare security to employees and their dependents.
An employee can add up to five family members (1+5) as dependents to avail of benefits under this scheme. Parents (Mother/Father) and Parents-in-law (mother-in-law/father-in-law) of applicants can be up to 100 years of age. Age limit for unmarried & unemployed sibling brother/sister) is 30 years. The age limit for an unmarried & unemployed son is 30 years. There is no age limit for unmarried & unemployed daughters. Likewise, there is no age limit for dependent children and siblings with certified mental or physical disabilities. A beneficiary can choose from any of the leading hospitals in all major cities across India that are impaneled with Su Swastha Yojana. Option of mid-term addition and deletion of members is available (in the case of birth of a child, marriage, death of a member etc.) 24 X 7 help-desk and call centre for hospitalization assistance is provided.
A Help-desk is present in all hospitals for support and assistance. Members avail of post-hospitalization benefits of up to 30 days from the date of hospital discharge. This covers post-discharge expenses like medicine, follow-up treatments and tests. There is an emphasis on Women's health with Maternity benefits up to Rs 50,000/- for normal & cesarean delivery, and IVF (In-Vitro Fertility) treatment with coverage up to 2.0 lakhs. For a newborn child, health coverage of the child starts from day one of enrollment.
This scheme also covers Daycare procedures such as Dental and Ophthalmic treatment (non-cosmetic), Dialysis, Radiotherapy, Chemotherapy for Cancer patients, Angiography, Endoscopic treatment etc. Vehicular accidents and Trauma are also covered. In case of an emergency hospital admission, for expenses not pre arranged as cashless, reimbursement will be issued. Details of the Scheme and the enrollment procedure are available on the website www.suswasthasikkim.com.