- Details
- Benefits
- Eligibility
- Application Process
- Documents Required
- Frequently Asked Questions
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Sikkim
Su-Swastha Yojana
Family
Health
Hospital
Insurance
Medical
Premium
Details
Launched in April 2021, the scheme "Su-Swastha Yojna" by the Department of Health & Family Welfare, Government of Sikkim aims to provide comprehensive and affordable healthcare coverage to the employees of the Government of Sikkim and their families. Through this scheme, cashless hospitalization at top-tier hospitals across India is provided to the eligible beneficiaries. The scheme covers regular employees in service of the Government of Sikkim and dependent family members up to a maximum of 5 dependents in a scheme that provides 10 lacs of cover to the family per year.
Benefits
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'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 ₹3500 per 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.
Eligibility
The applicant should be a regular employee in service of the Government of Sikkim or the dependent family members of such employee (spouse; brother and/or sister; children (own or legally adopted); parents of self or spouse) (up to a maximum of 5 dependents).
Application Process
Online
Offline
Step 2: Login to the website using your registered Mobile Number. Verify your Mobile Number via OTP. You will be taken to the online enrolment form.
Step 3: There are two parts of the application. First, the employee must fill and submit part 1 of the form which is to enrol himself/herself in the scheme. Then he/she should fill and submit part 2 of the form. Fill in all the mandatory fields and if required, upload all the mandatory documents in the specified format and size.
Step 4: Agree to the self-declaration and submit the application, you will receive confirmation message on your phone (SMS) as well as an email confirmation. Please note that the application will go to your respective nodal officers for approval.
Once submitted successfully, the application is evaluated and processed. Once approved, your application you will receive a link to download your member e-card on SMS and email. This card is required for availing any benefits of Su-Swastha later.
In case of any query or assistance please reach us at info@suswasthasikkim.com or call us at 9800347944
Documents Required
- Passport Size Photo
- One of the following ID Proofs that shows the identity of the employee and the dependents: Voter’s Card, Aaadhaar Card, Driver’s license, Passport, or Any other government ID
- One of the following Proofs of the Relationship between employee and dependent: Aadhaar Card, Voter’s ID, PAN Card, Passport, Driver’s License, Hospital Discharge Card (attested by a gazette government official for newborn babies), Birth Certificate, Immunization Certificate, School Certificate (attested by school authority and gazette government official), Marriage Certificate, Affidavit (attested by gazette government official in lieu of no government issue proof)
Frequently Asked Questions
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
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Check Eligibility
Sikkim
Su-Swastha Yojana
Family
Health
Hospital
Insurance
Medical
Premium
Details
Benefits
Eligibility
Application Process
Documents Required
Frequently Asked Questions
Launched in April 2021, the scheme "Su-Swastha Yojna" by the Department of Health & Family Welfare, Government of Sikkim aims to provide comprehensive and affordable healthcare coverage to the employees of the Government of Sikkim and their families. Through this scheme, cashless hospitalization at top-tier hospitals across India is provided to the eligible beneficiaries. The scheme covers regular employees in service of the Government of Sikkim and dependent family members up to a maximum of 5 dependents in a scheme that provides 10 lacs of cover to the family per year.
Was this helpful?
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