- विवरण
- फ़ायदे
- पात्रता
- अपवाद
- आवेदन प्रक्रिया
- आवश्यक दस्तावेज़
- अधिकतर पूछे जाने वाले सवाल
- स्रोत और संदर्भ
- प्रतिपुष्टि
कुछ गलत हो गया। कृपया बाद में पुन: प्रयास करें
योजनाओं के लिए आवेदन करने से पहले आपको साइन इन करना होगा
कुछ गलत हो गया। कृपया बाद में पुन: प्रयास करें
ऐसा लगता है कि आपने अपना आवेदन पहले ही शुरू कर दिया है।अधिक जानने के लिए कृपया जाएँ
आवेदन करें
योजनाओं के लिए आवेदन करने से पहले आपको साइन इन करना होगा
कुछ गलत हो गया। कृपया बाद में पुन: प्रयास करें
ऐसा लगता है कि आपने अपना आवेदन पहले ही शुरू कर दिया है।अधिक जानने के लिए कृपया जाएँ
आवेदन करें
पात्रता की जाँच करें
Su-Swastha Yojna - Sikkim
Sikkim
विवरण
फ़ायदे
- Cashless admission and discharge across network hospitals take away the hassle of arranging funds when someone needs to get admitted at a hospital.
- Best healthcare accessible to beneficiaries by empanelment of top-tier hospitals and Institutes in India.
- Assurance of quality of care, with the Su-Swastha Facilitation Center keeping oversight of medical care provided by hospitals for the beneficiaries.
- Transparent billing with standardization of tariff with hospitals based on infrastructure and quality of care provided.
- Communication with patient and family at each step of care.
- The beneficiary members as per rules can avail of the benefits of Su-Swastha Yojna in any of the 400+ empaneled hospitals within the Su-Swastha Yojna network of providers.
- 10 lacs base cover + 10 lacs additional critical care coverage for the family- irrespective of the number of dependents in the family.
- The scheme covers hospitalization expenses for periods of more than 24 hrs for in-patient treatment.
- The scheme covers road Ambulance Expenses-Expenses incurred for transportation of the Beneficiary by private ambulance service from home/one hospital to another hospital. 3500 per hospitalization to a maximum of 3 times a year.
- All pre-existing diseases are covered from day 1 of completing enrolment.
- Post-hospitalization- Medical Expenses incurred up to 30 days from the date of discharge from the hospital.
- This scheme also covers special conditions, treatments and implants, Vehicular accidents, and Trauma.
- Coverage for Delivery Maximum ₹ 50,000- newborn baby cover limit up to include.
- The scheme covers daycare Dental and Ophthalmic treatment inclusive of implants.
- Organ Donor Expenses-Expenses incurred for organ transplantation from the Donor to the recipient Su Swastha beneficiary are payable provided the claim for transplantation is payable.
पात्रता
अपवाद
- Advances of any amount are not covered in Su-Swastha Yojna since the Yojna functions as a cashless service for its members.
- Intentional self-injury is not included.
- Use of intoxicating substances, substance abuse, drugs/alcohol, smoking, and tobacco chewing, and illnesses resulting due to such abuse is excluded.
- Venereal Diseases and Sexually Transmitted Diseases are excluded.
- Injury/disease directly or indirectly caused by or arising from or attributable to war, invasion, act of a foreign enemy, warlike operations (whether war be declared or not).
- Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials.
- Expenses incurred on weight control services including surgical procedures such as Bariatric Surgery and /or medical treatment of obesity.
- Expenses incurred on High-Intensity Focused Ultra Sound, Uterine Fibroid Embolisation, Balloon Sinoplasty, Enhanced External Counter Pulsation Therapy and related therapies, Chelation therapy, Deep Brain Stimulation, Hyperbaric Oxygen Therapy, Rotational Field Quantum Magnetic Resonance Therapy, VAX-D, Low-level laser therapy, Photodynamic therapy, and such other therapies similar to those mentioned under this exclusion.
- Charges incurred on diagnostics that are not consistent with the treatment for which the insured is admitted in the hospital/nursing home. Admission is primarily for diagnostic purposes with no positive existence of sickness/ disease/ailment/injury and no further treatment is indicated.
- Items for post-operative home-based therapies and aides such as crutches, wheelchairs cushions and walking sticks, braces, oxygen cylinders, and accessories for use of the residence and other aids of similar nature are excluded.
- Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending Physician of the hospital where the insured underwent treatment.
- Cosmetics, diapers, oral hygiene products, talcum powder and toiletries are not covered.
- Unconventional, Untested, Unproven, Experimental therapies.
- Stem cell Therapy, Autologous derived Stromal vascular fraction, Chondrocyte Implantation, Procedures using Platelet Rich Plasma, and Intra articular injection therapy.
- Oral Chemotherapy, Immuno-therapy, and Biologicals, except when administered as an in-patient, when clinically indicated and hospitalization warranted.
- All types of Cosmetic, Aesthetic treatments of any description, all treatments for Priapism and erectile dysfunctions, and Change of Sex.
- Plastic surgery (other than as necessitated due to an accident or as a part of any illness)
- Hospital record charges and other charges
- Inoculation or Vaccination (except for post–bite treatment and for medical treatment for therapeutic reasons).
- Dental treatment or surgery (in excess of what is specifically provided) unless necessitated due to accidental injuries and requiring hospitalization.
- Hospital registration charges, admission charges, telephone charges, and other charges.
- Any hospitalizations which are not Medically Necessary / do not warrant Hospitalization
- Other Excluded Expenses as detailed and periodically revised as in the website www.suswastha.sikkim.gov.in
- Any claim arising out of Accidents that the beneficiary has caused
- Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel or from any nuclear waste from combustion (including any self-sustaining process of nuclear fission) of nuclear fuel.
- Nuclear weapons material-The radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof.
- Nuclear, chemical, and biological terrorism.
आवेदन प्रक्रिया
आवश्यक दस्तावेज़
अधिकतर पूछे जाने वाले सवाल
How long will the Su-Swastha membership be valid?
The Su-Swastha membership is applicable till the employee is in service of the Government of Sikkim.
Is the membership to be renewed every year?
Yes, the membership is to be renewed every year, check your membership details or the member card for validity.
Can I modify the membership?
The membership can be modified at any time during the tenure of the Su-Swastha Yojna to add or delete dependent beneficiaries added to an employee. Deleting or adding a new member requires the employee to fill out a modified beneficiary form.
How many members of a family can be added to one employee as dependents?
A maximum of 5 family members can be added to one employee as dependents.
In what condition the cashless benefits cannot avail?
Cashless benefits cannot be availed if the beneficiary is admitted electively or in a medical emergency in a non-empanelled hospital across India, in or outside the state of Sikkim.
Can a primary member add or remove a dependant anytime during the tenure of the membership?
Yes, a primary member can add or remove a dependant anytime during the tenure of the membership without requiring the consent of the dependant for such removal.
Can an employee delete his/her own membership in Su-Swastha Yojna?
An employee cannot delete his/her own membership in Su-Swastha Yojna, the employee shall have to inform if he/she leaves regular employment e.g. due to resignation, termination or retirement. In these conditions, Su-Swastha cover shall cease to apply.
Are there any exclusion?
Yes, Su-Swastha Yojna has comprehensive healthcare coverage which provides security against the majority of illnesses requiring hospitalizations. But there are limits that apply in certain circumstances, for which it is important to read the Su-Swastha Yojna Policy document carefully and follow the process while availing benefits.
How can a Govt. employee apply under this scheme?
A government employee can apply under the scheme by both online or offline mode.
How can I get e-card to avail the services under this scheme?
Once submitted successfully the application is evaluated and processed by the employer. And, once the employer has approved your application you will receive a link to download your member e-card on SMS and email.
Can I apply thought email also?
Yes, the filled application form can also be submitted via email to support@suswasthasikkim.com along with all documents and photos attached.
How can an employee dependent exit from the scheme?
A dependent can be exit from the scheme in the following conditions: Removed from the dependent list by the employee, Exit of an employee from the scheme automatically exits all dependents, Termination of membership due to a discovery of non-eligibility, Termination of Su-Swastha Yojna
समाचार और अपडेट
कोई नई खबर और अपडेट उपलब्ध नहीं है
शेयर
कुछ गलत हो गया। कृपया बाद में पुन: प्रयास करें
योजनाओं के लिए आवेदन करने से पहले आपको साइन इन करना होगा
कुछ गलत हो गया। कृपया बाद में पुन: प्रयास करें
ऐसा लगता है कि आपने अपना आवेदन पहले ही शुरू कर दिया है।अधिक जानने के लिए कृपया जाएँ
आवेदन करें
योजनाओं के लिए आवेदन करने से पहले आपको साइन इन करना होगा
कुछ गलत हो गया। कृपया बाद में पुन: प्रयास करें
ऐसा लगता है कि आपने अपना आवेदन पहले ही शुरू कर दिया है।अधिक जानने के लिए कृपया जाएँ
आवेदन करें
पात्रता की जाँच करें
Su-Swastha Yojna - Sikkim
Sikkim
शेयर
समाचार और अपडेट
कोई नई खबर और अपडेट उपलब्ध नहीं है