Su-Swastha Yojna – Top tier healthcare delivered with a human touch
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What is Su-Swastha

Su-Swastha Yojna is the Employees' Health Services Scheme of the Government of Sikkim. 
This scheme, envisioned and launched by the Honorable Chief Minister of the State or Sikkim Shri Prem Singh Tamang, aims to provide healthcare services to employees of the Government of Sikkim and their dependent family members for a cashless benefit covering hospitalizations across top tier hospitals in India. 

The values created for the member beneficiaries of Su-Swastha Yojna are 

  • Cashless admission and discharge across network hospitals to take away the hassle of arranging funds when someone needs to get admitted at a hospital 
  • Best healthcare accessible to Su-Swastha 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 Su-Swastha 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 

In the first phase of launch in April 2021, the Su-Swastha Yojna aims to cover 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
The scheme renews every year and new benefits are planned to be added as further phases of the Yojna are implemented.

Eligibility for enrolment in Su-Swastha Yojna

The Su-Swastha Yojna is primarily designed to be a cashless health services scheme, for the employee and his/her dependent family members. Only enrolled beneficiary members as per below rules can avail benefits of Su-Swastha Yojna in any of the 400+ empanelled hospitals within the Su-Swastha Yojna network of providers.

The following beneficiaries are eligible for enrolment in Su-Swastha Yojna

  1. Employee in a regular employment with a department of Government of Sikkim
  2. A family member dependent on the employee from the following relationships
    • spouse
    • brother and/or sister
    • children (own or legally adopted)
    • parents of self or spouse

The employee must enrol himself /herself before adding dependents in the scheme.

A maximum of 5 family members can be added to one employee as dependents. However employee can choose to enrol any of the family members above as per guidelines of eligibility which can be viewed or downloaded here.

  1. Digital enrolment Process
    • Digital enrolment via an online process can be done by accessing enrolment forms on our website and filling it directly online. Enrol here.
    • 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
    • Both forms have mandatory documents to be attached for each member like passport size photo, Voter’s Card, Aadhar card and proof of relationship for dependent family members. Please keep documents ready while filling the form
    • Once submitted successfully the application is evaluated and processed by employer. Once employer has 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.
    • Download a user guide for digital enrolment here. 
  2. Paper Applications 

    The enrolment forms can be downloaded from website here and filled in English Language and clear handwriting and submitted with necessary documents and photos to the department nodal officer 
    Each department has nodal officers made in charge of enrolment of employees of their respective departments. 
    The list of nodal offers can be found here. 

  3. Email application

    The application form can be downloaded here, filled and submitted via email to support@suswasthasikkim.com along with all documents and photos attached

  4. List of documents- ID proof

    a. Passport Size Photo

    b. ID Proof

    Must show identity of employee and dependents

    • Voter’s Card
    • Aadhar Card
    • Driver’s license
    • Passport
    • Any other government ID
    c. Proof of relationship

    Must show relationship between employee and dependent

    • Aadhar Card
    • Voter’s ID
    • PAN Card
    • Passport
    • Driver’s License
    • Hospital Discharge Card attested by 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
  • The Su-Swastha membership is applicable till the employee is in service of the Government of Sikkim.
  • The membership is to be renewed every year, check your membership details or the member card for validity
  • The membership can be modified 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 a modify beneficiary form which can be accessed here.
  • Any forms for adding a beneficiary or deleting a beneficiary can be submitted in the same ways as enrolment- using our online portal on our website, submitting to the employer or submitting in a Su-Swastha enrolment center. Go to the enrolment process here to read how.
  • Examples of when you may want to add a dependent are- marriage, birth of a baby, adoption of a child etc.
  • Examples of when you may want to delete a beneficiary dependent on you are- death of a family member, divorce, or when a child is married or employed and is no longer dependent on you, or because of any reason if a beneficiary is not required to be dependent on you for healthcare.
  • 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 exclusions?
Yes, Su-Swastha Yojna has comprehensive healthcare coverage which provides security against majority of illnesses requiring hospitalizations. But there are limits which apply in certain circumstances for which it is important to read the Su-Swastha Yojna Policy document carefully, click to download and follow the process while availing benefits.

  • Not an emergency
  • Choose a hospital from a list of network hospitals on our website or call us
  • Visit hospital for consultation and decision to admit for treatment on a planned date
  • Ask insurance department to apply for pre-authorization letter from Su-Swastha
  • Hospital’s insurance department fills pre-authorization form and submits it to Su-Swastha online
  • Su-Swastha issues pre-authorization letter
  • Hospital admits patient for treatment
  • Hospital raises bill and Discharge
  • Su-Swastha approves claims for included charges and send SMS intimation of same to both hospital and patient
  • Patient settles excluded charges directly with hospital on discharge
  • Hospital claim is processed and payment made

For initiating cashless pre-authorization use login->employee login>pre-authorization path on our website or Click Here.

Hospital should use login->provider login->pre-authorization for raising a pre-auth request and login->provider login>raise a claim for raising a cashless claim request or click here

  • Su-Swastha member beneficiary chooses the nearest hospital in an emergency – this hospital is not in network of Su-Swastha Hospitals
  • Beneficiary intimates Su-Swastha of the current hospitalization and details
  • Hospital treats patient, raises bill and discharges after patient settles bill directly with patient.
  • Employee raises a reimbursement claim with Su-Swastha Yojna and submits all documents required for such claim
  • Su-Swastha office processes claim as per terms and conditions of Su-Swastha and approves a payment note
  • Employee member receives the claim amount paid by employer.

For raising reimbursement claim use login->employee login>raise a claim path on our website or Click Here.

  1. Both types of processes are available only to Su-Swastha members- employee and dependents; if you are not a member yet enrol here.
  2. Read list of documents for reimbursement claim here
  3. View inclusions and exclusions here
  4. Find a hospital here
  • Retirement (inclusion of retired employees in Su-Swastha Yojna is currently not available- stay tuned to government notifications on our wedsite news and media for updates)
  • Termination of service by employer
  • Termination of membership due to a discovery of non-eligibility
  • Termination of Su-Swastha Yojna
  • Resignation by employee
  • Demise of employee
  • Removed from dependent list by employee
  • Exit of employee from scheme in above conditions automatically exits all dependents
  • Termination of membership due to a discovery of non-eligibility
  • Termination of Su-Swastha Yojna

The renewal of Su-Swastha Yojna is required every year; any changes in employee’s eligibility or dependents eligibility and application is reviewed upon renewal. If there are no changes scheme renews with same cover for all members of employee’s family.

Future of Su-Swastha

As we progress into the future, Su-Swastha Yojna shall continue looking for expansion of services to create more value for its beneficiaries by providing better, convenient and timely healthcare services and facilities to the members of Su-Swastha.

We strive to improve our services by taking into consideration your needs and feedback.

Click here to provide your valuable suggestions.