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The Su-Swastha Yojna is the Employee Health Services Scheme launched by the Govt of Sikkim in 2021. In the current year of launch this scheme is valid for the Regular Employee of the Govt of Sikkim and his/her dependent family members. In this scheme, employees and their dependents shall be able to avail healthcare services for hospitalizations on a cashless basis in empanelled hospital network across India.
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.
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
Dependents as below shall be considered as “dependent family members/ beneficiaries”. A family can have a maximum of five (5) dependent beneficiaries for one (1) government employee.
Maximum of five (5) dependents can be added for a primary member or employee the list of dependents mentioned above; in no case can more than 5 dependents be added to a primary member. However, any combination of family members from the list of eligible dependents above can be used to constitute and enrol 5 dependents in the scheme.
In no case can the enrolment/membership for a dependent continue if the primary member is not enrolled in the scheme; if the primary member has exited the scheme due to causes including but not limited to death, retirement, termination or resignation, the cover of benefit for dependents automatically stops.
Primary member can add or remove a dependent anytime during the tenure of the membership without requiring a consent of the dependent for such removal
The employee contribution is Rs 200/- per employee per month. The rest of the healthcare fund is created by government contributions.
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.
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.
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.
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.
The list will be continuously updated on the website www.suswasthasikkim.com
Cashless benefits cannot be availed if the beneficiary is admitted electively or in a medical emergency in a non-empaneled hospital across India, in or outside the state of Sikkim. In such cases the beneficiary is required to settle the bill directly with hospital and apply for reimbursement through Su-Swastha Facilitation Center
The OPD basis treatment is to be availed using the current system of OPD bills submission and reimbursement. If there is any change in this system the beneficiaries shall be duly notified.
In case of routine or elective hospitalization of non-emergency nature - follow the below process to avail benefits as per Su-Swastha Yojna
In case of emergency hospitalizations- follow the below process to avail benefits as per Su-Swastha Yojna
No, the scheme is valid only till the time you are in employed with the Government. Also, if the primary member has exited the scheme due to causes including but not limited to death, retirement, termination or resignation, the cover of benefit for dependents automatically stops.
My spouse but 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.
If I had to admit myself in emergency in the closest hospital and the hospital is not listed in the network hospital list, what do I do?
In this case you will have to make the payment from your own pocket and apply for reimbursement through Su-Swastha. See Question number 12 above.
No, please see the dependent eligibility section on www.suswasthasikkim.com or in the FAQ section.
Yes, you can add your parents or your parents-in-law as dependent.
The total coverage per family is only rupees ten lakhs (10 lacs0
If you have noted down your id number, the id number should suffice the need. We encourage beneficiaries to save both their e-card as well as their member ID in their phone so that they do not have to carry a physical card at all.
You can use one of the following numbers
If you don’t have any of the above IDs please contact your employer for this. Please do not use your employee ID other than above.
Not from Su-Swastha but you may avail the leave and travel allowance from your respective departments subject to their terms and conditions.
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.
Two numbers are issued against each enrolled employee. The policy ID is 1 per family. But every registered person in the family will be provided with their unique Su Swastha member ID Card.
You can simply download one more from the website and save it to your phone or print it on plain paper to use.
A hospital that has signed a MoU with the Govt for providing patients with healthcare facilities under Su-Swastha Yojana is an empaneled hospital. The list of network hospitals will be continuously updated in suswastha.sikkim.gov.in
Where can the beneficiary first approach for initiating treatment under the Scheme? Can a Beneficiary go directly to a private empaneled hospital?
For availing treatment under the scheme, a beneficiary can go directly to any empaneled hospital or call the helpline before planning a hospitalization at 9800347944.
Cashless care does not cover non-medical expenses or exclusions that are outlined in the scheme document available on website. These costs shall not be reimbursed. But for charges which are included in cashless care, but are paid by patient directly to hospital for any reason shall be reimbursed to employee by employer.
For non-cashless care similarly all medical expenses included in Su-Swastha Yojna shall be reimburses directly by employer. Even in non-cashless care patients will not be reimbursed for charges they have paid but are excluded from the scheme.
Read inclusions and exclusions of Su-Swastha Yojna carefully on our website or call or WhatsApp at 9800347944.
What will happen if the total cost of treatment is above Rs 10 lakhs per family at any time or if Rs 10 lakhs get exhausted before one year for a beneficiary family?
In case the amount ensured under Su Swastha Yojana gets exhausted, the beneficiary will have to bear the extra cost on their own expense.
In case of any queries or grievance, a beneficiary can use below channels-
Yes, hospitals typically will charge an advance for planned treatment at time of admission, or within 24 hours for emergency care. They will also raise a bill for items which are excluded from Su-Swastha Yojna- read carefully inclusions and exclusions of Su-Swastha Yojna on our website. Call or WhatsApp on 9800347944 for any clarifications.
At the time of Hospitalization within and outside Sikkim, the Beneficiary will need to show his/her Su-Swastha Card along with one ID Proof (Aadhar Card/Voter ID / PAN card / Driver’s License etc.)
Below are the list of exclusions which are not covered under the cashless scheme of Su-Swastha Yojna:
Su-Swastha Facilitation Center
Old STNM Hospital
Gangtok, Sikkim 737101