Su Swasthya Yojana 2025 is a cashless healthcare scheme initiated by the Department of Health & Family Welfare, Govt of Sikkim under vision of CM Shri Prem Singh Tamang. The Scheme covers medical assistance to Govt employees and their dependents, through all India network of hospitals.
The scheme is renewable annually, with additional benefits planned for future phases.
Benefits
- Cashless hospitalization at 400+ empaneled hospitals across India.
- Su-Swastha Facilitation Center ensures quality medical care and standardized billing.
- Dedicated patient support for communication with families during treatment.
- Comprehensive health coverage, including:
- ₹10 lakh base cover + ₹10 lakh additional critical care cover (Total ₹20 lakh per family).
- Pre-existing diseases covered from day one.
- Post-hospitalization expenses covered for up to 30 days.
- Road ambulance assistance up to ₹3,500 per hospitalization (maximum 3 claims per year).
- Maternity benefits up to ₹50,000 for delivery, including newborn baby coverage.
- Daycare dental and ophthalmic treatments, including implants.
- Coverage for organ donor expenses in transplantation cases.
Eligibility Criteria
- Government employees of Sikkim with regular appointment.
- Central/Other State Government employees deputed to the Government of Sikkim.
- A maximum of 5 dependents per employee.
Eligible Dependents
- Parents (biological only) of the primary member or spouse (step-parents not included).
- Legally wedded spouse (If both spouses are government employees, they can enroll separately or as dependents).
- Children (biological or legally adopted):
- Unemployed, unmarried male child up to 30 years.
- Unemployed, unmarried female child (no age limit).
- Children with certified disabilities (mental/physical) – coverage continues as long as the primary member is employed.
- Biological siblings (unmarried & unemployed) up to 30 years.
- Siblings with certified disabilities (mental/physical) covered throughout the employment tenure of the primary member.
Important Notes
- Primary enrollment is mandatory before adding dependents.
- If the primary member exits the scheme (due to retirement, resignation, or death), dependents lose eligibility.
- Dependents can be added or removed anytime without their consent.
- Providing false dependent information may result in penalties for the employee.
Exclusions
- Treatment in non-empaneled hospitals (except in medical emergencies).
- Self-inflicted injuries, substance abuse, venereal diseases, and STDs.
- Treatment related to war injuries, nuclear radiation, or terrorist acts.
- Cosmetic/aesthetic surgeries and weight-loss treatments.
- Stem cell therapy, experimental treatments, and certain specialized therapies.
- Vaccinations (except post-bite treatments).
- Air travel injuries unless the insured is a fare-paying passenger.
- Travel allowance for attendants, patients, or escorts.
Application Process
Online Application
- Visit the Official Website: Su-Swasthya Yojana Portal.
- Complete the Enrollment Form:
- Step 1: The employee registers in the scheme.
- Step 2: The employee adds dependents (if any).
- Attach Required Documents (see list below).
- Submit the application for employer approval.
- Receive a digital e-card upon successful approval.
Offline Application
- Visit the nearest Su-Swastha Facilitation Center.
- Collect the physical enrollment form.
- Submit the filled form along with supporting documents.
- Receive confirmation and digital e-card after approval.
Required Documents
- Passport-size photograph.
- Employee ID Proof (any one of the following):
- Voter ID
- Aadhaar Card
- Driver’s License
- Passport
- Any other government-issued ID
- Proof of Relationship for Dependents (any one of the following):
- Aadhaar Card
- Voter ID
- PAN Card
- Passport
- Driver’s License
- Hospital Discharge Card (for newborns, attested by a gazetted officer)
- Birth Certificate
- Immunization Certificate
- School Certificate (attested by school authority & gazetted officer)
- Marriage Certificate
- Affidavit (attested by a gazetted officer if no government-issued proof is available)
Frequently Asked Questions (FAQs)
1. How long is Su-Swastha membership valid?
Membership is valid for one year and must be renewed annually.
2. Can I modify my membership?
Yes, dependents can be added or removed anytime without their consent.
3. How many dependents can an employee add?
A maximum of 5 dependents per employee.
4. When is cashless hospitalization not available?
- When admitted electively in a non-empaneled hospital.
- If the treatment is not medically necessary.
5. Can an employee delete their own membership?
No, but exiting the scheme due to resignation, retirement, or death will automatically remove dependents.
6. How can a government employee apply?
Employees can apply online via the Su-Swasthya Yojana Portal or offline at a Su-Swastha Facilitation Center.
7. How can I get my e-card?
After employer approval, a link will be sent via SMS & email to download the digital e-card.
8. Can I apply via email?
No, applications must be submitted through the online portal or offline at facilitation centers.
9. How can a dependent exit the scheme?
If the primary member exits, all dependents automatically lose coverage.
Sources & References
- Official Website – Su-Swasthya Yojana