Not eligible for Ayushman Bharat card? West Bengal announces new health insurance scheme: Check if you can apply

West Bengal has announced a new state health insurance scheme. It is meant for people ineligible for the central “Ayushman Bharat Yojana” scheme. The scheme is called “Mukhyamantri Swasthya Bima Yojana”, meaning Chief Minister’s Health Insurance. Eligible residents must already hold coverage under “Swasthya Sathi”, Anandabazar Patrika reported.

Earlier in July, Chief Minister Suvendu Adhikari announced the scheme at a public meeting in Rejinagar. CM Adhikari said, “Those who will not get Ayushman Bharat will get the Mukhyamantri Swasthya Bima Yojana. Under this scheme, insurance coverage of up to ₹5 lakh will be available.”

“The state government will ensure that the benefits of this card are available not just in this state, but across all of India,” he added.

Who are eligible?

Only permanent state residents excluded from Ayushman Bharat can enrol here. This scheme aims to protect people from catastrophic medical treatment costs. Coverage focuses specifically on complex and expensive disease treatments.

Certain conditions determine eligibility, however, under this new scheme. Families earning above ₹8 lakh annually won’t qualify for benefits. Anyone covered under the West Bengal Health Scheme 2008 is excluded automatically.

Similarly, beneficiaries of the Central Government Health Scheme (CGHS) 1954 cannot enrol in this new scheme. ESI Scheme members are also entirely excluded from this insurance.

Employees or pensioners covered by public sector health insurance remain ineligible, too. This includes coverage from statutory bodies or urban self-governing institutions.

People receiving regular medical allowances won’t qualify for enrolment either. Senior citizens above 70 years are also specifically excluded here, according to the publication.

Individuals excluded through the SIR process cannot access this scheme. However, exceptions exist for certain pending legal cases. Those with unresolved CAA applications remain eligible despite exclusions elsewhere. Similarly, pending SIR Tribunal cases don’t disqualify applicants from enrolment.

Cashless coverage worth ₹5 lakh

Eligible families will receive cashless coverage worth ₹5 lakh annually. Each family member receives an individual insurance card separately.

Pre-existing illnesses and conditions are covered under this scheme. No reimbursement option exists; treatment remains entirely cashless throughout.

The scheme relies heavily on digital monitoring systems from launch. An IT platform will immediately oversee the entire scheme’s implementation. Aadhaar-based biometric verification is mandatory for all enrolments. ABHA ID usage is compulsory during hospital admission and discharge.

Treatment types and medical guidelines will mirror Ayushman Bharat’s existing rules. This ensures consistency between the state and central schemes.

The interest in “Ayushman Bharat” was high on Google India during 27-28 July:

Swasthya Sathi

Mamata Banerjee introduced Swasthya Sathi as West Bengal’s flagship health insurance scheme. It offered up to ₹5 lakh annual coverage per family. Treatment remained entirely cashless through a paperless IT network.

The TMC government funded the entire premium, with zero contribution required. Eligible households receive smart cards issued to the eldest woman. There was no cap on family size or the number of members.

Pre-existing illnesses were covered immediately upon enrolment. Coverage also extended to pre- and post-hospitalisation expenses. Originally meant for low-earning workers, it then covered broader populations. Permanent government employees already receiving allowances remained generally excluded.

After the regime change, Swasthya Sathi has been phased out. It will now be replaced by the new Mukhyamantri Swasthya Bima Yojana.