Not eligible for Ayushman Bharat card? West Bengal announces new health insurance scheme: Check if you can apply
Residents of West Bengal who were unable to secure benefits under the national Ayushman Bharat program now have another option. The state government has
West Bengal Launches Alternative Health Coverage for Those Missed by National Scheme
Theindiapostdaily.com – Residents of West Bengal who were unable to secure benefits under the national Ayushman Bharat program now have another option. The state government has unveiled the Mukhyamantri Swasthya Bima Yojana, a fresh health insurance initiative designed specifically for these individuals. According to Anandabazar Patrika, applicants must currently possess active Swasthya Sathi coverage to qualify for this new program.
Announcement and Key Benefits
Chief Minister Suvendu Adhikari revealed the initiative during a public gathering held in Rejinagar earlier this July. He explained the purpose clearly:
“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 chief minister further assured citizens that the advantages of this card would extend beyond state borders, making it usable across the entire country. Each family unit will receive separate individual cards for every member, ensuring comprehensive protection.
Who Qualifies for This Scheme?
Permanent residents of West Bengal who fall outside the Ayushman Bharat eligibility criteria can enroll. The primary goal is shielding families from devastating medical expenses related to complicated and costly treatments. Several specific conditions determine whether someone can join:
- Families with annual income exceeding ₹8 lakh are disqualified
- Individuals already covered under the West Bengal Health Scheme 2008 cannot participate
- Recipients of the Central Government Health Scheme (CGHS) 1954 are excluded
- Members of the ESI Scheme are entirely barred from enrollment
- Public sector employees and pensioners with existing health insurance coverage remain ineligible
- Those receiving regular medical allowances do not qualify
- Senior citizens aged above 70 years are specifically excluded
However, certain exceptions apply. People excluded through the Social Information Registry (SIR) process may still access this scheme if they have pending legal matters. Similarly, individuals with unresolved CAA applications remain eligible despite other exclusions. Pending SIR Tribunal cases also do not prevent applicants from joining.
Digital Infrastructure and Coverage Details
The program offers cashless treatment worth ₹5 lakh per year. Pre-existing illnesses and medical conditions receive full coverage under this arrangement. Unlike traditional models, there is no reimbursement mechanism; all treatments remain completely cashless from start to finish.
From day one, the scheme depends on robust digital monitoring. An IT platform will manage the entire implementation process. Aadhaar-based biometric verification becomes mandatory for every enrollment. Additionally, using an ABHA ID during both hospital admission and discharge is compulsory.
Medical guidelines and treatment categories will follow the same standards as Ayushman Bharat, ensuring uniformity between state and national programs.
Transition from Swasthya Sathi
Mamata Banerjee originally introduced Swasthya Sathi as West Bengal’s premier health insurance initiative. The program provided up to ₹5 lakh in annual family coverage through a paperless digital network. The TMC administration paid the full premium without requiring any household contribution. Smart cards were distributed to the eldest woman in eligible families, with no restrictions on family size.
Pre-existing conditions were covered immediately upon registration. The scheme also included pre- and post-hospitalization expenses. While initially targeted at low-income workers, it eventually expanded to serve wider populations. Permanent government employees receiving allowances were generally kept out.
Following the recent political shift, Swasthya Sathi is being gradually phased out. The Mukhyamantri Swasthya Bima Yojana will now take its place as the state’s primary health insurance offering.
