Mukhya Mantri Swasthya Bima Yojana - West Bengal

Mukhya Mantri Swasthya Bima Yojana (MMSBY) - Key Highlights

Why Was Mukhya Mantri Swasthya Bima Yojana Introduced

Prior to the introduction of Mukhyamantri Swasthya Bima Yojana (MMSBY), a lot of families in West Bengal had to incur high out-of-pocket costs for hospitalisation, especially if they did not have any government health insurance scheme. Although schemes like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) provided some financial coverage to specific economically vulnerable households, a large number of families continued to lack income protection against high-cost medical care.

To address this gap, the Government of West Bengal launched MMSBY to expand access to affordable healthcare. The scheme provides financial assistance for hospitalisation and selected medical procedures, enabling eligible families to receive cashless treatment without facing a significant financial burden. Like Mukhyamantri Jan Arogya Yojana (HIMCARE) in Himachal Pradesh, Mukhyamantri Amrutum (MA) Yojana in Gujarat, and Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) in Maharashtra, MMSBY offers cashless hospitalisation benefits to eligible beneficiaries.

Who is Eligible for Mukhya Mantri Swasthya Bima Yojana (MMSBY)

• Permanent Resident of West Bengal: The applicant must be a permanent resident of West Bengal and possess valid proof of residence as prescribed by the state government.
• Enrolled under the Swasthya Sathi Scheme: The applicant or their family must be registered under the Swasthya Sathi health insurance scheme, as MMSBY is extended to eligible Swasthya Sathi beneficiaries.
• Not Covered under AB PM-JAY: The applicant must not be eligible for or covered under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). MMSBY has been introduced to provide health insurance coverage to Swasthya Sathi beneficiaries who are outside the ambit of the central health insurance scheme.

Who is Not Eligible for Mukhya Mantri Swasthya Bima Yojana (MMSBY)

• Families with an annual income exceeding ₹8 lakh.
• Employees or pensioners covered under the West Bengal Health Scheme (WBHS), 2008.
• Employees or pensioners covered under the Central Government Health Scheme (CGHS).
• Employees or pensioners covered under the Employees' State Insurance (ESI) Scheme.
• Employees or pensioners covered under any Group Medical Insurance Scheme provided by Central or State Public Sector Undertakings (PSUs), Urban Local Bodies (ULBs), statutory bodies, corporations, trusts, societies, boards, or other government-controlled organisations.
• State Government, Central Government, or parastatal employees and pensioners who receive a medical allowance under applicable government rules.
• Family members aged 70 years or above under the Ayushman Vay Vandana Scheme.
• Individuals who have been removed from the register during the Special Intensive Revision (SIR).

What MMSBY Covers

• Cashless Health Insurance Coverage : Cashless hospitalisation treatment up to ₹5 lakh per family per year, on a family floater basis, meaning the full amount is shared across all covered family members rather than being fixed per person.
• Empanelled Hospital Network :Treatment at hospitals already empanelled under AB PM-JAY, since MMSBY is designed to use the same hospital network and IT infrastructure (Transaction Management System and Beneficiary Identification System).
• Coverage for Pre-existing Diseases: MMSBY covers pre-existing diseases from the first day of enrolment, with no waiting period, ensuring eligible beneficiaries can access treatment immediately.
• Family Coverage: The scheme covers all eligible family members under a single family floater policy, with no restriction on family size, allowing every eligible member of the household to avail benefits.

What MMSBY does not Cover

• Outpatient (OPD) consultations – Doctor consultations, follow-up visits, and treatments that do not require hospital admission have not been notified as covered.
• Non-hospitalisation medical expenses – Routine diagnostic tests, medicines purchased from pharmacies, and other medical expenses that do not involve hospitalisation have not been specified as covered.
• Treatments outside the approved package list – Only treatments included in the scheme's approved package list will be covered. Any procedures or services outside these packages will not be covered.

How to Apply for Mukhya Mantri Swasthya Bima Yojana (MMSBY)

• Step 1 : Go to the official Swasthya Sathi portal to check your enrolment status.
  Portal: swasthyasathi.gov.in
• Step 2 : Verify your eligibility by entering your registered mobile number or Swasthya Sathi registration details. Only beneficiaries enrolled under Swasthya Sathi and not covered under AB PM-JAY are eligible.
• Step 3 : Complete Aadhaar-based verification through the designated online portal or at an authorised enrolment camp, as notified by the Department of Health & Family Welfare.
• Step 4 : Receive your free digital MMSBY health card. An individual digital card is issued to each eligible family member after successful verification.
• Step 5 : Use the MMSBY card to avail cashless treatment at AB PM-JAY empanelled hospitals across India.

Documents Required for Mukhya Mantri Swasthya Bima Yojana

The Government has not yet notified the list of documents yet however, they must required to submit these documents-:

• Aadhaar Card of the applicant.
• Proof of Address in West Bengal.
• Ration Card or Family ID (if prescribed by the Government).
• Recent passport size photograph.
• Aadhaar registered mobile number.
• Any other documents as specified by the Government of West Bengal from time to time in accordance with the guidelines issued by the government.

Support and Contact Information

MMSBY and Other Schemes

• Swasthya Sathi Scheme - West Bengal's cashless health insurance scheme covering hospitalisation for eligible resident families.
• Ayushman Bharat (PM-JAY) - India's central health insurance scheme covering up to ₹5 lakh per family per year for economically weaker households.
• Mukhyamantri Jan Arogya Yojana (HIMCARE) - Covers families not eligible under AB PM-JAY. This is one of the closest models to MMSBY.
• Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) - Maharashtra's cashless state health scheme for BPL and marginally above-BPL families, covering up to ₹1.5 lakh per year.