West Bengal Health Schemes: Swasthya Sathi, PM-JAY & MMSBY Guide

In mid-2026, West Bengal's public health insurance system underwent a significant transformation. The state's universal health scheme, Swasthya Sathi, which had been in place since 2016, transitioned to become the foundational platform for a new, multi-layered model. This new structure integrates beneficiaries into the national Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY).

To ensure continued coverage for residents who are part of Swasthya Sathi but do not meet the central criteria for PM-JAY, the state government introduced the Mukhyamantri Swasthya Bima Yojana (MMSBY). As a result, healthcare in West Bengal is now provided through a combination of these three schemes, aiming to offer comprehensive coverage with the added benefit of nationwide portability for most residents.

West Bengal Health Schemes: At a Glance

The helpline numbers are for the Swasthya Sathi scheme, which serves as the base platform. Helplines for MMSBY have not been publicly announced.

• Health Coverage per Family — Up to ₹5 lakh per year
• Swasthya Sathi Launch Date — December 30, 2016
• Adoption of Ayushman Bharat (PM-JAY) — July 2026
• Mukhyamantri Swasthya Bima Yojana (MMSBY) Announced — Late July 2026
• Swasthya Sathi Toll-Free Helpline — 1800-345-5384
• Swasthya Sathi WhatsApp Helpline — 9073313211

Rates shown are as per the The Indian Express (2026) and are subject to periodic revision. Always verify the latest approved rates on the official source.

What is Covered by West Bengal's Health Schemes?

The primary benefit across Swasthya Sathi, Ayushman Bharat (PM-JAY), and the Mukhyamantri Swasthya Bima Yojana (MMSBY) is a cashless health coverage of up to ₹5 lakh per family, per year. This coverage is for secondary and tertiary care hospitalisation.

Key features of the coverage include:

The entire premium for these schemes is paid by the government, with the state government bearing the full cost for those who do not meet the central government's funding criteria for PM-JAY. A significant advantage of the new structure is the nationwide portability offered by both PM-JAY and MMSBY, allowing beneficiaries to receive cashless treatment at empanelled hospitals across India.

• Coverage for pre-existing diseases is included from day one of enrolment.
• There is no cap on the family size included under the policy.
• Parents of both spouses can be included in the family's coverage.

Who is Eligible for Coverage?

Eligibility for health coverage in West Bengal is now determined through a tiered system based on the Swasthya Sathi database.

1. **Swasthya Sathi:** This scheme serves as the foundational enrolment platform. It is open to all permanent residents of West Bengal who are not covered by any other government-sponsored health insurance or do not receive a medical allowance as part of their salary.

2. **Ayushman Bharat (PM-JAY):** From the pool of Swasthya Sathi beneficiaries, those who meet the specific deprivation and occupational criteria defined by the Socio-Economic Caste Census (SECC) of 2011 are eligible for the centrally sponsored PM-JAY scheme.

3. **Mukhyamantri Swasthya Bima Yojana (MMSBY):** This new state scheme is specifically for permanent residents of West Bengal who are enrolled in Swasthya Sathi but are *not* eligible for PM-JAY. An annual family income ceiling of ₹8 lakh has been introduced for eligibility under MMSBY.

How to Enrol and Get a Health Card

The enrolment process begins with the Swasthya Sathi scheme, which acts as the gateway to the other schemes.

**Step 1: Enrol for Swasthya Sathi**

Enrolment is done by submitting a physical application, known as Form B. These forms are often available at 'Duare Sarkar' (government at your doorstep) camps organised by the state government. Applicants need to provide documents such as an Aadhaar card, proof of residence, and a ration card. Once the application is processed, a Swasthya Sathi smart card is issued in the name of the eldest female member of the family. This card contains the family's details, biometrics, and a registered mobile number.

**Step 2: Check Eligibility for Ayushman Bharat (PM-JAY)**

Holding a Swasthya Sathi card is the first step, but it does not automatically mean enrolment in the centrally funded PM-JAY. Beneficiaries must check their eligibility on the national PM-JAY portal at `beneficiary.nha.gov.in`. The rollout of Ayushman Bharat cards in West Bengal was scheduled to begin in July 2026.

**Step 3: Coverage under MMSBY**

Beneficiaries of Swasthya Sathi who are not found to be eligible for PM-JAY and meet the income criteria are intended to be covered under the Mukhyamantri Swasthya Bima Yojana. The application process for this is integrated with the existing Swasthya Sathi system. However, detailed operational guidelines and specific enrolment dates for MMSBY were yet to be announced as of late July 2026.

Integration of Swasthya Sathi with Ayushman Bharat (PM-JAY)

After operating its own scheme for several years, West Bengal announced its decision to join the Ayushman Bharat (PM-JAY) scheme in May 2026. The state has clarified that Swasthya Sathi will continue to function as the base enrolment platform, and its existing beneficiaries are being migrated and integrated into the national PM-JAY framework.

This integration means that eligible West Bengal residents can now benefit from PM-JAY's pan-India hospital network. For beneficiaries who are part of the Swasthya Sathi database but do not fit the central government's SECC 2011 criteria for PM-JAY, the West Bengal government will bear the full premium cost to onboard them onto the Ayushman Bharat platform, ensuring they receive comparable benefits.

Using Health Cards at Empanelled Hospitals

The process for availing cashless treatment at empanelled public and private hospitals is straightforward and card-based. When a beneficiary needs hospitalisation, they must present their Swasthya Sathi smart card or Ayushman Bharat card at the hospital's help desk.

The hospital staff will verify the card details using an online portal. After verification, the hospital will seek a pre-authorization for the estimated cost of the treatment. Once the pre-authorization is approved by the insurer or the implementing agency, the patient can receive cashless treatment up to the coverage limit of ₹5 lakh. The beneficiary does not need to pay any money for covered procedures at the hospital.

Frequently Asked Questions

I have a Swasthya Sathi card. Do I need to apply for a new card?

Your Swasthya Sathi card remains your primary identification for the state's health scheme database. However, you should check your eligibility for Ayushman Bharat (PM-JAY) on the national portal. If eligible, you will be issued an Ayushman Bharat card. The process for migrating Swasthya Sathi beneficiaries began in July 2026.

What is the main difference between Swasthya Sathi and the new Mukhyamantri Swasthya Bima Yojana (MMSBY)?

Swasthya Sathi is the foundational scheme for enrolment. MMSBY is a new scheme launched in July 2026 specifically for Swasthya Sathi beneficiaries who are NOT eligible for the national Ayushman Bharat (PM-JAY) scheme and have a family income below ₹8 lakh per year. MMSBY also offers pan-India portability, similar to PM-JAY.

Can I use my health card for treatment outside West Bengal?

Yes, if you are covered under Ayushman Bharat (PM-JAY) or the Mukhyamantri Swasthya Bima Yojana (MMSBY). Both of these schemes provide for nationwide portability, allowing you to get cashless treatment at any empanelled hospital across India.

Is the treatment completely free?

The scheme provides cashless treatment up to ₹5 lakh per family per year for secondary and tertiary care hospitalisation at empanelled hospitals. This covers most expenses related to hospitalisation, including pre-existing conditions. Any costs exceeding the ₹5 lakh limit or for treatments not covered by the scheme would have to be paid by the patient.

What happens if a family's income is above ₹8 lakh per year?

The Mukhyamantri Swasthya Bima Yojana (MMSBY) has an annual family income ceiling of ₹8 lakh for those not eligible for PM-JAY. The research notes do not specify the provisions for families enrolled in Swasthya Sathi with incomes above this threshold who are also not eligible for PM-JAY.

How can I find a list of hospitals covered under the scheme?

You can find the list of empanelled hospitals on the official Swasthya Sathi portal (swasthyasathi.gov.in) for hospitals in West Bengal. For the nationwide network under PM-JAY, you can search for hospitals on the Ayushman Bharat national portal (beneficiary.nha.gov.in).

Related

• Government hospital OPD guides in West Bengal
• How to find an Ayushman Bharat (PM-JAY) hospital near you
• Ayushman Bharat PM-JAY eligibility check
• Government health schemes in India: a guide

Medical Disclaimer

The information provided in this article is for general informational and educational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.