West Bengal MMSBY scheme: Know eligibility, diseases covered and how to apply

Free, individual digital cards will be issued to every family member following mandatory verification. Authentication will take place via designated camps, official web portals, or hospital helpdesks. An online application feature is scheduled to launch shortly.

Know more details of MMSBY, which covers 2,000 diseases, including mental ailments, and even knee replacement surgeries. Here is how to apply for Bengal’s new Rs 5 lakh health insurance scheme:

Under the newly launched Mukhyamantri Swasthya Bima Yojana (MMSBY) and the updated Health Benefit Packages (HBP 2022) for West Bengal, the government provides comprehensive cashless coverage for nearly 1,950 to 2,000 disease categories and specialized procedures. The scheme is designed to offer end-to-end medical care, covering pre-existing conditions from day one without any cap on family size.

A major focus of the package options includes critical surgeries and specialized inpatient care.

In orthopedics, the scheme covers high-end surgical procedures such as total knee replacements and total hip replacements. For cardiovascular, vascular, and neurological needs, beneficiaries have access to advanced interventional radiology procedures, including arterial and venous angioplasty, stenting, coil and glue embolization, thrombolysis, and brain aneurysm interventions.

Emergency procedures, such as complex laceration care and resuscitation, are also structured into the benefit tiers.

The coverage extends to extensive specialized medical management across multiple departments. In obstetrics and gynecology, packages cover routine and high-risk deliveries (such as cases involving severe pre-eclampsia, severe anemia, or diabetes), Caesarean sections, hysterectomies, and laparoscopic interventions. Mental health care is fully integrated, offering treatments for intellectual disabilities, organic mental disorders, schizophrenia, mood disorders, substance abuse, and neurodevelopmental conditions like Autism Spectrum Disorder.

Furthermore, burn management is thoroughly covered, providing financial aid for thermal, scald, electrical, and chemical burns based on severity, alongside post-burn contracture reconstruction surgeries. Patients undergoing treatment also receive coverage for high-end diagnostic tests and specialized pharmaceutical therapies. Diagnostic support includes CT and ultrasound-guided needle biopsies, fine-needle aspirations, genetic workups, diskography, and Video EEG monitoring. For critical medical conditions, specialized medications such as intravenous immunoglobulins (IVIG), targeted biological drugs like Rituximab, advanced antibiotics, and therapies for rare or severe infections will be provided to ensure patients receive essential care without out-of-pocket expenses.

Hospital registration process, patient categories

To ensure uninterrupted patient care, the health department has updated the Swasthya Sathi Transaction Management System (TMS) portal (https://ssai.swasthyasathi.gov.in/) with specific registration pathways.

Those with printed cards: Patients listed in the PM-JAY card printing databases verified via National Food Security Act (NFSA) records with pending card approval are eligible for WB PM-JAY. Treatment continues under Swasthya Sathi while approval is monitored at beneficiary.nha.gov.in.

If e-KYC or VVS (Vay Vandana Scheme for patients aged 70+) is incomplete, staff must initiate verification via the NHA portal. Treatment proceeds under Swasthya Sathi without delay. Patients not found in NFSA records are redirected to MMSBY. Hospitals will print the MMSBY application form for the patient, confirm portal submission, and proceed with standard Swasthya Sathi admission will be directed to PM-JAY TMS. In the event of portal technical issues, hospital staff can select “Facing issue in PM-JAY TMS,” submit a consent form with a screenshot, and proceed under Swasthya Sathi. Patient.

Hospital execution steps

Log on to https://ssai.swasthyasathi.gov.in/ using official hospital credentials. Navigate to Beneficiary Enrollment Module and then to New Registration to begin verification.

Route the patient based on portal prompts: PM-JAY TMS for printed cards, technical exception forms for portal errors, NHA portal verification for pending e-KYC, or MMSBY form issuance for unlisted beneficiaries.

Application Process (Form B): Download the form. Visit the official Swasthya Sathi Website or collect Form B from your nearest Block Development Office (BDO) or municipal office. Fill in the details, enter the head of the family’s name, address, district, block/municipality, and the Aadhaar and Ration Card numbers of all family members.

Submit documents: Submit the completed form along with photocopies of the required documents to your local authority (BDO or municipal office).

Verification and Smart Card: After official verification, your Unique Registration Number (URN) will be generated, and you will receive your Swasthya Sathi Smart Card at an official camp.