Bengal Mukhya Mantri Swasthya Bima Yojana: eligibility, exclusions, how to apply

State government health scheme: Employees or pensioners covered under the West Bengal Health Scheme 2008.

Central government health scheme (CGHS): Employees or pensioners covered under the CGHS 1954.

ESI coverage: Employees or pensioners covered under the Employees’ State Insurance Act 1948.

PSU/statutory body insurance: Employees or pensioners enrolled in any group medical insurance scheme operated by central or state public sector undertakings, urban local bodies, statutory corporations, trusts, societies, or boards.

Medical allowance recipients: State or central government, parastatal employees and pensioners drawing a regular medical allowance.

Senior citizens: Individuals over 70 years of age (as they qualify for coverage under the Ayushman Vaya Vandana Yojana).

Electoral roll deletions: Individuals whose names were removed during the Special Intensive Revision (SIR) of the electoral roll under the absentee, deceased, shifted, or duplicate lists. Applicants with pending Citizenship Amendment Act or SIR tribunal adjudications remain eligible if they satisfy all other conditions.

MMSBY vs Swasthya Sathi

While the MMSBY builds upon the foundations laid by Swasthya Sathi, it introduces key structural changes:

Pan-India portability: Under Swasthya Sathi, cashless medical treatment was primarily limited to empanelled hospitals within the state. In contrast, the MMSBY offers nationwide portability, allowing beneficiaries to access cashless treatment at any Ayushman Bharat-empanelled hospital across India—a major relief for people travelling or working outside the state.

Refined income and target criteria: Swasthya Sathi provided near-universal coverage by removing income barriers for all residents (except those on specific government health schemes). The MMSBY introduces a defined annual family income ceiling of Rs 8 lakh along with targeted exclusions to streamline resources for families without secondary coverage.

What remains the same

Despite these logistical upgrades, the key benefits that protect families against medical debt remain intact:

Coverage amount: Families receive up to Rs 5 lakh per year for secondary and tertiary care hospitalisation on a floater basis.

Pre-existing conditions: Covered from Day 1 with zero waiting period.

No family cap: No limit on the number of dependent family members who can be covered under a single policy unit.

How to apply

Because MMSBY targets residents covered under Swasthya Sathi who lack Ayushman Bharat coverage, the application and verification process is integrated directly into the state’s existing healthcare setup.

Swasthya Sathi cardholders can check their eligibility status directly on the official portal (swasthyasathi.gov.in) by entering their registered mobile number or unique registration number.

If your family is not yet registered under Swasthya Sathi, you can fill in the standard registration form on the official portal or submit a physical copy at local administrative camps (such as Duare Sarkar outreach drives or block development or municipal offices).

Required documents

To complete or verify your application, you will need:

Aadhaar numbers of all family members.

Khadya Sathi, Digital Ration Card.

Self-declared income certificate confirming annual family income is Rs 8 lakh or less.