Ayushman Bharat Rolls Out in West Bengal: What Changes for Swasthya Sathi Beneficiaries?

West Bengal is set to implement the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) across the state. The scheme is expected to cover approximately 1.43 crore poor families, elderly citizens, and frontline health workers in the state. This rollout marks a significant shift in how health insurance is delivered to West Bengal's residents.

Under PM-JAY, the Central government provides cashless health insurance cover of up to ₹5 lakh per family per year for hospitalisation expenses. The scheme targets the poorest 40% of households as identified through the Socio-Economic Caste Census (SECC) 2011, all senior citizens aged 70 years and above, and frontline healthcare workers such as ASHA workers and Anganwadi workers. The premium-sharing arrangement between the Centre and states is 60:40 — meaning the Central government pays 60% and the state pays the remaining 40% of the insurance premium for these eligible categories.

Before this development, West Bengal operated its own state-funded scheme called Swasthya Sathi, which offered health coverage of up to ₹5 lakh per family per year to around 2.45 crore families who were not covered by any other government health scheme. Swasthya Sathi covered all permanent residents of the state on a near-universal basis. With PM-JAY now being introduced, Swasthya Sathi beneficiaries are also expected to be brought under the national scheme. For this group — which falls outside the PM-JAY-defined beneficiary list — the state government will pay the full insurance premium from its own funds, while residents will gain access to the broader national network.

One of the key advantages of shifting to PM-JAY is portability. The scheme operates across a network of over 36,000 empanelled hospitals throughout India. A beneficiary from West Bengal can use the PM-JAY card to avail treatment at any empanelled hospital in any state. This is particularly useful for residents who travel or relocate for work. The newly formed State Health Authority in West Bengal is currently in the process of uploading patient and hospital data to the national portal to enable this integration.

For exam preparation, this development is relevant across multiple dimensions. First, it illustrates Centre-State cooperation in welfare delivery — here, a state scheme (Swasthya Sathi) is being integrated into a centrally sponsored scheme (PM-JAY), with the state continuing to fund coverage for those outside the Central criteria. Second, it highlights PM-JAY's core features: ₹5 lakh annual cover, SECC 2011-based targeting, senior citizen inclusion from age 70, premium-sharing at 60:40, and pan-India portability. Third, it demonstrates how states can extend a Centrally Sponsored Scheme beyond the mandated beneficiary list by contributing additional premium, showing fiscal federalism in health policy.