An expert comparison of eligibility, benefits, and the reasons behind West Bengal's unique health model.
When it comes to public health insurance in India, two names often come up: the national Ayushman Bharat (PMJAY) and West Bengal's own flagship program, Swasthya Sathi. A common point of confusion for many is whether these schemes are the same, and if not, why West Bengal chose to implement its own program instead of adopting the national one. The fact is, West Bengal does not implement the Ayushman Bharat scheme.
This article provides a clear, head-to-head comparison of Swasthya Sathi and Ayushman Bharat. We will break down the fundamental differences in their philosophy, eligibility criteria, and unique features. Understanding these differences is key to appreciating why the Swasthya Sathi scheme is the only applicable cashless health card for the residents of West Bengal.
| Feature | Swasthya Sathi (West Bengal) | Ayushman Bharat (PMJAY) |
|---|---|---|
| Eligibility | Universal: Covers every resident of West Bengal not covered by other govt. schemes. | Targeted: Covers only families listed in the SECC 2011 database. |
| Coverage Amount | ₹5 Lakh per family per year. | ₹5 Lakh per family per year. |
| Card Holder | Card issued in the name of the senior-most female member of the family. | Card issued to any verified family member. |
| Funding | Fully funded by the Government of West Bengal. | Funded by the Central and State Governments in a 60:40 ratio. |
| Portability | Valid in West Bengal and at empanelled hospitals outside the state. | Valid at any empanelled hospital across India (national portability). |
The core idea behind Swasthya Sathi is **universality**. The Government of West Bengal wanted to provide a health security net to every single resident, irrespective of their income or social standing. By making eligibility universal, the state removed complex identification processes and ensured that no deserving family is left out simply because their name was not on a decade-old census list. This approach is rooted in the belief that healthcare is a right for all citizens.
The decision to issue the card in the name of the female head of the household is another defining feature, aimed at empowering women and giving them control over their family's healthcare decisions. Before applying, it's a good idea to know the basic documents required for health cards in general.
Ayushman Bharat, on the other hand, is a **targeted scheme**. Its objective is to provide financial protection to the most vulnerable sections of society—the bottom 40% of the population. The eligibility is strictly based on the deprivation and occupational criteria identified in the Socio-Economic Caste Census of 2011. While this ensures that the poorest of the poor are covered, it can leave out many low-income and lower-middle-income families who are just above the poverty line but cannot afford expensive medical treatments.
If you are a resident of West Bengal, the **Swasthya Sathi scheme is the only program you need to be concerned with**. Your Ayushman Bharat (PMJAY) card from another state will not be valid here, and you cannot apply for PMJAY as a West Bengal resident.
The state's decision to run its own universal scheme ensures that you, along with every other resident, have access to a powerful ₹5 lakh cashless health cover. The process is straightforward: enroll during the government's "Duare Sarkar" (Government at your Doorstep) camps, get your card, and you are ready to use it at any empanelled hospital. This makes the system simple, inclusive, and highly effective for the people of West Bengal.
No. The Swasthya Sathi scheme is exclusively for the residents of West Bengal.
No. The entire premium for the Swasthya Sathi scheme is paid by the Government of West Bengal. The enrollment and the card are provided completely free of cost to all citizens.
Yes, the scheme has empanelled over 2,000 hospitals, including a vast number of private hospitals in West Bengal and some super-speciality hospitals in other states for advanced treatments.