Mahatma Gandhi Sarbat Sehat Bima Yojana

The Mahatma Gandhi Sarbat Sehat Bima Yojana (MGSSBY) is a flagship health insurance scheme launched by the Government of Punjab to provide universal secondary and tertiary healthcare coverage to its residents. It is one of the most comprehensive state-level health insurance programmes in India, extending the benefits of the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to a broader segment of Punjab’s population under the state’s welfare mission.

Background and Launch

The MGSSBY was officially launched on 20 August 2019 by the Chief Minister of Punjab, marking a major step toward achieving the goal of “Health for All”. While the central government’s Ayushman Bharat programme covered only families listed in the Socio-Economic Caste Census (SECC) 2011, the Punjab Government decided to extend coverage to additional categories of beneficiaries to ensure inclusivity and social justice.
The scheme was implemented by the State Health Agency (SHA), Punjab, under the Department of Health and Family Welfare, as part of the Tandarust Punjab Mission, aimed at improving the overall health and well-being of the state’s citizens.

Objectives

The Mahatma Gandhi Sarbat Sehat Bima Yojana seeks to provide cashless and paperless health insurance to all eligible families in Punjab. Its primary objectives include:

• Ensuring financial protection against catastrophic health expenditures.
• Providing quality healthcare services to both rural and urban residents.
• Reducing out-of-pocket medical expenses for low-income families.
• Promoting universal access to secondary and tertiary health services.
• Integrating existing public and private healthcare systems through a single digital platform.

Beneficiary Coverage

The MGSSBY covers a much larger population base than the central Ayushman Bharat scheme, benefiting around 76% of Punjab’s population. The beneficiaries are divided into multiple categories:

1. SECC-2011 Families – Covered under the Ayushman Bharat (Central Scheme).
2. Smart Ration Card Holders – Families identified under the National Food Security Act (NFSA).
3. Small and Marginal Farmers – Identified through the Punjab Mandi Board.
4. Journalists and Accredited Media Persons – Registered with the Department of Information and Public Relations.
5. Building and Other Construction Workers – Enrolled under the Punjab Labour Welfare Board.
6. Small Traders and Shopkeepers – Registered under the Punjab Excise and Taxation Department.

In total, the scheme covers more than 46 lakh families, translating to approximately 2.8 crore beneficiaries.

Key Features

1. Insurance Coverage: Each eligible family is entitled to ₹5 lakh per annum for cashless treatment at empanelled hospitals for secondary and tertiary healthcare.
2. Network of Empanelled Hospitals:
   • Includes both public and private hospitals across Punjab.
   • Hospitals must meet specific quality and infrastructure criteria before being empanelled.
3. Paperless and Cashless Treatment: Beneficiaries can avail of free treatment through an e-card or ration card, with the entire transaction process being digital and transparent.
4. Comprehensive Coverage: The scheme covers over 1,500 medical and surgical procedures, including cardiology, nephrology, oncology, orthopaedics, neurosurgery, and gynaecology.
5. Pre- and Post-Hospitalisation Benefits: Expenses related to diagnostics, medicines, and follow-up care are included within the coverage limit.
6. Pan-India Portability: Beneficiaries can access cashless treatment not only in Punjab but also in other states where Ayushman Bharat empanelled hospitals are available.
7. E-Card for Beneficiaries: Each family receives an MGSSBY e-card, which serves as proof of eligibility and enables quick verification at hospitals.

Funding and Implementation

The funding structure of MGSSBY integrates both state and central resources:

• For families covered under Ayushman Bharat, the Centre and State share the cost in a 60:40 ratio.
• For additional state-sponsored categories, the Punjab Government bears the entire cost.

The State Health Agency (SHA), Punjab, is responsible for:

• Contracting the insurance company through open bidding.
• Overseeing hospital empanelment, claims management, and grievance redressal.
• Maintaining the digital health database of beneficiaries.

Technological Framework

The entire operation of MGSSBY is digital, integrating enrolment, verification, and claim processing through a single online platform. Key technological components include:

• Beneficiary Identification System (BIS): For real-time verification of eligible families using Aadhaar or ration card.
• Transaction Management System (TMS): For digital approval and claim settlement.
• Online Empanelment Portal: To manage hospital registrations and compliance.
• Helpline and Feedback Mechanism: To ensure transparency and resolve beneficiary grievances promptly.

Achievements and Impact

Since its launch, MGSSBY has made significant progress in extending affordable healthcare coverage across Punjab:

• Over 46 lakh families enrolled and active under the scheme.
• More than 10 lakh beneficiaries availed free treatment within the first few years of implementation.
• Over 800 hospitals (public and private) empanelled for service delivery.
• Cardiac surgeries, dialysis, cancer therapy, and trauma care recorded among the most availed services.
• Substantial reduction in out-of-pocket expenditure for hospitalised families.
• Played a vital role during the COVID-19 pandemic, by covering hospitalisation costs for infected patients.

Challenges

While the scheme has achieved wide coverage, several challenges persist:

• Delays in claim settlement to hospitals, occasionally affecting service continuity.
• Lack of awareness among rural populations about registration and benefits.
• Infrastructural gaps in some rural hospitals, leading to dependence on private facilities.
• Fraudulent claims and misuse in isolated cases requiring strict monitoring.

To address these, the State Health Agency has enhanced monitoring mechanisms, strengthened auditing, and increased outreach campaigns.

Integration with Other Initiatives

MGSSBY forms an integral part of Punjab’s broader health strategy, complementing initiatives such as:

• Tandarust Punjab Mission – promoting holistic public health and wellness.
• Ghar Ghar Nigrani App – for disease surveillance and preventive healthcare.
• eSanjeevani Telemedicine Services – for remote consultations.
• Sarbat Sehat Helpline – providing beneficiary assistance and feedback services.

Significance

The Mahatma Gandhi Sarbat Sehat Bima Yojana has emerged as a model for state-driven universal healthcare in India. Its significance lies in:

• Expanding health insurance beyond the central scheme to include multiple vulnerable groups.
• Reducing the economic burden of diseases on low-income and rural families.
• Integrating technology into health governance for greater transparency.
• Strengthening public-private partnerships in healthcare delivery.

It also embodies the Gandhian philosophy of social equity and collective welfare, ensuring that even the poorest citizens have access to dignified and quality healthcare.