Sarbat Sehat Bima Yojana (SSBY)

The Sarbat Sehat Bima Yojana (SSBY) is a comprehensive health insurance initiative launched by the Government of Punjab to provide cashless health care services to residents of the state. It represents Punjab’s commitment to achieving universal health coverage and ensuring access to quality medical treatment for all sections of society, particularly the economically weaker segments.

Background and Launch

The scheme was officially launched on 20 August 2019 by the Chief Minister of Punjab. It serves as the state-specific extension of the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). While the central scheme primarily covers beneficiaries identified under the Socio-Economic Caste Census (SECC) 2011 data, the Punjab Government expanded its reach through SSBY to include several additional categories of residents, thereby ensuring more inclusive coverage.
The programme is implemented by the State Health Agency (SHA), Punjab, under the Department of Health and Family Welfare, and is a crucial component of the state’s “Tandarust Punjab Mission”, which aims to create a healthier and more equitable society.

Objectives

The main objectives of the Sarbat Sehat Bima Yojana are:

• To provide financial protection to families against catastrophic health expenditure.
• To ensure cashless treatment at both public and empanelled private hospitals.
• To expand health insurance coverage beyond the central Ayushman Bharat eligibility list.
• To promote equitable access to quality healthcare services across rural and urban areas.
• To reduce the economic burden of hospitalisation and prevent impoverishment due to medical costs.

Coverage and Beneficiary Categories

The Sarbat Sehat Bima Yojana covers a wide range of beneficiaries, extending far beyond the centrally identified population. The scheme benefits approximately 76% of Punjab’s population, making it one of the most extensive state health insurance programmes in India.
The key beneficiary groups include:

1. SECC-2011 Families: Beneficiaries under Ayushman Bharat PMJAY.
2. Smart Ration Card Holders (NFSA Beneficiaries): Families identified under the National Food Security Act.
3. Small and Marginal Farmers: Identified by the Punjab Mandi Board.
4. Journalists: Accredited journalists and their families registered with the Information and Public Relations Department.
5. Construction Workers: Registered under the Building and Other Construction Workers Welfare Board.
6. Small Traders: Registered with the Punjab Excise and Taxation Department.

Each eligible family is entitled to cashless health insurance coverage of ₹5 lakh per annum per family for secondary and tertiary care treatment in empanelled hospitals.

Implementation and Institutional Framework

The scheme is managed through the State Health Agency (SHA), Punjab, which oversees its planning, coordination, and monitoring. The SHA is supported by district-level committees and nodal officers responsible for enrolment, hospital empanelment, and grievance redressal.
Insurance Partner: The scheme is implemented through an insurance-based model. The Punjab Government selects an insurance company through a competitive bidding process to handle claims, reimbursements, and beneficiary payouts.
IT Platform: SSBY operates on a digital platform that integrates enrolment, verification, hospital empanelment, and claims management. Beneficiaries are identified through Aadhaar authentication and Smart Ration Card data, ensuring transparency and accuracy.

Key Features

1. Cashless and Paperless Treatment:
   • Beneficiaries can avail of free treatment up to ₹5 lakh per family per year.
   • The process is completely cashless and paperless at empanelled hospitals.
2. Wide Network of Hospitals:
   • Both government and private hospitals are empanelled under the scheme.
   • Hospitals must meet quality and infrastructure standards to ensure proper care delivery.
3. Pre- and Post-Hospitalisation Coverage:
   • The scheme includes diagnostic services, medicines, and follow-up care associated with hospitalisation.
4. Comprehensive Disease Coverage:
   • Treatment is available for over 1,500 medical and surgical procedures, including cardiology, oncology, nephrology, orthopaedics, gynaecology, neurosurgery, and others.
5. Portability:
   • Beneficiaries can access services from any empanelled hospital in Punjab and across India under Ayushman Bharat empanelment.
6. E-Card Facility:
   • Each family is issued an e-card (Sarbat Sehat Bima Card) for easy identification and hospital admission.

Funding Pattern

The Sarbat Sehat Bima Yojana is a jointly funded scheme:

• For Ayushman Bharat (AB-PMJAY) beneficiaries, costs are shared between the Central and State Governments in a 60:40 ratio.
• For state-sponsored categories, the Punjab Government bears the entire premium cost.

This blended funding model allows the state to expand coverage while aligning with national health policy objectives.

Enrollment Process

The enrollment process involves:

1. Beneficiary Identification: Verification using Aadhaar and ration card details.
2. Card Issuance: Eligible families receive a Sarbat Sehat Bima Card through Common Service Centres (CSCs) or designated enrolment camps.
3. Hospital Admission: Beneficiaries can present their card at any empanelled hospital to avail of cashless treatment.

Awareness campaigns and outreach programmes are conducted at the district level to ensure all eligible families register for the scheme.

Monitoring and Grievance Redressal

The State Health Agency maintains a real-time monitoring dashboard to track:

• Number of beneficiaries enrolled.
• Claims processed and payments made.
• Hospital performance and compliance with scheme guidelines.

A grievance redressal mechanism allows beneficiaries to report issues through helplines, district offices, or the online portal.

Achievements and Impact

Since its inception, the Sarbat Sehat Bima Yojana has achieved several milestones:

• Over 46 lakh families have been enrolled under the scheme.
• Thousands of patients have benefited from free treatment for major diseases, including heart surgery, cancer therapy, and kidney dialysis.
• Empanelled hospital network has expanded to include more than 800 hospitals across Punjab, covering both rural and urban areas.
• The scheme has significantly reduced out-of-pocket expenditure, particularly for low-income families.
• During the COVID-19 pandemic, SSBY played a crucial role by covering treatment costs for infected patients and supporting hospital capacity.

Challenges

Despite its success, the scheme faces operational challenges:

• Ensuring timely claim settlements to hospitals.
• Preventing misuse or fraudulent claims.
• Increasing awareness among rural populations about eligibility and benefits.
• Strengthening monitoring to maintain consistent quality of care.

The government continues to refine processes and expand the digital monitoring system to address these issues effectively.

Significance

The Sarbat Sehat Bima Yojana represents a progressive model of state-level health insurance, combining central and state efforts to provide equitable healthcare. It integrates welfare and technology to create a responsive and transparent healthcare safety net.
The scheme aligns with Punjab’s goal of achieving “Health for All”, ensuring that no citizen is denied medical treatment due to financial constraints. It reflects the vision of a Healthy and Prosperous Punjab (Tandarust Punjab) through preventive, curative, and financial health protection measures.