Explainer: All about Punjab's ambitious insurance plan

The Punjab government has rolled out a universal health insurance scheme that ensures cashless medical treatment of up to Rs 10 lakh per family across the state. The scheme endeavours to bring about 65 lakh families under its ambit.

Registration for the Mukh Mantri Sehat Yojana (MMSY) started in Tarn Taran and Barnala districts on September 23, for which 128 camps each have been set up. It was scheduled to become operational from October 2, but with the state government bogged down in flood relief work, it has reportedly been postponed to December.

Who is eligible

The medicare venture aims to cover three crore residents across the state. All bona fide residents of Punjab are eligible to be enrolled regardless of income, age, gender or family size.

Chief Minister Bhagwant Singh Mann said while all government-run health institutions are already on board for the scheme, around 500 private hospitals have also been empanelled. “In a year, irrespective of the number of people in the family seeking treatment, each family can get treatment for 2,000 ailments, for up to Rs 10 lakh, for free,” he said. Cosmetic surgery is not included.

Enrolment process

Health and Family Welfare Minister Dr Balbir Singh said only the Aadhaar card and voter ID card are required to register under the scheme. Each family member will get an individual health card.

The scheme was initially announced in Punjab’s Budget for the 2025-26 fiscal, presented in March this year, with an allocation of Rs 778 crore.

Ayushman comparisons

MMSY is different from the Ayushman Bharat — Mukhya Mantri Sehat Bima Yojana (AB-MMSBY), a scheme jointly funded by the Central government, which bears 60 per cent of the cost, and the state government the rest. A sum of Rs 137 crore has been earmarked for the Ayushman Bharat Health Infrastructure Mission (ABHIM).

While both are essentially health insurance schemes in Punjab, the AB-MMSBY, launched in 2019, differs significantly from the MMSY in scope, coverage and eligibility. While MMSY is a universal scheme, covering every Punjab resident without any eligibility criteria, AB-MMSBY is aimed at specific socio-economic groups, leaving out a significant portion of the residents like those falling in the higher-income slab.

MMSY offers double the coverage per family annually compared to the Rs 5 lakh limit under AB-MMSBY. Also, MMSY integrates with AB-MMSBY by allowing a top-up of Rs 5 lakh for families already enrolled under Ayushman Bharat.

The Centre had also sought some clarifications from the state government on the modalities of the MMSY and its interface with the existing AB-MMSBY.

Rollout plan

Dr Balbir Singh said that 16.5 lakh families enrolled under AB-MMBSY would initially be covered under this scheme for up to Rs 5 lakh and the remaining top-up of Rs 5 lakh for treatment would be provided under the state’s health scheme. For the remaining 48.5 lakh families, the state government will bear the entire insurance premium.

With a simplified registration process requiring little documentation, the MMSY also does away with the verification of eligibility like Socio Economic and Caste Census data, income proof and state-specific criteria required for AB-MMSBY.

Concerns, demands

While medical associations have welcomed the MMSY, terming it a ground-breaking initiative, they have also expressed concerns over the relatively low overall budget allocation of Rs 5,598 crore for the health sector out of the state’s total budget of Rs 2.36 lakh crore.

The need for empanelling more private heathcare centres has also been projected to avoid an overload on government facilities. Officials said the number of private empanelled hospitals could go up to 1,000 from the present 500.

Treatment outside Punjab is permitted in Ayushman Bharat empanelled hospitals. AB-MMSBY has also faced challenges of limited hospital empanelment, which the MMSY aims to address.

Punjab’s medicare infrastructure remains under strain due to the gap between available facilities and the projected requirements. OPD visits statewide are approximately six crore annually, out of which government hospitals account for 70 per cent, while annual IPD admissions are in the vicinity of 25 lakh.

The state’s health infrastructure has suffered a hit during the floods. According to the Minister, medical infrastructure worth Rs 780 crore was damaged, including 1,280 dispensaries and health-wellness centres.