What was Biju Swasthya Kalyan Yojana (BSKY)?

Biju Swasthya Kalyan Yojana was an Odisha government health assurance programme designed to improve access to healthcare and reduce the financial burden of treatment. Odisha's health assurance arrangements have since evolved, with GJAY and AB-PMJAY operating in convergence.

What is Gopabandhu Jana Arogya Yojana (GJAY)?

GJAY is Odisha's state health assurance scheme. It includes healthcare services at government facilities and annual coverage for specified treatments at empanelled hospitals for eligible families.

What is the difference between BSKY, GJAY, and AB-PMJAY?

BSKY was an earlier Odisha health assurance programme. GJAY is the state's health assurance scheme, while AB-PMJAY is the national scheme. Odisha now implements AB-PMJAY in convergence with GJAY. These should not be treated as three separate benefits that can automatically be added together.

How much health coverage is available under GJAY?

The stated annual family coverage is ₹5 lakh for eligible families, with an additional ₹5 lakh available for eligible women after the initial family coverage limit has been exhausted, subject to the applicable rules.

Does every woman in Odisha automatically receive an additional ₹5 lakh?

No. The additional coverage is subject to scheme eligibility and conditions. It is not an unconditional cash payment. Beneficiaries should verify their eligibility and available coverage before relying on this benefit.

Can beneficiaries receive treatment at private hospitals?

Yes, eligible beneficiaries can access specified treatments at empanelled private hospitals. The hospital must participate in the relevant scheme, and the treatment must meet the applicable coverage and approval requirements.

Can people covered under Odisha's scheme receive treatment outside the state?

Eligible beneficiaries may be able to receive covered treatment at participating hospitals outside Odisha through the applicable national network. Coverage is not available automatically at every hospital, so the hospital and treatment should be verified in advance.

Does the scheme cover every medical expense?

No. Coverage depends on the applicable scheme rules and approved treatment packages. Beneficiaries should confirm what is included and whether any expenses may fall outside the approved package.

Should families covered under GJAY or AB-PMJAY also buy private health insurance?

It depends on the family's healthcare needs, financial situation, hospital preferences, and the protection already available through the government scheme. Private health insurance may provide additional benefits, but its exclusions, waiting periods, limits, and premiums should be reviewed before buying a policy.

Does GJAY cover every hospital bill?

No. Coverage depends on eligibility, hospital participation, approved treatments, and scheme rules. Some expenses may fall outside the approved coverage.

Can eligible people receive treatment outside Odisha?

Yes, eligible people may access covered treatment at participating hospitals outside the state through the applicable network. Confirm hospital participation and treatment coverage before admission.

Odisha Health Insurance: GJAY and Women's Coverage

Q: What is Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)?

AB-PMJAY is a national health assurance scheme introduced by the Government of India. Odisha began implementing it in convergence with GJAY on 13 January 2025, expanding access to covered treatment through participating hospitals.

Health Insurance

Term Insurance

Blogs

Claims

Tools

Partner with us

Health Insurance
- Explore Insurers
- Explore Insurance Plans
- Explore Insurance Types
Term Insurance
- Explore Insurers
Blogs
Claims
- Claim Stories
- Explore Insurers
Tools
- Explore Calculators

Partner with us

OneAssure

Blogs

Health Insurance Guides

Odisha Health Insurance Scheme: GJAY, Ayushman Bharat and Women's Coverage

Understand Odisha's health insurance schemes, how additional coverage for eligible women works, who may qualify, and what families should check before hospital treatment.

Written by

Jaison F Joy

Read time : 5 minutes

Published on : October 12, 2026

Need advice tailored to you?

Looking for the right plan? You don't have to guess. Let us compare the fine print for you and give you an unbiased recommendation.

Need advice tailored to you?

Looking for the right plan? You don't have to guess. Let us compare the fine print for you and give you an unbiased recommendation.

Hospital treatment can be expensive, especially when a family member needs surgery or specialist care. Government health insurance schemes in Odisha can help eligible families manage these costs. One important benefit is the additional health coverage available to eligible women after the family's initial coverage limit is exhausted.Odisha's Gopabandhu Jana Arogya Yojana (GJAY) works alongside Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). This arrangement is called convergence, which means two government schemes work together to provide health coverage.Here's how the schemes work, who may qualify, and what families should know before seeking treatment.

Quick Overview

Scheme: GJAY, working alongside AB-PMJAY.
Initial family coverage: ₹5 lakh per year under the applicable scheme rules.
Additional coverage for women: Up to ₹5 lakh after the initial family limit is exhausted, subject to eligibility and scheme rules.
Treatment: Government healthcare facilities and specified treatments at participating hospitals.
Eligibility: Depends on the applicable scheme and the family's records.

How Does Odisha's Health Insurance Scheme Work?

Gopabandhu Jana Arogya Yojana (GJAY) is Odisha's state health insurance scheme. It supports healthcare services at government facilities and covers specified treatments at approved private hospitals for eligible families.An approved hospital is called an empanelled hospital. This means the hospital has been approved to provide treatment under the scheme.At government healthcare facilities, the state pays for covered health services. At participating private hospitals, eligible families can access specified treatments within their available coverage.However, the rules for accessing services at government facilities differ from those for receiving covered treatment at private hospitals. This is why families should check their eligibility before depending on the scheme for hospital treatment.

How Does the Additional Coverage for Women Work?

One distinctive feature of Odisha's health insurance scheme is the additional ₹5 lakh available to eligible women after the initial family coverage limit has been exhausted.Consider this example.A family has ₹5 lakh in initial coverage. One family member receives covered treatment costing ₹3 lakh, leaving ₹2 lakh.If an eligible woman in the family later needs hospital treatment, she may be able to use the remaining ₹2 lakh and up to ₹5 lakh in additional women's coverage. This means up to ₹7 lakh could be available for her treatment, depending on the scheme rules and the approved treatment costs.If the initial family coverage has not been used, an eligible woman may be able to access up to ₹10 lakh in total under the stated coverage structure.Does every woman automatically receive an extra ₹5 lakh?No. The additional coverage is not an unconditional cash benefit. Eligibility, the amount of family coverage already used, and the applicable rules determine how much coverage is available.Families should confirm their coverage before relying on this benefit.

What Are BSKY, GJAY and Ayushman Bharat?

You may come across three names when researching Odisha's health insurance schemes. They are related, but they do not represent three separate benefits that every family can automatically combine.Biju Swasthya Kalyan Yojana (BSKY) was an earlier Odisha government health programme that supported access to healthcare and treatment at participating private hospitals for eligible people.Gopabandhu Jana Arogya Yojana (GJAY) is Odisha's state health insurance scheme. It supports healthcare services at government facilities and covers specified treatments at participating hospitals.Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is the national health insurance scheme. Odisha began implementing it alongside GJAY on 13 January 2025.For families, the important point is to check which scheme benefits currently apply to them. Do not assume that benefits from all three names can be added together.

Who Is Eligible for Coverage?

Eligibility depends on the type of benefit being accessed.Official GJAY information identifies eligible National Food Security Act (NFSA) and State Food Security Scheme (SFSS) cardholders, along with existing BSKY Smart Card holders, among the groups eligible for special health coverage.NFSA stands for National Food Security Act, while SFSS stands for State Food Security Scheme.Not everyone automatically qualifies for covered treatment at private hospitals. Your family's records and the rules of the applicable scheme matter.If you are unsure whether you qualify, check your details through the relevant government scheme service or ask the hospital's scheme help desk before planned treatment.

Where Can You Get Treatment?

Eligible people may receive care at government healthcare facilities and participating private hospitals.Under the GJAY and AB-PMJAY arrangement, eligible people may also receive covered treatment at participating hospitals outside Odisha through the applicable network. This can help families who live outside the state or need treatment elsewhere.However, not every hospital or medical procedure is covered. Before admission, confirm that the hospital participates in the scheme and offers the treatment you need.

What Should You Check Before Hospitalisation?

Before planned treatment, confirm these four things:

Your eligibility: Check whether your family qualifies under the applicable scheme.
Hospital participation: Make sure the hospital is approved for the treatment you need.
Treatment approval: Ask whether the procedure is covered and whether prior authorisation, meaning approval before treatment, is required.
Available coverage: Check how much of the initial family limit has been used and whether the additional coverage for women applies.

These checks can help you understand what the scheme may cover and reduce confusion about hospital expenses.

Is Government Health Insurance Enough?

GJAY and AB-PMJAY can help eligible families manage hospital expenses, but coverage depends on the scheme's rules, approved treatments, and participating hospitals.Private health insurance may offer additional benefits or access to a different hospital network. However, private policies also have premiums, exclusions, waiting periods, and coverage limits.Before buying a separate policy, understand the benefits your family already has. Then consider whether you need additional protection for medical expenses that may not be covered.

Final Takeaway

Odisha's health insurance schemes combine state and national programmes, with additional coverage for eligible women being one of their distinctive features.If you live in Odisha, check your eligibility, available coverage, and participating hospitals before relying on the scheme for treatment. Knowing these details can help your family make better-informed healthcare decisions.

Frequently Asked Questions

Get answers to common questions about our insurance policies and services.

1-5 of 12 FAQs

Talk to an OneAssure Insurance Expert

Get the best policy with proper guidance
Get on a Call Now.

Health Insurance Guides

Kerala Healthcare System & Health Insurance: Complete Guide to KASP, Private Care, AYUSH & NORKA Care Plus

Jaison F Joy

A simple look at how Kerala's healthcare system works, from primary care and prevention to government schemes, private hospitals, AYUSH, digital health and support for NRIs.

Health Insurance Guides

Healthcare & Health Insurance in Karnataka: Complete Guide to AB-ArK, Hospitals & Coverage

Jaison F Joy

A simple guide to Karnataka's healthcare system, from government health centres and Ayushman Bharat-Arogya Karnataka to private hospitals, preventive care, AYUSH and health insurance.

Life Insurance Compare

Beginner's guide to life insurance & types of LIPs in India 2024

Simmran Sharma

Discover the essentials of life insurance in India with our comprehensive guide. Learn about key terms in life insurance and types of life insurance policy in India.