Two weeks ago, 28 year old Senthil Kumar (name changed) from Tiruppur died of a heart attack in a labour camp near Dammam, Saudi Arabia. His body came home to Chennai because his employer agreed to pay for the airfare. His family received ₹10 lakh under the Pravasi Bharatiya Bima Yojana (PBBY). The district collector handed over the cheque, cameras flashed, and the story ended there. Senthil’s case is the only side of PBBY the Indian state likes to showcase: the neat success story where the system appears to work. The rest is silence.

Senthil was, in a brutal sense, fortunate. The policy was valid, the paperwork was in order, the claim went through. For every family like his, there are hundreds of thousands of Tamil workers in the Gulf and Malaysia who live and work as if insured, but are effectively unprotected. Tamil Nadu’s own data show that about 2.2 million emigrants were abroad in 2015, sending home roughly ₹61,843–62,000 crore that year – around 14–14.5% of the state’s income and more than the state’s own tax revenue. Those remittances build houses, pay school fees and plug holes in state finances. Yet, when these same workers fall ill, collapse from heat, or are injured on site, the system that counts their money looks the other way.

On paper, PBBY is the shield. Since 2003, and in a revised form from 2017, it has been mandatory for ECR passport workers going to the Gulf and other destinations. For a one time premium of ₹275–₹375 for two or three years, it promises ₹10 lakh for accidental death or permanent disability, ₹1 lakh in medical cover (capped at ₹50,000 per hospitalisation), ₹50,000 for family hospitalisation in India, a ₹35,000 maternity benefit, repatriation airfare and up to ₹45,000 in legal expenses. The brochure looks generous. The lived reality is less so. A ₹1 lakh cap on treatment might help with a short hospital stay, but it barely dents the cost of cancer, kidney failure or cardiac care in private hospitals in the Gulf. Everyday health needs, outpatient visits, diagnostics, medicines for back pain and hypertension or depression are almost entirely outside the frame, even though these are exactly what drive most out of pocket health spending for migrant and low income households in India.

Then there is the question of access. To activate the “safety net” beyond death benefits, a worker or family must be able to document illness or injury in ways that satisfy insurers and missions: proper hospital bills, employer certificates, sometimes a police report. Under the kafala system, where sponsors control mobility, documents and often passports, obtaining that paperwork without angering an employer is difficult. Miss a stamp, a date, a signature, and the claim can be rejected. National data illustrate how rarely the safety net is actually used: between 2006–07 and June 2025, over 83 lakh PBBY policies were issued, but only 3,302 claims were received and 2,210 settled – a crude claims ratio of around 0.04%. This vanishingly small number sits uneasily beside evidence from the Asia–Pacific that over 80% of migrant workers report work related injuries or illnesses, many in high risk sectors such as construction and manufacturing.

Awareness is the other weak link. The Tamil Nadu Migration Survey shows that one in ten households has an emigrant, but also that emigration is highly stratified: better educated, repeat migrants are more likely to understand contracts and schemes, while first time, low educated workers and women in domestic work depend almost entirely on brokers. In practice, the PBBY premium is usually folded into an opaque “placement package” of ₹1–1.5 lakh, financed through loans. Pre departure orientation, where it exists, is often a rushed session in Hindi or English at an airport or training centre. Policies are almost never explained in Tamil; claim procedures, online portals and embassy contact points remain abstract ideas for someone who will soon be living in a fenced camp outside Riyadh or Doha. For many workers, “insurance” is something that agents and employers talk about, not a right they know how to use.

Women bear the sharpest edge of this neglect. TNMS suggests that about 20% of female emigrants are illiterate, and a large share of women from Tamil Nadu in the Gulf are employed as domestic and care workers, isolated in private homes where working hours, mobility and bodily autonomy are tightly controlled. Sexual harassment, overwork, miscarriages and mental health crises rarely fit neatly into the claim categories of an accident death hospitalisation product. The maternity benefit looks progressive on paper; in practice, pregnancy can trigger termination and forced return. PBBY may finance the ticket home but does little to address the structural violence that made that ticket necessary.

This is not just an implementation gap; it reflects a deeper choice. The Indian state has tacitly accepted a model in which the role of a poor Tamil worker is to migrate, endure, remit, and if he or she dies, to leave behind a cheque that proves the system is “working”. A low premium, catastrophic insurance scheme becomes a convenient fig leaf: it allows Delhi to claim it has protected its migrants without seriously confronting the Gulf’s labour regimes, the recruitment industry’s debt traps, or the lack of meaningful consular enforcement. Tamil Nadu, for its part, has world class data on migration through TNMS, which quantifies not just remittances but also costs, debt, and reasons for return. Yet unlike Kerala, which actively leverages migration data to shape policy and institutions, Tamil Nadu has been slow to build a robust state level welfare architecture for its emigrants. There is no dedicated migrant welfare board with teeth, no Tamil language 24×7 helpline in major destination countries, and no public reporting on how many PBBY claims filed by Tamil workers are accepted, delayed or rejected.

Fixing this does not require reinventing the wheel; it requires political will and a shift in perspective. First, PBBY literacy must be treated as a right, not an afterthought. Pre departure orientation should be compulsory, in Tamil, with clear visual material and take home information, backed by simple SMS or app based tools that let migrants and families verify policy status and submit basic claim information without going through employers. Second, the product itself needs rethinking: moving from a narrow hospitalisation-only model towards a benefit package that meaningfully supports outpatient care and mental health, especially for workers in high risk and isolated settings. This would require re pricing premiums and, crucially, subsidising them fully or partly from public funds rather than leaving them to be mediated and inflated by agents. Third, transparency is non negotiable: annual, state wise, gender-disaggregated data on PBBY policies, claims, rejections and processing times should be published and debated.

Ultimately, the debate around PBBY is a test of what kind of relationship India wants with its emigrant citizens. Are they merely remittance-sending bodies whose deaths can be wrapped in a cheque and a condolence speech, or workers and rights holders whose health and dignity the state is willing to defend beyond its borders? Tamil Nadu’s 2.2 million emigrants already underwrite a significant share of the state’s prosperity. They deserve more than a photograph with a collector and a closed file. They deserve a protection regime that works while they are alive, not just compensation after they are gone.

Dr Vani Archana is Senior Fellow, Pahle India Foundation, New Delhi.