BACKGROUND: Financial burden due to health care costs are high in India and a small percentage of the population are protected through any health insurance program. To protect people from high economic cost of illness, and reduces inequality in health care access government of Kerala introduced a comprehensive health insurance scheme. OBJECTIVES: This study tries 1. To explore the factors affecting the enrollment in Comprehensive Health Insurance Scheme, 2. To find out the health care utilization pattern among insured and associated factors. METHODS: Exploratory Case study, both quantitative and qualitative Methods used to track the objectives of the study. An interview conducted on 150 insured households. In-depth interviews conducted on 10 kudumbasree (women support groups) groups and 10 key informants’ interviews were also done. RESULTS: In addition to education and health risk, awareness about the scheme is high especially among females. About 97.4% of respondents were from poor families and, 40.7 % don’t have any permanent income. APL family (above poverty line) registration is negligible (2.6%) only. Around 91.3% don’t have any other form of health insurance coverage. 42% respondents utilized the scheme and 34.0% of households have had history of chronic diseases. Majority of respondents (97.3%) registered through kudumbasree group. All respondents reported that coverage is not enough and out patients care should be included. Qualitative interviews revealed that many eligible members were excluded, and delay in settling of claims, provider choice is limited .Women empowerment in health related matters and enrollment is appreciable through Kudumbasree groups. CONCLUSIONS: Access to health care and access to medicine is increased. Concerted effort is needed for the successful implementation and sustainability of the scheme.