This is a case study of the Yeshasvini Health Insurance Scheme for rural farmers and peasants in Karnataka. The scheme, now in its second year of operation, covers 2.2 million farmers and peasants who pay an annual premium of Rupees 60 ($1.50) for comprehensive coverage of all surgical procedures and outpatient care. The scheme is unique in that it has overcome many of the problems associated with health insurance schemes for the poor (such as low levels of coverage and benefits). These features raise the potential of the scheme to be a model for developing countries in providing a modicum of health security for their citizens. In this case study we describe the origins and functioning of the scheme and analyze its performance todate, with a view to assessing the generalizability of this model of health insurance to other populations and countries. We find support for transferability to several other states in India, particularly those with a reasonable network of private hospitals. We also identify the institutional conditions that influence success of a scheme like this, while discussing some of the critical problems that occurred during the scheme’s first year of operations.