Providing universal health insurance to the 1.2 billion people of India is a daunting task, complicated by high poverty rates and a large unorganized labor sector. Health centers are concentrated in urban areas, despite the majority of the population being rural. Emergency medicine takes on added significance in view of inaccessibility of healthcare. Government and private partnerships in community health insurance schemes have played a significant role in making affordable healthcare accessible to rural communities and families below the poverty line. In this paper we have looked at the current situation in India, as well as the specific example of a community health insurance scheme provided by the Manipal group in coastal Karnataka to the rural fishing and agricultural community. Health indicators in this region are generally more positive than the rest of the country. Enrollment in this program has increased every year since its initiation. We then look at emergency medicine, which as a distinct field is still in its infancy in India. At present only 24 teaching hospitals across the country have post graduate programs in this field. Current emergency health management in most centers is cumbersome and involves significant delay in delivering care.