Background and Objectives: The Bayelsa Health Insurance Scheme (BHIS) is a state-designed social security plan in which enrollees benefit from a shared pool of cash based on premiums paid by participants. The study aimed to assess the self-reported effectiveness, service utilization, level of satisfaction, and barriers among beneficiaries, and proffer solutions to improve the scheme. Methods: The study was a descriptive cross-sectional survey using a structured questionnaire. This questionnaire assesses the BHIS impact in Kolokuma/Opokuma LGA through six sections capturing demographics, service utilization, satisfaction, financial implications, access barriers, and improvement solutions using standardized scales and matrices, preceded by informed consent. Data was analyzed using SPSS and Microsoft Excel. Results: The major barriers to service utilization were constant unavailability of claimed services at accredited facilities (90.1%) excessive waiting time (76.4%), late/non-referral to specialized centers (67.5), rigid BHIS protocols (63.1%), insufficient insurance coverage (55.2%), complex billing systems (50.7%), and shortage of BHIS staff (50.0%). Conclusions: Possible solutions include the training and retraining of staff and service providers, providing subsidies for couples who are both government employees, initiating adequate supervision, monitoring, and feedback mechanisms, rapid referral protocols, and integrating and encouraging the establishment of health equity funds.