Healthcare has become quite expensive in modern times when new and improved treatments are revolutionizing the healthcare industry. The cost of treatments, medicines and hospitalisation has increased considerably making it difficult for lower income and middle income individuals to afford quality healthcare in times of a medical crisis. Since healthcare is a basic need of every individual, the Government of India has launched different types of health insurance schemes to fulfil this need.
Many of these health schemes are group health insurance schemes which are sponsored by the Government. As such, individuals are able to avail coverage without the need of paying a premium. Other schemes, on the other hand, require individuals to pay a low and affordable amount of premium to avail coverage. All the health insurance schemes proposed and launched by the Government aim to provide affordable coverage to the less fortunate. Let’s have a look at the different types of Government health schemes which are available in India –
1. Pradhan Mantri Jan Arogya Yojana (PMJAY)
Popularly called the Ayushman Bharat Scheme, this health insurance scheme is the latest offering by the Indian Government for the economically backward sections of the society. 10.74 Crore families which are defined to be ‘poor and vulnerable’ are covered under the scheme. Hospitalisation expenses of the covered families are covered up to INR 5 lakhs. Premiums are borne by the Government. Cashless hospitalisation facility is provided to the insured members. The coverage is offered on a family floater basis and there is no limit on the number of family members who can be covered under the scheme. A ‘Golden Card’ is issued by the Government to the beneficiary families and this card should be produced at the hospital for availing cashless claims.
2. Aam Admi Bima Yojana (AABY)
The Aam Admi Bima Yojana is a personal accident micro insurance policy. AABY covers rural households that do not own a land and individuals engaged in 45 occupational groups recognised under the scheme. The features of the scheme are as follows –
- Only one family member is covered. That member should either be the head of the family or an earning member
- Premium is paid by the Government
- Age limit under the scheme is 18 to 59 years
- In case of natural death a benefit of INR 30, 000 is paid. In case of accidental death or total permanent disability, INR 75, 000 is paid. The benefit reduces to INR 37, 500 in case of permanent partial disability due to an accident.
- Add-on benefit of scholarship for the children is also available where INR 100/month per child is paid
- The scheme is currently being offered only by LIC
3. Rashtriya Swasthiya Bima Yojana (RSBY)
The RSBY scheme provides health insurance coverage to families which are categorised as BPL (Below Poverty Line) families. The features of the scheme include the following –
- Coverage for hospitalisation expenses is provided up to INR 30, 000
- Pre-existing illnesses are covered from the first day itself
- There is no limit on entry age
- A maximum of 5 family members can be covered which include self, spouse and three dependent members
- Covered family has to pay only INR 30 for registration. The premium is paid by the Government.
4. Employment State Insurance Scheme (ESIS)]
ESIS provides coverage to workers employed in non-seasonal factories which have employment strength of at least 10 employees. Its features are as follows –
- Coverage is provided for self and dependants
- Coverage includes hospitalisation costs and cash benefits in case of sickness and disablements
- Dependant benefit is paid to dependants of those workers who die in an accident in the course of employment. A regular pension is paid as benefit
5. Central Government Health Scheme (CGHS)
The scheme covers employees, pensioners and dependants of Central Government. CGHS is available in 71 Indian cities. Coverage is wide and includes hospitalisation, domiciliary care, consultation facilities, health education, etc. Allopathy as well as non-allopathic AYUSH treatments are also covered under the scheme.
6. Universal Health Insurance Scheme (UHIS)
UHIS is a scheme offered by the four public sector health insurance companies. The scheme is designed for BPL families. Coverage is provided as under –
- Hospitalisation – up to INR 30, 000
- Accidental death – INR 25, 000
- Loss of earning – INR 50 per day for up to 15 days
Premiums are low and subsidised. The existing subsidy in premium is INR 200 for individual plans, INR 300 for floater plan covering five members and INR 400 for floater plan covering seven members.
7. Awaz Health Insurance Scheme
This is a State specific health insurance scheme which has been launched by the Government of Kerala. The scheme provides health insurance coverage for migrant workers who are working in Kerala. The Awaz health insurance scheme offers hospitalisation cover to workers as well as coverage against accidental death and disablement. Coverage is available for workers in the age bracket of 18 to 60 years. The coverage limit is INR 15,000 for hospitalisation expenses, INR 1 lakh for accidental permanent disablement and INR 2 lakhs for accidental death.
8. Bhamashah Swasthya Bima Yojana
Another State sponsored health insurance scheme, the Bhamashah Swasthya Bima Yojana has been launched by the Government of Rajasthan. The scheme aims to provide cashless hospitalisation facilities to the rural people of the State. The scheme is applicable for individuals who are citizens of Rajasthan, have been included in the National Food Security Scheme and National Health Insurance Scheme and those who are below the poverty line. A Bhamashah Card is needed to avail cashless treatments. Coverage under the scheme for general diseases is allowed for up to INR 30,000 and for critical diseases the limit increases to INR 3 lakhs. Pre and post hospitalisation expenses are also covered for 7 and 15 days respectively.
9. Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS)
The Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) insurance scheme has been launched by the Government of Tamil Nadu and is a State specific health insurance scheme. The scheme is an indemnity health insurance plan which covers actual medical expenses suffered by the insured beneficiaries. Coverage under the scheme is as follows –
|Expenses covered||Coverage limit|
|Hospitalisation expenses||Up to INR 1.5 lakhs|
|Expenses incurred on specific illnesses mentioned in Annexure D||Up to INR 1.5 lakhs|
|Follow-up procedures||Depends on the procedure performed. The limits are specified in Annexure E|
|Diagnostic procedures||Depends on the procedure performed. The limits are specified in Annexure F|
The scheme is available as a family floater cover covering the proposer, spouse, dependent children and dependent parents. Individuals who are residents of Tamil Nadu (to be proved by a residency certificate) and have an annual income below INR 72,000 can be covered under the scheme. Orphans, migrant workers and refugees from Sri Lanka can also enjoy covered under the scheme subject to certain terms and conditions.
10. Karunya Arogya Suraksha Paddhati (KASP)
The Karunya Arogya Suraksha Paddhati scheme is a State sponsored health insurance scheme launched in Kerala. The scheme covers families below and above the poverty line whose annual income is up to INR 3 lakhs. All Government hospitals in Kerala and selected private hospitals provide cashless treatments to insured beneficiaries. Coverage for kidney related ailments is INR 3 lakhs while for other specified diseases it is INR 2 lakhs. Haemophilia patients would be included in the lifelong scheme offered by the Government.
11. Mahatma Jyotiba Phule Jan Arogya Yojana Scheme (MJPJAY)
This is also a State specific health insurance scheme applicable in the State of Maharashtra. The MJPJAY scheme replaced the earlier health insurance scheme called Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY). The scheme provides coverage to below and above poverty line families in the 36 districts of Maharashtra. Hospitalisation coverage of INR 1.5 lakhs is allowed per family on a family floater basis. In case of renal transplant, however, the coverage limit is increased to INR 2.5 lakhs considering the additional therapy costs involved in such transplants. This Government health scheme covers 971 surgeries/procedures/therapies with 121 follow-up procedures in 30 specified categories. Families living in any district of Maharashtra holding an Antyodaya Anna Yojana Card, yellow Ration Card, Annapurna Card, orange ration card including farmers from 14 specific districts who have white ration card can be covered under the scheme.
12. Mukhyamantri Amrutam Yojana (MAY)
The Mukhyamantri Amrutam Yojana is a medical insurance scheme offered by the Government of Gujarat for families who are below the poverty line. The scheme covers cardiovascular surgeries, neurosurgeries, burns, trauma, cancer, neonatal diseases and renal diseases.
13. Pradhan Mantri Suraksha Bima Yojana (PMSBY)
The Pradhan Mantri Suraksha Bima Yojana scheme is available for all Indian citizens who are aged between 18 years and 70 years and have a bank account. The plan covers death, total and permanent loss of sight in both eyes, loss of both hands, loss of both legs or loss of one eye and one limb. Moreover, coverage is also allowed for permanent loss of sight in one eye or loss of use of one hand or leg. Coverage limit is INR 2 lakhs for death and permanent and total disability and INR 1 lakh for permanent partial disability and the premium is INR 12.
14. Rajiv Aarogyasri Community Health Insurance Scheme (RACHI)
The RACHI scheme is a health insurance scheme for the poor population of Andhra Pradesh. The scheme is funded by the Government of Andhra Pradesh and it provides free health insurance coverage to families belonging to the BPL (Below Poverty Line) category. Coverage for up to INR 2 lakhs is provided under the scheme for hospitalisation and treatments. Coverage is available on a family floater basis to allow all members of the family to get coverage under the scheme.
15. Yeshasvini Health Insurance Scheme
The scheme is officially called Yeshasvini Cooperative Farmers Health Care Scheme and it was launched in the year 2002 by the Karnataka Government. The scheme covers co-operative farmers in the State of Karnataka and offers them health insurance coverage. Coverage is allowed for 823 surgical treatments and other medical expenses. Farmers who are members of the Rural Cooperative Society of Karnataka can be covered under the scheme. Covered farmers are required to contribute towards the scheme. The amount of contribution is INR 250 for Rural Yeshasvini and INR 710 for Urban Yeshasvini.
16. West Bengal Health Scheme
This health insurance scheme has been launched by the Government of West Bengal for its employees. Pensioners of Government of West Bengal, employees of IAS (Indian Administrative Services), IFS (Indian Forest Services), IPS (Indian Police Services) and retired AIS officers can avail coverage under this scheme. Reimbursement of medical expenses is done for insured beneficiaries if they avail inpatient hospitalisation treatments within West Bengal or in nine specified hospitals outside West Bengal. OPD cover is also allowed for fifteen types of specified diseases. The scheme was renamed to West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme 2014 in the year 2014 and the scheme allowed cashless treatments for up to INR 1 lakh per insured member.
Features and advantages of Government health insurance schemes
Government health insurance schemes are launched by the Central or State Governments and they have the following features and benefits –
- Many schemes provide free health insurance coverage to lower income families. This allows poor people to get access to quality healthcare in a medical emergency without worrying about affordability of medical costs
- Even if the health insurance scheme is not free, the premiums payable are quite low and affordable making it easy for the poor families to avail coverage
- These Government health insurance schemes are aimed at social welfare of the lower income group families of India. It gives them the basic facility of healthcare in times of medical emergencies
Know these Government health schemes to know how the Government is trying to uplift the economically backward sections of the society. These schemes are instrumental in allowing the poor to afford good treatments for their medical problems. The schemes are, therefore, quite popular and they help the poor population of India improve their standard of living.
Different Government health schemes have different eligibility criteria. If the scheme is introduced by a State Government, it would usually be for the citizens of that particular State. Moreover, some schemes are meant only for families who belong to the BPL category. As such, all Government health schemes are not open for all.
Some Government health schemes are sponsored and funded by the Central or the State Government while others require beneficiaries to pay a small premium. So, all Government health schemes are not free of cost. Some might involve payment of a premium.
Usually, the Aadhaar Card serves as the main identity proof for availing coverage under a Government health scheme. However, many schemes might also require a ration card, citizenship certificate, income certificate and other documents depending on their eligibility requirements.
Yes, Government health schemes have specified exclusions which depend on the scheme. Common exclusions include cosmetic treatments, maternity related expenses, outpatient expenses, dental treatments, etc.