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Health Insurance

Key government health insurance schemes in India and their benefits

In this article, we will explore 5 key cost-effective government health insurance schemes in India available to the public and their eligibility criteria, cost, and benefits.

Government health insurance schemes in India
Key cost-effective government health insurance schemes in India to assist Indian families for any socio-economic problems coming due to major health shock.

Government Health Insurance Schemes in India

The cost of healthcare in India is steadily rising. Especially in the bigger cities and private hospitals, it is not easy for the common man to pay the huge medical bills easily. Also, the insurance companies have not been able to penetrate a large section of the society. As per the report published in Indian Express, only 27% of Indian population currently has enrolled any kind of health insurance. At the same time, the government has come forward and launched many socialist schemes for example recently launched Ayushman Bharat – National Health Protection Mission (AB-NHPM). In the following section, we’ve tried to list down some major government health insurance schemes in India being run by the central government.

1. Employment State Insurance Scheme (ESIS)

  • Scheme Detail – Employees’ State Insurance Scheme(ESIS) is a specially designed social security scheme which caters to specific needs of India’s working population and their dependent family members covered as part of the ESIS scheme. The ESIS scheme not only provides statutory provisions to working population in the organized sector but also provides them socio-economic protection in times of need.
  • Eligibility – All factories with 10 or more employees, and certain establishments (shops, hotels, restaurants, cinemas, newspapers, etc) employing 20 or more people, besides private educational and medical institutions in certain States, are required to implement the scheme for their workers.
  • Cost – For all employees earning Rs 21,000 or less per month as wages, the employer contributes 4.75 percent and employee contributes 1.75 percent. For new establishments, the contribution rate for employees is 1% of wages and 3% payable by Employers (for first 24 months). Exemptions: Employees earning daily wages up to Rs. 137 need not pay their part of the contribution, however, Employers will continue to contribute to them.
  • Benefits – Insured and their dependents receive full medical care without any ceiling on expenses. Care is also available to the disabled (permanently) as well as the retired personnel on the small premium of Rs. 120 annually. The comprehensive information for benefits is available at ESIS website.

2. Central Government Health Scheme (CGHS)

  • Scheme Details – CGHS is implemented to provide comprehensive health care coverage to employees and pensioners of Central Govt. establishments and their dependents. The scheme is available to only selected cities.
  • Eligibility – CGHS is applicable to central government employees, pensioners, and their dependents. The scheme is restricted to few cities only which are covered by CGHS.
  • Cost – Cost of the premium for scheme varies on the salary of the employee. If you earn more than Rs 7600 per month, a deduction of Rs. 500 is made from your salary. If your salary is up to Rs 1650 per month, only Rs 50 deduction will be made.
  • Benefits – Domiciliary care, dispensary services, Specialist consultation, Hospitalization, and Health Education.

3. Rashtriya Swasthiya Bima Yojana (RSBY)

  • Scheme Details – RSBY scheme is specially designed to provide health coverage for people living below poverty line (BPL families. Rashtriya Swasthiya Bima Yojana scheme provides protection to BPL families from any major health shock and the financial liabilities it brings along with it.
  • Eligibility – RSBY is applicable to a BPL family of 5 members max. The membership may include the head of the house, spouse and max 3 dependents.
  • Cost – Beneficiaries need to pay only Rs. 30/- as registration fee and receives a biometric-enabled smart card for identification. This helps them to avail of the benefits provided by the scheme. The premium for the insurer is paid by Central and State Government on the basis of a competitive bidding.
  • Benefits – RSBY beneficiaries can avail of in-patient coverage up to Rs. 30,000/- for most of the diseases that require hospitalization. The scheme is available to fix predefined rates at empaneled hospitals only. Pre-existing illness of insurers is also covered from the start and there is no constraint on coverage except max limit of 5 members.
  • This scheme is to be subsumed with Ayushman Bharat – National Health Protection Mission (AB-NHPM) soon.

4. Aam Aadmi Bima Yojana (AABY)

  • Scheme Details – This is one of the most important schemes in our list of government health insurance schemes in India as it affects a very large section of the rural, landless families. AABY is a tailored for rural households who do not have any land and provides a comprehensive social coverage to the family. As part of the AABY scheme, the head of the family or one earning member is covered. The new AABY scheme is the result of mergers between 2 social schemes – Aam Admi Bima Yojana (AABY) and Janashree Bima Yojana (JBY).
  • Eligibility – The member to be covered should be aged between 18 and 59 years. Also, the member can be head/ one earning member for the BPL family/marginally above poverty line under a vocational group/rural landless family.
  • Cost – The premium to be charged initially is Rs.200/- per member per annum. Premium is shared equally by the Central Government and the State Government.
  • Benefits – Death benefit to policyholder/nominee in case of natural death-Rs 30,000, On death due to accident / on permanent disability due to the accident (loss of 2 eyes or 2 limbs )-Rs 75,000. In case of partial permanent disability due to accident Rs 37,500. Free scholarship to 2 children between 9th to 12th class, up to Rs. 100 per month.

5. Universal Health Insurance Scheme (UHIS)

  • Scheme Details – The four public sector general insurance companies have been implementing UHIS for improving the access to health care to poor families especially the ones living under the poverty line (BPL families). This scheme not only provides coverage to individuals but to the groups or families as well.
  • Eligibility – The Universal Health Insurance Scheme (UHIS) has been redesigned targeting only the BPL families. The scheme is applicable to all individuals from 5 Years to 70 Years of age.
  • Cost – The premium subsidy has been enhanced from Rs.100 to Rs.200 for an individual, Rs.300 for a family of five and Rs.400 for a family of seven, without any reduction in benefits.
  • Benefits – The scheme provides for reimbursement of medical expenses up to Rs.30,000/- towards hospitalization floated amongst the entire family, death cover due to an accident @ Rs.25,000/- to the earning head of the family and compensation due to loss of earning of the earning member @ Rs.50/- per day up to maximum of 15 days.

We see that there are many government health insurance schemes in India that are designed to assist public. The government has over the years tried to make sure that the various schemes are made flexible enough to incorporate ever-changing need of families and changing scenarios of the healthcare in the country. As and when the need arises the governments have tried to add new schemes and enhance the benefits of existing schemes to ensure the public is benefitted.

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