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Government Health Insurance Schemes

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Government Health Insurance Schemes

Considering the contemporary scenario, we are witnessing that medical inflation is significantly high and reaching new heights daily. This has made accessibility and affordability to proper medical healthcare facilities quite difficult for middle and lower-income groups.

However, since healthcare is one of the primary requirements of every individual, the Government of India has launched several budget-friendly schemes to make it easier for every Indian to access proper medical care at affordable costs.

What is a Government Health Insurance Scheme?

Government health insurance schemes imply those health plans directly sponsored by the state or the central government. The chief focus of such schemes is to make easy accessibility to advanced medical treatment and care for common people without burning holes in their pockets. These schemes even encourage the improvement and development of medical facilities across every rung.

List of Health Insurance Schemes sponsored by the Government of India

Considering the latest statistics, 17 government health insurance schemes are currently active in the country. These are:

  1. Ayushman Bharat
  2. Mukhyamantri Amrutum Yojana
  3. Awaz Health Insurance Scheme
  4. Bhamashah Swasthya bima Yojana
  5. Aam Aadmi Bima Yojana
  6. Universal Health Insurance Scheme
  7. Central Government Health Scheme
  8. Karunya Health Scheme
  9. Chief Minister’s Comprehensive Insurance Scheme
  10. Employees’ State Insurance Scheme
  11. Mahatma Jyotiba Phule Jan Arogya Yojana
  12. Pradhan Mantri Suraksha Bima Yojana
  13. Dr. YSR Aarogyasri Health Care Trust Andhra Pradesh State Government
  14. Yeshaswini Health Insurance Scheme
  15. Rashtriya Swasthya Bima Yojana
  16. Telangana State Government-Employees and Journalists Health Scheme
  17. West Bengal Health Scheme.

Brief about each of the 17 health schemes of the Government of India:

1. Ayushman Bharat Scheme

This particular scheme has been specially crafted after considering the prospects of Universal Health Coverage or in short UHC. Since the entire Indian health service sector is vastly segmented, Ayushman Bharat targets towards making them comprehensive. This health plan focuses on ensuring uninterrupted medical care to all the countrymen, considering the entire health service sector as an unsegmented whole.

Ayushman Bharat holds 2 major components: Pradhan Mantri Jan Arogya Yojana and Health and Wellness Centres. To ensure easy availability of proper medical care, the government has set, up 150000 HWCs across the country. The government has developed these HWCs as more updated and advanced versions of the previous Primary Health Centres and sub-centres.

This scheme has been designed especially for economically weaker people. It offers yearly health coverage of up to INR 500000 per family, with a premium payable amount of INR 30.

2. Awaz Health Insurance Scheme of India

This health plan is not a central government health scheme but is issued by the Kerala State Government. The health plan offers health insurance coverage exclusively to migrant workers working in the state. It provides hospitalisation coverage and coverage for accidental disablement and death. The age of the workers must range between 18 and 60 years. The coverage extent is capped at INR 15000 for hospitalisation, INR 1 lakh for accidental permanent disablement and INR 2 lakhs for accidental death.

3. Aam Aadmi Bima Yojana Policy

This is a special personal accident micro-insurance health plan. It exclusively covers rural families who do not own any land and individuals being engaged in any one of the 45 occupational groups listed by the government. Some significant features of this scheme include:

○ Only a single member of the family, who is either the head of the family or the breadwinner of the family, is covered
○ The government pays the premium
○ The age of the policyholder must be between 18 and 59 years
○ A death benefit of INR 30000 is paid in the case of natural death. In the case of total permanent disability or accidental death, this limit is INR 75000. In the case of partial permanent disability, this limit is reduced to INR 37500.
○ An add-on scholarship benefit of INR 100 per month per child is available
○ Currently, only the Life Insurance Corporation of India (LIC) offers this scheme.

4. Bhamashah Swasthya Bima Yojana Policy

This is yet another state-sponsored health insurance plan, launched by the state government of Rajasthan. It offers cashless hospitalisation benefits to the rural people belonging to the state. This particular scheme is exclusively available to the people of Rajasthan belonging below the poverty line. They need to be included in the National Health Insurance Scheme and National Food Security Scheme.

You need a valid Bhamshah card to avail of the cashless medical facility. The coverage limit for general ailments is capped at INR 30000 and INR 300000 for critical ailments. Pre- and post-hospitalisation expenses up to 7 and 15 days are covered respectively.

5. Central Government Health Scheme of India

This scheme offers health coverage to Central Government employees, pensioners, and dependents. This health scheme is only available in 71 cities in India. It offers comparatively elaborate coverage including consultation, domiciliary treatment, health education, consultation fees, etc. Unlike several other government health schemes, CGHS also offers AYUSH coverage.

6. Chief Minister’s Comprehensive Insurance Scheme of India

This is yet another state-specific health insurance scheme, launched by the state government of Tamil Nadu. This is an indemnity plan, which provides coverage for the actual medical expenses incurred by the insured individual. Some of the important aspects of its coverage scope are:

EXPENSES COVEREDCOVERAGE LIMIT
Hospitalisation costsUp to INR 150000
Expenses incurred for treating certain particular ailments listed in Annexure DUp to INR 150000
Expenses incurred due to follow-upsDetermined by the types of procedures performed. Annexure E mentions the specified limits
Investigation proceduresAnnexure F mentions the specific details

This is a family floater health insurance scheme, covering the proposer, the spouse, their dependent children, and parents. However, the proposer must be a Tamil Nadu resident as per the residency certificate, with an annual income below INR 72000. Apart from them Sri Lankan refugees, migrant workers, and orphans can also utilise this coverage, following certain specific terms and conditions.

7. Employees’ State Insurance Scheme of India

Any non-seasonal factory worker with at least 10 employees in the organisation is eligible to utilise the coverage of this scheme. Some of the significant features of this scheme include:

It covers for self and dependents

In the case of sickness and disablement, it offers hospitalisation coverage along with cash benefits

During the employment course, if an employee passes away in an accident, the dependents tend to receive dependent benefits as a regular pension scheme.

8. Karunya Health Scheme of India

This health scheme has been introduced by the Kerala state government. It covers families with an annual income of not more than INR 300000. The insured beneficiaries tend to receive cashless treatment facilities across all the government hospitals in Kerala and also in some selected private hospitals. It offers coverage of up to INR 300000 for kidney issues, while for other issues, this limit is INR 2 lakhs. This government-induced health scheme offers lifelong medical coverage for haemophilia patients.

9. Mahatma Jyotiba Phule Jan Arogya Yojana Plan

This is also a state-sponsored health policy, introduced in Maharashtra. This current scheme has replaced the previous health scheme named Rajiv Gandhi Jeeevandayee Arogya Yojana. It provides medical coverage to Maharashtrian people spread across its 36 districts, belonging both below and above the BPL level. As per the family floater plan terms, each family can enjoy hospitalisation coverage up to INR 1.5 lakhs. This limit is extended up to INR 2.5 lakhs in the case of a kidney transplant, considering further follow-up treatment costs. This particular scheme specifies 971 medical procedures along with 121 follow-up processes, spread across 30 specific categories.

Any family residing in any of the 36 Maharashtrian states, and holding a valid yellow ration card, Annapurna card, Antyodaya Anna Yojana card, or orange ration card and farmers of 14 designated districts holding white ration cards are covered under this scheme.

10. Mukhyamantri Amrutum Yojana Plan

This is a Gujarat state government-sponsored health insurance scheme, specifically targeting families belonging to the BPL category. It covers neurosurgeries, cardiovascular surgeries, cancer, trauma, burns, renal issues, and neonatal health issues.

11. Pradhan Mantri Suraksha Bima Yojana Policy

This health scheme is for every Indian citizen belonging to the people of the age group between 18 to 70 years who holds a valid bank account. It covers total and permanent loss of sight in both eyes and limbs, any one eye or any one of the limbs, and death. The coverage is up to INR 2 lakhs for death and total and permanent disability, and INR 1 lakh for the purpose of partial and permanent disability. Even the premium amount is priced very low at only INR 12.

12. Andhra Pradesh State Government Dr YSR Aarogyasri Health Care Trust

In short, this special health scheme is termed the RACHI scheme. It is funded and sponsored by the Andhra Pradesh State Government. This health plan is specifically designed for those families living below the poverty line category. It offers hospitalisation and treatment coverage of up to INR 2 lakhs this is a family floater plan and allows the entire family to enjoy its coverage.

13. Employees and Journalists Health Scheme of the Telangana State Government

As the name suggests, this is a special health scheme that has been introduced by the state government of Telangana for all its journalists and employees. It is equally helpful for the current employees, retired employees and pensioners of this government. You can avail of cashless treatment under this policy depending on the specified terms, rules and regulations as mentioned in the plan. This makes the treatment procedure comparatively easier during medical emergencies.

14. Rashtriya Swasthya Bima Yojana Plan

This special government health scheme targets employees who work in any unorganised sector and generally do not possess any health insurance coverage. This risks their savings to a significant extent, often leading to exhaustion during medical emergencies.
This scheme has been introduced by the Ministry of Labour and Employment of the government of India. Any unorganised sector worker belonging to the BPL category can avail of the coverage of this scheme. It also offers family coverage of up to a maximum of 5 members.

15. Universal Health Insurance Scheme of India

Four public sector health insurance companies offer this particular health scheme. It has been specifically crafted to keep the requirements of people living below the poverty line. In the case of hospitalisation, it offers coverage of up to INR 30000; INR 25000 for accidental death; and loss of earnings, it provides INR 50 per day for up to 15 days.

The premium amount is highly subsidised and significantly low. For any individual plan, the current subsidy in premium is INR 200; INR 300, for a floater plan covering a maximum of 5 members; and INR 400 for a plan covering 7 family members.

16. Yeshaswini Health Insurance Scheme of India

The official name of this government health scheme is Yeshasvini Cooperative Farmers Health Care Scheme. Karnataka State Government launched it back in 2002. It provides health coverage to the farmers of Karnataka. The benefits of this scheme can be utilised for 823 specified medical treatments and other miscellaneous medical expenses. All the farmers who are members of the Rural Cooperative Society of Karnataka can avail of this coverage. The insured individuals must contribute INR 250 and INR 710 for Rural and Urban Yeshasvini plans respectively.

17. West Bengal Health Insurance Scheme

As the name specifies, this scheme has been introduced by the West Bengal State Government for its employees. Any employee of the Indian Administrative Service, Indian Forest Service, Indian Police Service, retired AIS officers and pension holders of the West Bengal Government can utilise the benefits of this health scheme.

If the insured individual avails of in-patient hospitalisation treatment within West Bengal or 9 other specific hospitals outside West Bengal, the benefits of this plan can be utilised. It also offers OPD coverage of 15 types of specific ailments.

It was renamed as West Bengal Health for All Employees as well as Pensioners Cashless Medical Treatment Scheme 2014, back in 2014. For much-insured individuals, this scheme allows cashless treatment of up to INR 1 lakh per year.

Benefits of government health insurance schemes

Some of the most highlighting standard benefits of government health insurance schemes operating in India include the following:

  1. Indoor treatment facilities at both government and other empanelled network hospitals
  2. Diagnostic health investigation coverage at empanelled and government hospitals and healthcare centres
  3. Medicine coverage
  4. Cashless treatment facilities in listed diagnostic centres and hospitals
  5. Reimbursement facilities during medical emergencies
  6. Accessible to the comparatively weaker section of society
  7. Covers a considerably wide range of ailments and other critical illnesses.

Features of government health insurance schemes

Some of the chief characteristics of government health insurance schemes include:

  1. The policies are available at a very reasonable cost
  2. Specially crafted to encourage every person even those belonging to the BPL category to avail of these health insurance facilities
  3. Ensures a basic health cover for economically weaker people
  4. Assures the policyholders to have access to proper healthcare opportunities at a reasonable rate

Basic health insurance plans Vs. Government health insurance schemes

FEATURESGOVERNMENT HEALTH INSURANCE PLANA BASIC HEALTH INSURANCE PLAN
PREMIUMLow premiumComparatively higher premium
DISCOUNTHeavily discounted due to government sponsorshipDepends on market competition and trends
NCB BENEFITNot availableAvailable
COVERAGEOffers coverage with an upper limitEnsures comprehensive coverage of almost all medical expenses
AMOUNT OF SUM INSUREDLow to moderateComparatively higher, leading to a higher premium amount
CUSTOMERSOpen to all with a special focus on the economically weaker section of societyAnyone can access it
ELIGIBILITYAvailable chiefly to the lower income groupsAvailable to all
POLICY PURCHASE TIMEMay be time-consumingInstant Purchase
NETWORK HOSPITALSA wide network including both public and private hospitalsExtensively private hospitals
MATERNITY BENEFITSAvailable only for a single child under specific circumstancesAvailable, depending on the terms of the plan
AMBULANCE COSTSAvailable only in selected plansAvailable in almost all plans
DOMICILIARY COSTSNot availableAvailable, depending on the scope of the plan
ONLINE RENEWALMay or may not happenPossible
CUMULATIVE BONUSNot availableAvailable for claim-free year
HEALTH CHECK-UPNot coveredCovered in certain plans
MONTHLY PREMIUM PAYMENT FACILITYNot availableAvailable in certain plans
TAX BENEFITSNot availableAvailable u/s 80D of the IT Act

Frequently Asked Questions

Different plans have different sets of eligibility criteria. You can check the individual plan concerned before purchasing.

Yes, however, you have to submit other valid documents specifically essential for purchasing a particular government health plan.

Not all government health plans provide online availability. You need to clarify before buying.

Under standard circumstances, any cosmetic medical procedure, maternity costs, OPD treatment costs, and dental treatment costs do not remain under the purview of any government health plan. However, each plan provides different sets of exceptions. You need to clarify the exact norms of the plan concerned before proceeding.

Here, the premiums are determined depending on the total number of individuals covered under the particular policy. Under certain circumstances, these schemes require beneficiaries to pay a pre-fixed amount as a yearly premium. However, it is best to know the details of your chosen scheme beforehand prior to purchasing.

No, certain schemes are sponsored and funded by the central or the state government, while some others require the policyholder to pay a small premium.

Generally, an Aadhaar card is sufficient as valid identity proof. However, depending on the terms and conditions of the specific plan, it may require income proof, residential proof, etc.

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