Types of government health insurance schemes in India
There are several government health insurance schemes in India designed to provide essential healthcare services to various sections of society. These govt health insurance plans ensure that even the most underserved groups have access to medical care without the burden of high costs for an overall healthy population.
Here is a list of government health insurance schemes in India that you should know:
1. Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana – PMJAY
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is a health insurance scheme introduced by the Indian government to provide free healthcare services to low-income individuals and families. It provides a coverage of Rs. 5 lakhs per year for both tertiary and secondary hospitalization expenses. It is the biggest healthcare scheme in the world, covering over 500 million individuals.
The Ayushman Bharat scheme covers the following expenses:
· Medical examination and consultation fees
· Pre and post-hospitalization expenses
· Medicines and medical consumables
· Non-intensive and ICU services
· Complications during medical treatments
· Laboratory and diagnostic procedures
· Food services
The Ayushman Bharat scheme does not cover individuals who:
· Own a vehicle
· Have a monthly income over Rs. 10,000
· Are government employees
· Hold a Kisan card
· Live in properly built houses
· Own more than 5 acres of agricultural land
· Have landline phones and refrigerators
2. Central Government Health Scheme
The Central Govt Health Scheme (CGHS) is a comprehensive health care program for working and retired employees of the Central Government of India and their dependents. Introduced in 1954, this government mediclaim policy offers a range of medical facilities including dispensary services, specialist consultations, and hospitalization.
The Central Government Health Scheme ensures all central government employees and their families have easy access to healthcare services across the country.
Under this scheme, the eligibility for hospital wards in private hospitals depends on the individual's pay scale. Here are the details:
Ward Type
|
Monthly Basic Pay Drawn by the Individual
|
General
|
Up to Rs. 36,500
|
Semi-private
|
Rs. 36,501 to Rs. 50,000
|
Private
|
Above Rs. 50,500
|
3. The Mahatama Jyotiba Phule Jan Arogya Yojana
Mahatama Jyotiba Phule Jan Arogya Yojana is a health insurance by Government of Maharashtra. It is targeted at low-income families in the state and provides free access to medical and surgical treatments in both government and private hospitals.
This government medical insurance scheme provides coverage for all pre-existing diseases with benefits like hospitalization expenses, follow-up care, and pre and post-hospitalization costs. It provides coverage of up to Rs. 1.5 lakhs per family per policy every year.
To be eligible for this scheme, individuals must meet the following criteria:
· They must be a part of any of the identified distressed districts of Maharashtra.
· They must hold a valid white/yellow/orange ration card, an Annapurna Card, and an Antyodaya Anna Yojana Card (AAY).
· If the individual is a farmer, they must belong to the agriculturally distressed districts of Maharashtra.
4. The Rashtriya Swasthya Bima Yojana (RSBY)
Rashtriya Swasthya Bima Yojana (RSBY) is a government health insurance plan introduced to provide health insurance coverage to the below-poverty-line (BPL) families in the country. The scheme provides coverage of up to 30,000 and covers up to 5 members of the family. Beneficiaries insured under this scheme receive an RSBY card that they can use to access medical care at various hospitals across the country.
The Rashtriya Swasthya Bima Yojana provides coverage for:
· Hospitalization expenses
· Pre and post-hospitalization expenses
· Transportation expenses
· Dental treatment
· Daycare treatment
· Newborn coverage
To be eligible for this government health insurance scheme, an individual must meet the following criteria:
· They must be an Indian citizen working in an unorganized sector.
· They must be from a BPL household.
· They must be registered under welfare boards.
5. The Bhamashah Swasthya Bima Yojana
Bhamashah Swasthya Bima Yojana is a health insurance scheme launched by the Government of Rajasthan. It aims to provide access to affordable and quality healthcare services to the residents of the state. The Bhamashah Swasthya Bima Yojana provides coverage of up to Rs. 30,000 for common ailments and up to Rs. 3 lakhs for critical illnesses.
This govt health insurance scheme is for low-income families and provides them with cashless healthcare services through both public and private hospitals.
It provides coverage for:
· Pre and post-hospitalization expenses
· Transportation expenses
· Cashless treatment
· Pre-existing ailments
· Critical diseases
· General illnesses
To be eligible for this government health insurance scheme, an individual must meet the following criteria:
· They must be a resident of Rajasthan.
· They must have an active bank account under the Bhamashah Swasthya Bima Yojana.
· They must hold a Below Poverty Line (BPL) card.
6. The Aam Aadmi Bima Yojana (AABY)
Aam Aadmi Bima Yojana (AABY) is a social security scheme launched by the Government of India to provide insurance coverage to low-income families, especially those working in rural and unorganized sectors. It provides coverage for loss of income due to death or disability. The premium amount for the AABY scheme is Rs. 200 per person which is divided between the central government, state government, and the insured individual.
Under the Aam Aadmi Bima Yojana, individuals can avail of the following benefits:
Coverage
|
Benefit
|
Death from natural causes
|
Rs.30,000
|
Death due to an accident
|
Rs.75,000
|
Partial permanent disability
|
Rs.37,500
|
Total permanent disability
|
Rs.75,000
|
Scholarship
|
Rs.100 per month per child (for a maximum of two children studying between class 9 and 12)
|
7. The Pradhan Mantri Suraksha Bima Yojana (PMSBY)
Pradhan Mantri Suraksha Bima Yojana (PMSBY) is a government health insurance scheme that provides accidental death and disability benefits. It comes with an affordable premium of just Rs. 12 per annum and is offered to individuals between 18 and 70 years of age with a bank account.
The PMSBY offers worldwide coverage, insuring individuals against accidents occurring anywhere in the world. It provides coverage for three major aspects:
Coverage
|
Benefit
|
Accidental death
|
Rs. 2 lakhs
|
Permanent total disability due to an accident
|
Rs. 2 lakhs
|
Permanent partial disability due to an accident
|
Rs. 1 lakh
|
8. The Employees' State Insurance Scheme (ESI)
Employees' State Insurance (ESI) is a social security and health insurance scheme for employees working in the organized sector. It is managed by the Employees' State Insurance Corporation (ESIC) under the Ministry of Labour and Employment, Government of India.
The scheme protects employees and their families from the financial burden of medical treatments by providing medical and cash benefits. It offers a pension known as a dependent benefit to the family members in case the insured person dies or gets injured while at work.
The Employees' State Insurance scheme provides the following social security benefits:
· Medical benefit
· Sickness benefit
· Maternity benefit
· Disablement benefit
· Dependents benefit
· Funeral expenses
· Confinement expenses
· Vocational rehabilitation
· Physical rehabilitation
The Employees' State Insurance scheme does not cover employees with a monthly income greater than Rs. 21,000. Additionally, the disability benefits are only extended to employees or workers with a maximum wage of Rs. 25,000 per month.
