Government Health Insurance Schemes in India

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Government Health Insurance Schemes In India

Good health and well-being are instrumental in the life of any individual. However, the uncertainty and unpredictability associated with one's health are uncontrollable factors. Whether it is an accident, a viral infection, or a critical illness, we are all vulnerable to a wide gamut of health-related risks. This is one of the many reasons why it is pivotal to have a suitable health insurance plan.

At Tata AIG, we offer various types of health insurance, starting at ₹15 per day. We offer health insurance for individuals and families alike. In addition to this, we offer medical insurance plans for various critical illnesses, including health insurance for diabetics.

You can check out, assess, and buy our health insurance online at our official website by following a few easy steps.

Along with health insurance plans from private insurance companies, you can also enrol under a government health insurance policy in India. Here is a detailed description of the various government health insurance policies in India.

What is Government Health Insurance?

A government health insurance scheme is, as its name suggests, a medical insurance plan that is sponsored and/or supported by the government at any level, central and state alike. Since the access to healthcare and health insurance in India is far from ideal, particularly in the rural regions of the nation, the central and state governments have launched and backed several health insurance policies.

The state has a responsibility to ensure the health and well-being of its citizens, and one way of doing that is the development of robust public health infrastructure and collaborations with the private sector for the implementation of health insurance schemes.

Government health insurance schemes usually comprise a substantial sum insured at an affordable premium so as to ensure that all sections of the population have access to health insurance.

Various Government Health Insurance Schemes In India

The Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Designed to cater to the health insurance requirements of the bottom 40 per cent of the population of the country, in terms of income levels, the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a government health insurance scheme that provides medical insurance coverage of ₹5 lakhs to the poor and the vulnerable.

Some of the health insurance benefits included in the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana are as follows:

  1. A hospitalisation cover up to 3 days
  2. A post-hospitalisation cover of up to 15 days
  3. A cover for all pre-existing conditions with no waiting period.
  4. No restrictions on the number of family members under the coverage of the scheme
  5. Cashless treatment at any government or private hospital in the country under the scheme
  6. Coverage for 1,393 procedures
  7. Coverage for the expenses for treatment, drugs, physician's fee, diagnostics, ICU charges, etc.
  8. An annual premium of ₹30

The Aam Aadmi Bima Yojana (AABY)

One of the various government health insurance schemes in India is the Aam Aadmi Bima Yojana. People practising one of the 48 vocations listed in the scheme can become beneficiaries after the payment of a premium of ₹200 per annum. This scheme offers both a life cover and an accidental death cover to its members.

The coverage under the Aam Aadmi Bima Yojana is as follows:

  1. A sum insured of ₹30,000 for the natural death of the beneficiary
  2. A sum insured of ₹75,000 for the accidental death of the beneficiary.
  3. Coverage for only the earning member or head of a family

The Employees' State Insurance Scheme (ESI)

Primarily designed to help factory workers handle the expenses following accidents and occupational hazards, the Employees' State Insurance Scheme is available for the workers employed in various factories in India. The workers drawing wages not in excess of ₹21,000 per month can participate in this scheme. This ceiling is ₹25,000 for persons with disabilities.

The premium for participation in this health insurance scheme is shared by the employers and the employees. However, workers earning wages lower than ₹137 per day are exempt from the payment of their share of the premium. Here's the coverage provided by the Employee State Insurance Scheme (ESIS)

  1. Medical Benefit for the insured and their family
  2. Sickness Benefit for a maximum of 91 days of sickness per annum
  3. Extended Sickness Benefit up to 2 years in case of the occurrence of 34 malignant diseases as well as long-term ailments
  4. Enhanced Sickness Benefit of up to 7 days for male beneficiaries and 14 days for female beneficiaries in case of sterilisation
  5. Maternity Benefit of 26 weeks, extendable by four weeks
  6. Disablement Benefit
  7. Dependents' Benefit in the event of the death of the insured due to an injury caused by their work or occupational hazard

The Pradhan Mantri Suraksha Bima Yojana (PMSBY)

With an aim to enhance the penetration of health insurance in India, the Government of India launched the Pradhan Mantri Suraksha Bima Yojana (PMSBY). This scheme offers insurance coverage for accidental death and disability. At an annual premium of ₹12, you can benefit from the following covers:

  1. A sum insured of ₹2,00,000 in case of accidental death or total disability
  2. A sum insured of ₹1,00,000 for partial disability The premium for the Pradhan Mantri Suraksha Bima Yojana gets automatically debited from the bank accounts of the beneficiaries every year. In order to subscribe to this scheme, you must have an Aadhar card and a Bank Account.

The Central Government Health Scheme

The Central Government Health Scheme is a government health insurance scheme launched by the central government to provide medical insurance to their employees. This category of employees includes:

  1. Employees in the Judiciary
  2. Employees in the Executive
  3. Employees in the Legislature
  4. Employees in the Press Department

The Central Government Health Scheme is available for the employees and pensioners from several central government departments, specifically listed in the scheme. Under this scheme, the eligible central government employees can have, amongst others, the following health insurance benefits.

  1. Cover for PPF Treatment and the issuance of medicines
  2. Cover for consultation with specialists at government hospitals
  3. Indoor treatment at government hospitals and empanelled hospitals
  4. Cover for family welfare services
  5. Cover for Maternity expenses
  6. Cover for AYUSH Treatment (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy)

The Mahatma Jyotiba Phule Jan Arogya Yojana

The Mahatma Jyotiba Phule Jan Arogya Yojana has been launched by the government of Maharashtra to provide health insurance to people living below the poverty line. This scheme provides cashless insurance benefits to the families holding a yellow, orange, or red ration card, Annapurna ration card, Antyodaya Anna Yojana ration card, the children living in government orphanages, the residents of governmental Mahila Ashrams and Senior Citizen Homes, etc.

The health insurance coverage provided by the Mahatma Jyotiba Phule Jan Arogya Yojana is as follows:

  1. A sum insured of ₹1,50,000 for the hospitalisation of the beneficiary and their family members
  2. A sum insured of ₹2,50,000 (including the sum insured mentioned above) for renal transplants
  3. Coverage of the entire family of the beneficiary under the ambit of the plan

The Bhamashah Swasthya Bima Yojana

The Bhamashah Swasthya Bima Yojana is a medical insurance plan specifically for the residents of the rural areas of the state of Rajasthan. In addition to the aforementioned category of people, the beneficiaries under the Rashtriya Swasthya Bima Yojana and the National Food Security Act can also be beneficiaries under the Bhamashah Yojana.

Here is the coverage available under the Bhamashah Swasthya Bima Yojana.

  1. A health insurance cover of ₹30,000 for general ailments
  2. A health insurance cover of ₹3,00,000 for critical illnesses
  3. Cashless treatment with a cover for all hospitalisation expenses
  4. Pre-hospitalisation expenses for up to 7 days before hospitalisation
  5. Post-hospitalisation expenses for up to 15 days following discharge from the hospital
  6. Cover for OPD treatments

The Rashtriya Swasthya Bima Yojana (RSBY)

The Rashtriya Swasthya Bima Yojana (RSBY) is a health insurance policy launched specifically for the people working in the unorganised sectors of India. Almost 93 per cent of the country's total workforce is constituted by the unorganised sector.

Here is the coverage available to the beneficiaries of the Rashtriya Swasthya Bima Yojana.

  1. A sum insured of ₹30,000 for a worker in the unorganised sector and their family
  2. Cover for hospitalisation expenses
  3. Cover for all pre-existing diseases
  4. Cover for transportation expenses up to ₹1,000
  5. Cashless Insurance
  6. A premium of ₹30 per annum

To Sum It Up

There are several central and state government health insurance schemes available in India. With substantial coverage and feasible premiums, these schemes are aimed at providing health insurance coverage to all the citizens of India. If you wish to participate in any such scheme, you can check whether you are eligible for it. You can also assess its coverage and premium.

In addition to government health insurance schemes, you can also opt for the Tata AIG health insurance plans that offer comprehensive medical insurance at as low as ₹15 per day*. You can peruse our health insurance plans on our official website.

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Frequently Asked Question

What is a Government Health Insurance Scheme?

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A government health insurance scheme is a medical insurance plan that is financed or supported by the government. Such schemes usually carry the goal of public welfare and are available at affordable premiums.

Can I Participate In a Government Health Insurance Scheme?

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Yes, you can participate in a government health insurance scheme, provided you fulfil the eligibility criteria for the said scheme. Some government health insurance schemes have no specific eligibility criteria in terms of sector of work, income level, etc. And are open to the general public.

However, there are some schemes that are available only for people engaged in a particular sector or employment or falling under a specific income group. Furthermore, unlike central government schemes, the scope of the health insurance schemes launched by state governments is usually restricted to the residents of a particular state.

Do the Premiums for Various Government Health Insurance Schemes Vary?

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Yes, different government health insurance schemes have varying premiums. The amount of premium is determined as per the terms and conditions of the scheme. In the case of most schemes, there is a fixed premium to be paid on an annual basis for subscription to as well as the renewal of the membership.

Is Each Government Health Insurance Scheme Implemented by the Central Government?

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No, there are several health insurance schemes that are launched and implemented by the respective governments of the various states in India. Along with the schemes launched by the central government, these schemes aim at ensuring the provision of health insurance to all the citizens of the country.

What is the Premium and Coverage for the Pradhan Mantri Suraksha Bima Yojana?

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The premium for the Pradhan Mantri Suraksha Bima Yojana is ₹12 per annum. This scheme provides the following covers to its beneficiaries.

  1. A cover of ₹2,00,000 for accidental death or total disability
  2. A cover of ₹1,00,000 for partial disability

Which state government has launched the Karunya Medical Insurance Plan?

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The Karunya Medical Insurance Plan has been launched by the government of Kerala. This plan carries the aim of providing health insurance coverage to the economically weak sections of the population of the state.

When is a Company Required To Register for the Employee State Insurance Scheme?

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A company is required to register for the Employee State Insurance Scheme when its employee count crosses 10.

Should I Participate In A Government Health Insurance Scheme?

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If a government health insurance scheme is in line with your health insurance requirements and budget, you can consider participating in that scheme. However, you must also assess and compare the medical insurance plans of the leading insurers in India, such as the Tata AIG health insurance plans.

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