National Health Insurance Schemes (NHIS): Benefits and Features

  • Author :
  • TATA AIG Team
  • Published on :
  • 18/05/2022

The cost of availing good quality healthcare has soared globally, and for the underprivileged, investing in a comprehensive health insurance policy may not be financially feasible.

Acknowledging the requirement of health coverage for every member of society, the Government of India introduced healthcare schemes with various health insurance plans. These plans collectively make up the National Health Insurance Scheme (NHIS).

What is the National Health Insurance Scheme (NHIS)?

NHIS’s full form is the National Health Insurance Scheme. The national health insurance scheme in India is an endeavour by the Central Government of India to make health insurance, and subsequently healthcare facilities and medical treatment, accessible to the underprivileged members of our society.

To further this objective, the Indian government, together with the National Knowledge Commission and the Ministry of Health and Family Welfare, developed the National Health Portal.

This portal offers holistic information regarding healthcare, making it accessible to a vast majority of the population. Let’s dive into the features and benefits of some of these national health insurance plans.

Popular Programs Under National Health Insurance Scheme India

Here is a list of some of the most popular national health insurance plans launched by the Government of India under the NHIS:

Rashtriya Swasthiya Bima Yojana (RSBY)

The RSBy is a national health insurance scheme that is curated for families who are below the poverty line (BPL). Launched by the Ministry of Labour and Employment, the objective of this health insurance policy is to offer economical health insurance coverage to BPL families.

Benefits and features of the Rashtriya Swasthiya Bima Yojana:

  • The hospitalisation cover limit is set at ₹30,000 and the hospital package rates have also been fixed

  • Pre-existing illnesses are also covered under this scheme without any age barrier

  • The coverage can be extended to five members of the family including self, three dependants, and a spouse

  • The premiums for the policy are paid by the government on behalf of the insurance holder. The latter needs to pay ₹30 for this national health insurance scheme registration.

  • Incentives are offered to both public and private hospitals to provide treatment for policyholders

  • Policyholders can get cashless treatment at any of the network hospitals with their NHIS ID card

  • The policy comes with pan-India healthcare coverage

Employment State Insurance Scheme (ESIS)

  • The ESIS offers socio-economic protection to working individuals and their dependents in the event of medical emergencies.

  • Benefits and features of the Employment State Insurance Scheme (ESIS):

  • Under this scheme, policyholders can avail of cash benefits in the unfortunate event of any health emergency, death due to occupation hazard, permanent and temporary disabilities, employment injury, etc.

  • The ESIS is valid for non-seasonal factory employees. However, the factory must employ more than 10 people.

  • The policy is also applicable to cinemas, hotels, restaurants, shops, newspaper establishments, and road-motor transport enterprises that have employed more than 20 workers

  • It is important to note, however, that the ESI scheme is implemented area-wise in all the States excluding Mizoram, Manipur, Sikkim, Arunachal Pradesh, and the Union Territories

Central Government Health Scheme (CGHS)

  • The CGHS is an all-inclusive healthcare service that is extended to the employees of the Central Government of India. This is also applicable to pensioners and their dependents residing in specific cities.

  • This policy was launched in 1954 and is extended through hospitals and polyclinics under Allopathic, Ayurveda, Yoga, Unani, Siddha, and Homoeopathy systems of medicine available under cities covered by CGHS.

  • Benefits and features of the Central Government Health Scheme (CGHS):

  • Coverage for hospitalisation

  • Coverage for expenses incurred in medical tests (ECG, X-ray)

  • Coverage for expenses incurred in laboratory tests

  • Pharmaceutical coverage

  • Domiciliary care

  • Consultation with a specialist doctor

In case of surgery or other medical treatment, cashless claims are offered

Aam Aadmi Bima Yojana (AABY)

Designed for rural and landless households, the AABy was launched on October 02, 2007. Under this national health insurance scheme, the breadwinner of a household aged between 10 and 59 years is covered.

Benefits and features of the Aam Aadmi Bima Yojana (AABY):

  • If the policyholder passes away because of natural causes before the age of 59, an amount of ₹30,000 as the death benefit is offered to the dependent family

  • If the policyholder dies in an accident the death benefit of ₹75,000 is offered to the dependent family. This benefit is also offered in the unfortunate event of permanent disability wherein the insured member loses two limbs or both eyes.

  • A benefit of ₹37,500 is provided to the insured and their dependent family in case of partial disabilities (losing one limb or an eye) as a result of an accident

Ayushman Bharat - National Health Protection Mission

Also known as the Pradhan Mantri Jan Aarogya Yojana aims to provide health coverage to the economically challenged strata of society. For this policy, the national health authority issues the Ayushman card that enables access to a range of private and public hospitals across the country.

Amongst the many national health card benefits a prominent one includes availing of the cashless facility at any of the network hospitals pan India.

Benefits and features of Ayushman Bharat:

  • A hospitalisation coverage of up to ₹5 lakhs is provided to a family per year under the Ayushman Bharat policy

  • Pre-existing illnesses are covered under the policy from day one

  • Under this national health insurance scheme, the policyholder is eligible for pre-hospitalisation cover of 3 days and post-hospitalisation cover of up to 15 days

National Health Insurance Scheme Registration Process

To avail of the national health card benefits, it is important to understand the national health insurance scheme registration process. Here is how it unfolds:

  • The insurance provider is provided with an electronic list of eligible BPL households. After this, the company prepares an enrollment schedule with dates for every village with the assistance of district-level officers.

  • According to the schedule, the BPL list is posted at the enrollment station and prominent places in every village before enrollment. The date and location of the enrollment in the village are published in advance, with mobile enrollment stations set up at local centres.

  • At these stations, the biometric information and photographs of insurance seekers are collected. Policyholders are offered smart cards with a photo.

  • Once the beneficiaries pay ₹30, they are provided with a smart card (authenticated by the government official), along with an information pamphlet describing the scheme and the list of hospitals.

  • The NHIS ID card download can be done online from the official portal. Some essential national health card benefits include:

  • Pan India coverage free of cost

  • Critical illness insurance covers 25 speciality categories such as neurosurgery, cardiology, etc., as well as treatment cost of oncology with chemotherapy for 50 different types of Cancer

  • Post-hospitalization expenses and follow-up treatment coverage

In Conclusion

Healthcare facilities are essential for every individual and for an inclusive society, it is important to ensure that every stratum has the opportunity to access medical care.

In this light, national healthcare schemes can further this cause. It is particularly important to invest in critical illness insurance as critical illnesses can significantly drain one’s finances.

National Health Insurance Schemes come with critical illness insurance so families with financial concerns can bear the cost of treatment.

However, a health insurance policy not only benefits the underprivileged but is an essential investment for everyone. For the sake of convenience, insurance companies have made it easy to buy health insurance online.

When you buy health insurance online, you can even get a discount on your premiums. The benefits of health insurance exceed financial assistance to offer peace of mind in a vulnerable health condition.

Disclaimer / TnC

Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.

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