National Health Insurance Scheme (NHIS) Benefits & Features

The National Health Insurance Scheme or the NHIS Scheme consists of centralised health insurance programmes developed and maintained by the GoI (Government of India) to bridge the growing disparity of access to quality healthcare among the citizens of India. So, the primary aim of these national health policies in India is to make better healthcare facilities and medical treatment accessible and affordable to all strata of society.

To implement this goal, the Government of India, along with the National Knowledge Commission and the Ministry of Health and Family Welfare, has developed the National Health Portal. The Portal’s objective is to serve as a one-stop-shop for all healthcare-related information and make this information accessible to a vast majority of the population. In addition, this portal lists all the major national health policies in India launched by the Government of India.

Here are the popular national health policies in India launched by the Government of India under the National Health Insurance Scheme (NHIS):

• Ayushman Bharat Yojana and the Pradhan Mantri Jan Arogya Yojana
• Rashtriya Swasthya Bima Yojana
• Central Government Health Scheme
• Employment State Insurance Scheme
• Aam Aadmi Bima Yojana
• Universal Health Insurance Scheme

Let us look at all the features and benefits of all these programmes under the National Health Insurance Scheme (NHIS) in detail.

An important component of the National Health Policy of 2017, the Ayushman Bharat Yojana or the Healthy India scheme, was launched by the honourable Prime Minister of India, Mr Narendra Modi, with the aim of achieving Universal Health Coverage. One of the objectives of this scheme is to subsume all major existing schemes sponsored by the Indian government, such as the Rashtriya Swasthya Bima Yojana and the Senior Citizen Health Insurance Scheme.

The Ayushman Bharat Yojana is made up of two aspects - the setting up of health and wellness centres across the country for healthcare accessibility and the Pradhan Mantri Jan Arogya Yojana (PMJAY).

The PMJAY is a centralised medical insurance scheme that makes secondary and tertiary healthcare services accessible and cashless for the marginalised and poor sections of society. Launched on 23rd September 2018, the PMJAY is an entitlement-based health insurance scheme that provides automatic coverage to the beneficiaries listed under the latest data of the Socio-Economic Caste Census (SECC) and offers a pan-India portable national health insurance card for easy access.

*The top benefits of the PMJAY under the NHIS scheme are *:

• A family floater health insurance policy coverage of ₹5 lakhs with complete coverage of all hospital costs.
• Three days pre-hospitalisation and 15 days post-hospitalisation cover.
• Swasthya Suraksha or health protection to approximately 10 crore families.
• Paperless, cashless and free treatment at government and networked private hospitals.
• Pre-existing diseases cover from day one.
• Almost 1350 medical packages cover hospitalisation, surgery, daycare expenses, ambulance costs, medical expenses and so on.
• Pan-India availability with setting up of health centres, networked private hospitals and national portability.
• Priority to women, elderly and girl children.
• Ayushman Bharat national health card for centralised access.
• Set up a 24x7 helpline number - 14555.

The Rashtriya Swasthya Bima Yojana (RSBY) is a national health policy in India established by the Government of India to ensure that the unprivileged sections of the society can tackle transportation and infrastructural challenges to get quality healthcare services at affordable costs and at hospitals of their choice. In addition, it offers a national health card for pan-India access.

One of the most popular government-led health insurance schemes, it was subsumed under the Ayushman Bharat Yojana.

Here are some top features and benefits of the RSBY under the NHIS scheme :

• Health insurance policy for the Below Poverty Line (BPL) families with a choice to opt for a public hospital or a private hospital for treatment.
• A family floater health insurance cover up to ₹30,000 per year, extending to 5 members of a family - self, spouse and 3 dependents.
• Biometric-enabled health card benefits in India to avail quality treatment across the country.
• Annual premium contribution of 75% by the central government and 25% by the respective state governments.
• Annual premium contribution of 90% by the central government and 10% by the respective state governments for north-eastern states and Jammu and Kashmir.
• Cashless hospitalisation benefit for all major healthcare services.
• 1 day pre-hospitalisation and 5 days post-hospitalisation cover.

Established by the central government of India in 1954, the Central Government Health Scheme or the CGHS is an all-inclusive National Health Insurance Scheme (NHIS) for the employees as well as pensioners of the central government and their legal dependents. The CGHS is available in select cities and offered via authorised and listed CGHS dispensaries, allopathic clinics and AYUSH centres.

The important aspects of the CGHS are :

• Dispensary services and general consultation
• Dispensing of necessary medicines
• Consultation services with polyclinics and specialists
• Medical and pathological tests, such as blood tests, X-rays, imaging, etc.
• Hospitalisation
• Domiciliary cover
• Health-based knowledge and education

The above services are provided either free of charge or at subsidised rates to eligible beneficiaries at authorised centres.

Established as per the ESI Act in the year 1952, the ESIS is a National Health Insurance Scheme (NHIS) programme that offers socio-economic protection through health insurance policies to employees and their dependents. Health issues, such as sickness, fatalities caused by injuries at the workplace, temporary/permanent disablement, etc. that may lead to loss of income are covered under this national health policy in India.

Registered beneficiaries under the ESI can receive medical treatment and insurance benefits for themselves and their families at authorised ESI centres and networked private and public hospitals across India.

• The ESIS offers :

• Sickness benefits

• Medical expense benefits

• Maternity cover

• Disability benefit

• Unemployment benefit

• Cover for dependents

• Rehabilitation benefit

Launched on 2nd October 2007, the Aam Aadmi Bima Yojana (AABY) is a social security scheme under the National Health Insurance Scheme (NHIS) aimed at landless, rural families. Under the scheme, the earning member of the eligible family, between the ages of 18 years to 59 years, is covered. The premium cost of ₹200 is paid by the central government of India and the respective state government.

• The AABY scheme covers :

• ₹30,000 compensation for natural death

• ₹75,000 compensation for partial/permanent disabilities (loss of both eyes or two limbs) or death caused by an accident

• ₹37,500 compensation for partial/permanent disabilities (loss of 1 eye or 1 limb) caused by an accident

Established and executed by four public insurance companies, the primary objective of the Universal Health Insurance Scheme (UHIS) under the National Health Insurance Scheme (NHIS) is to provide health insurance coverage for poor, economically weaker families.

The top features and benefits of the UHIS are:

• Can be purchased as an individual or a family floater health insurance policy.
• Offers health insurance coverage of up to ₹30,000 to cover hospitalisation expenses.
• Personal accident or accidental death cover of ₹25,000.
• Loss of income benefit of ₹50 in the form of daily cash compensation.

The importance of the National Health Insurance Scheme is defined by the high medical inflation rate and certain infrastructural issues that make access to quality and affordable healthcare a challenge in a developing country like India. To address this and ensure proper healthcare facilities for all citizens, the Government of India has launched the above-discussed schemes under the National Health Insurance Scheme. In addition, apart from the central government, every state government in the country also offers dedicated health insurance and welfare schemes for its citizens.

Along with the state and central governmental schemes, a slew of private health insurance companies also offers various types of health insurance policies with extensive coverage and a wide range of benefits, including the critical illness insurance benefit. In addition, especially after the Covid-19 pandemic, private insurers have also started offering targeted Covid-19 insurance plans.

At Tata AIG, we offer the Medicare range of health insurance plans with 3 plan variants that suit all unique health coverage needs. You can also expand your coverage with our Medicare Plus super top-up plan.

No matter which health insurance policy you choose, ensure to research all the policy coverages, inclusions, exclusions, features, eligibility, claim process, etc., before you buy a health insurance plan.