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Government Health Insurance Schemes
Only around 472 million individuals in India out of the 1.3 billion citizens have valid medical insurance coverage, according to a 2019 report. Therefore, the Government of India has started working towards providing good quality healthcare for the people. 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 access to healthcare and health insurance in India is far from ideal, particularly in the nation’s rural regions, 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.
Important Features and Benefits of Government Health Insurance Schemes
Here is a list of features and benefits of health insurance schemes:
- Policies are offered at a low price.
- Encourages people below the poverty line to avail of insurance.
- Ensures the poor people have some sort of insurance coverage.
- The government initiated policies help policyholders to feel assured.
Important Government Health Insurance Schemes and Details
Here are some of the most important schemes to consider, which have allowed millions of Indians to afford quality medical treatments and procedures when the need arises. Have a look at the following.
This scheme came into existence because of recommendations made by the National Health Policy. Ayushman Bharat Yojana is designed keeping in mind Universal Health Coverage (UHC). Health services in India are largely segmented and Ayushman Bharat aims to make them comprehensive. There are two components related to Ayushman Bharat: Health and Wellness Centres (HWC) and Pradhan Mantri Jan Arogya Yojana (PM-JAY). 150000 HWCs have been created in order to ensure better healthcare for the people. These HWCs are transformed versions of earlier initiatives like Sub Centres and Primary Health Centres. The PM-JAY is a health insurance scheme for the poor. It offers a health cover of Rs. 5 lakhs per family on an annual basis, and the payable premium is Rs. 30.
Awaz Health Insurance Scheme:
Launched by the Kerala government in 2017, this particular insurance policy targets the inter-state laborers in Kerala, who are without medical coverage. Besides financial assistance during medical emergencies, this scheme also offers a death benefit feature to the policyholder’s family members. One can claim medical coverage of up to Rs.15000 from such a plan. After the policyholder’s death, the death benefit feature provides a payout of Rs.2 lakh to surviving family members. However, this facility is only available to laborers aged between 18 and 60 years. Therefore, senior citizens do not qualify for such coverage
The Aam Aadmi Bima Yojana (AABY) is meant for people involved in certain vocations such as Carpentry, Fishing, Handloom weaving, etc. There are 48 such defined vocations. Before 2013, there were two policies of similar nature, AABY and Janashree Bima Yojana (JBY). After 2013, JBY was merged with AABY. The premium for Rs.30000 insurance policy is Rs. 200 for a year. The eligibility criteria for this policy are that one should be a family head or an earning member of one’s family (around the poverty line) and should be performing one of the 48 mentioned vocations.
This scheme came into existence to offer accident insurance to the people of India. In 2016, it was observed that only 20% of Indian citizens had insurance coverage. However, Pradhan Mantri Suraksha Bima Yojana aspires to change this statistic in a positive manner. People aged 18 to 70 and having a bank account can avail of the benefits of this scheme. This policy offers an annual cover of Rs. 1 lakh for partial disability and Rs. 2 lakhs for total disability/death for a premium of Rs. 12. The premium gets debited automatically from the insured person’s bank account.
Bhamashah Swasthya Bima Yojana:
Rajasthan Government supports insurance initiatives towards its citizens under the Bahmashah Swasthya Bima Yojana. This is a cashless claims scheme for rural people of Rajasthan. There is no prescribed age limit for availing of the benefits of this scheme. Those who are a part of the National Food Security Act (NFSA) and the Rashtriya Swasthya Bima Yojana (RSBY) are also qualified for this insurance policy. This scheme covers hospitalization expenses for general illnesses as well as critical illnesses as per the terms and conditions. It covers both in-patients as well as out-patient expenses.
Operated by the Central government, this insurance plan only caters to central government employees. High ranking employees of Indian Railways, Supreme Court judges, and other important workers under the central government can benefit from this plan. It offers hospitalization benefits, as well as domiciliary treatment coverage. Moreover, you can seek homeopathy and naturopathy expenses from such a policy as well. Presently, CGHS is available in 71 Indian cities.
This is a state government scheme. Tamil Nadu Government promotes it in association with United India Insurance Company Ltd. The Chief Minister’s Comprehensive Insurance Scheme is a family floater plan designed for quality health care. One can claim for hospitalization expenses up to Rs. 5 lakhs under this policy. Select government and private hospitals are a part of this scheme. People residing in Tamil Nadu earning less than Rs. 75000 annually are eligible for this scheme. More than a thousand procedures are covered under the Chief Minister’s Comprehensive Insurance Scheme.
Employees’ State Insurance Scheme was launched in the year 1952 to offer financial cover in case of illness, disability, or death faced by insured workers/employees. Initially, only Kanpur and Delhi were considered, but the scope of the scheme expanded with time. This policy got upgraded in the year 2015. Now, more than 7 lakh factories are a part of this scheme.
Karunya Health Scheme:
Kerala Government launched this initiative in the year 2012. Karunya Health Scheme is directed towards providing Health Insurance for listed chronic illnesses. It is a Critical Illness plan for the poor and covers major diseases such as Cancer, Kidney Ailments, Heart-related medical issues, etc. Those below or near the poverty line can enroll themselves for this cover. Aadhaar Card and appropriate Income Certificate are needed for this scheme.
Mahatma Jyotiba Phule Jan Arogya Yojana:
The Government of Maharashtra initiates this policy for the betterment of its downtrodden people. Rajiv Gandhi Jeevandayee Arogya Yojana was renamed Mahatma Jyotiba Phule Jan Arogya Yojana in the year 2017. Farmers from selected districts and people below and around the poverty line across all districts are eligible for this scheme. It is a family cover with a benefit of Rs. 150000. The diseases mentioned as inclusions in the scheme shall be covered from day one without any waiting period unless specified.
Mulkhyamantri Amrutum Yojana:
This specific scheme was launched in 2012 as part of a Gujarat government initiative. It aims to assist the state’s citizens belonging to the lower middle class and those below the poverty line. A sum insured of Rs. 3 lakhs is available to beneficiaries as part of a family floater policy. You can seek treatment at a variety of medical facilities, including trust-based hospitals, public and private hospitals.
Rather than being one scheme, this umbrella plan includes four policies for Andhra Pradesh residents. There are four schemes. Dr. YSR Aarogyasri – This scheme is dedicated to the welfare of the poor. Aarogya Raksha – This scheme is designed to benefit people Above Poverty Line (APL). Working Journalist Health Scheme – This scheme is for journalists and it offers cashless treatment in case of listed procedures. Employee Health Scheme – This scheme is for the benefit of state government employees.
Telangana State Government:
Employees and Journalists Health Scheme – The Telangana state government offers comprehensive medical coverage to its employees and journalists. Besides existing employees, this policy covers retired or ex-employees as well. Cashless treatment is the primary advantage of this scheme, enabling policyholders to seek treatment without facing financial shortcomings.
Labourers and those individuals working in the unorganized sector often lack any health insurance coverage. However, like others, these people also face sickness and accidents. Thus, the need for medical coverage is just as pronounced for them as it is for others. The Ministry of Labour and Employment is responsible for offering such policies to workers in the unorganized sector and their families (up to 5 people).
Globally, many developed and developing nations have some sort of health care scheme to benefit their poor people. In India, the Universal Health Insurance Scheme aspires to do that and much more. This scheme can be availed by the poorest of the poor in the age group of 5 to 70 years. It offers individual as well as group health insurance. It covers hospitalization, accident, and disability. The premium varies as per the size of the family. Those falling under the poverty line need to show proper documentation to avail of the policy.
Farmers in Karnataka, associated with a cooperative, can take advantage of financial benefits from this scheme. These people can acquire medical coverage against more than 800 procedures (Orthopaedic, Neurology, Angioplasty, etc.) across various medical fields. The scheme also extends its benefits to the family members of the main beneficiary. However, beneficiaries need to visit network medical facilities only to seek the necessary financial assistance during treatment.
West Bengal state government employees can benefit from this particular medical insurance scheme. It was introduced in 2008 and offers a sum insured of Rs. 1 lakh to the employee and his/her family members. It received an update in the year 2014 and was called West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme. The plan supports surgery costs, as well as OPD treatments, in certain cases. Its exceptions include cosmetic surgeries and non-emergency procedures.
Most frequent questions and answers about Government Health Insurance Schemes.
Different plans have different eligibility criteria. You can check the criteria and the documents required for the scheme and make your decision.
Not all schemes are initiated by the Central Government. State Governments also come up with dedicated Govt. Mediclaim policy/health insurance schemes.
While some Government health schemes in India enable direct bank debit facilities, not all schemes can be purchased online.
Generally, cosmetic procedures are not a part of Government insurance policies. Different plans might have different exceptions, there it is advised to read the respective policy wordings carefully to know the exceptions and advantages of the health insurance scheme.
The premiums for such plans differ based on the number of individuals covered. In some cases, schemes need beneficiaries to pay a pre-determined sum as a premium each year. Based on the scheme you are interested in acquiring, you should check the terms and conditions carefully.
To become eligible for this scheme, you must fulfill two major criteria. Firstly, you must be a resident of Tamil Nadu. Secondly, your household income is limited up to Rs.75,000 per year.