Government health insurance schemes are schemes that are sponsored by a state or a central government. The main objective of these schemes is to offer health insurance to the general public and enhance the healthcare sector of the country. The government by offering such schemes aims to provide a significant Sum Insured for a low premium to meet the suitability of different people. In India, various health insurance schemes have been launched by both Central and State governments to enhance health insurance coverage for all citizens.
Common features of government health insurance schemes are:
- Insurance cover is offered at low cost to lower-income groups.
- All sections of society are included under these schemes.
- Treatment in both government and private hospitals is included in most of the schemes.
- Online enrollment is available for some schemes.
19 Important Health Insurance Terms to Know
Central Government Health Insurance Schemes
1. Ayushman Bharat: It is a national health scheme funded by the Government of India to unify healthcare facilities. The scheme consists of two components: Health and Wealth Centres(HWC) and the Pradhan Mantri Jan Arogya Yojana(PM-JAY). PM-JAY is a health insurance scheme that provides insurance coverage of up to Rs. 5 lakh for each family per year with a premium of Rs. 30.
This scheme is specially designed for poor and rural families. It covers tertiary and secondary hospitalization expenses including pre-hospitalization, medication, and post-hospitalization expenses. The scheme covers 1350+ medical packages to cover almost all illnesses. People with a monthly income of less than 10,000 are eligible to apply for this scheme online.
2. Central Government Health Scheme: It is a scheme for central government employees and pensioners. Its benefits can be availed only by those employees who are enrolled under this scheme. It also includes supreme court judges, central railway board employees, etc. It covers employees from over 71 cities across India. This scheme covers hospitalization and health care under allopathy, and AYUSH.
3. Employee State Insurance Corporation Scheme: It provides protection to policyholders in case of health issues that require hospitalization. It offers disability benefits and unemployment allowance. This scheme was launched in 1952 to provide insurance coverage to workers working in factories where poor working conditions existed. This scheme was initially launched in Delhi and Kanpur but now has been extended to all states and union territories except Arunachal Pradesh, Manipur, Daman and Diu, Dadra and Nagar, and Lakshadweep Islands. A person employed in a non-seasonal factory that has 10+ employees and earns less than Rs. 21,000 per month is eligible for this scheme.
4. Rashtriya Swasthya Bima Yojana: This scheme has been launched for people working in the unorganized sector to provide healthcare services and social security to the BPL families. The main aim of this initiative is to reduce the medical expenditure of these BPL families and increase awareness about the facilities available. Individuals working in the unorganized sector and who are below the poverty line are eligible to apply for this scheme. Under this scheme, each family can get a sum of up to Rs. 30,000 on a family floater basis where it can cover 5 members in a family.
5. Universal Health Insurance Scheme: It is a health care scheme for the benefit of the poorest of the poor of India. Any individual below the poverty line and falling in the age group of 5 to 70 years is eligible to apply for this scheme. It offers both individual and as well as group health insurance. It covers hospitalization, accident, and disability. This scheme reimburses a sum of up to Rs. 30,000 for starters with a premium of Rs. 200 for individuals and Rs. 300 for a family of five and Rs. 400 for a family of 7.
Know the difference between Life Insurance and Health Insurance
State Government Health Insurance Schemes
1. Awaz Health Insurance Scheme: It is an initiative by the Government of Kerala to provide insurance and accidental death coverage for migrant workers. Coverage of up to Rs. 15000 is provided under health insurance and up to Rs. 2 lakh under accidental death. Migrant laborers of age 18 to 60 years are eligible for this scheme. To avail of the benefit of this scheme, laborers need to produce their Awaz smart cards. This card is regularly issued by the labor department of the state. Under this scheme, the family members of the migrant laborers are not covered.
2. Bhamashah Swasthya Bima Yojana: It is an initiative by the Rajasthan Government for the people of Rajasthan. All people who are part of the National Food Security Act and Rashtriya Swasthya Bima Yojana can avail insurance facility under this scheme. It covers hospitalization expenses for both general and critical illnesses and covers both in-patient and out-patient expenses. Premiums for each family are fixed and made yearly on a floater basis. Under this scheme, one can avail Rs. 30,000 for general illnesses and Rs. 3 lakhs for critical illnesses. This scheme is implemented via Bhamashah Cards.
3. Chief Minister’s Comprehensive Insurance Scheme: It is an initiative by the Government of Tamil Nadu for people residing in the state and earning less than Rs. 75,000 per annum. It aims to provide insurance benefits to economically backward sections of society. This scheme covers medical expenses related to ailments, critical illnesses, diagnostic procedures, etc. It is a family plan launched in association with the United India Insurance Company. The Beneficiaries are insured for a sum of Rs. 1 lakh each year for 4 years and in some cases, this amount can be raised to 1.5 lakh each year. One can easily apply for this scheme online on the official website of the Tamil Nadu Chief Minister.
4. Karunya Health Scheme: It is an initiative launched by Kerala Government to provide health insurance for some chronic illnesses. Individuals suffering from major chronic illnesses like Kidney disease, heart disease, cancer, etc and belong below or near the poverty line are eligible for this scheme. Government offers a benefit of up to Rs. 2 lakh to its policyholders. This can be increased to Rs. 3 lakh in extreme illnesses.
5. Mahatma Jyotiba Phule Jan Arogya Yojana: It is an initiative by the Government of Maharashtra to provide cashless benefits for serious illnesses requiring hospitalization. It covers the cost of medication, surgery, consultation, and diagnostics. People with Annapurna Card, Ration Card, and Antyodaya Anna Yojana Card and farmers from agriculturally distressed districts are eligible for this scheme. Policyholders have assured a sum of Rs. 1.5 lakh per year. This scheme also covers the treatment of COVID-19.
6. Mukhyamantri Amrutum Yojana: It is an initiative by the Government of Gujarat for lower-income groups of Gujarat. This scheme aims to provide good healthcare facilities to needy people. It covers all medical treatment including post-hospitalization expenses and diagnostics. This scheme offers a cover of up to Rs. 3 lakh per year on a family floater basis where 5 adult members of a family can be insured.
7. Dr. YSR Aarogyasri Health Care Trust Andhra Pradesh State Government: It is an initiative by the Andhra Government to provide financial aid to the people of the state. Beneficiaries can avail of scheme benefits after showing Aarogyasri card. This card is issued by the Aarogyasri Healthcare Trust. Four schemes are catering to different people:
- Dr. YSR Aarogyasri: for poor people.
- Arogya Raksha: for people above the poverty line.
- Working Journalist Health Scheme: for journalists.
- Employee Health Scheme: for state government employees.
8. Telangana State Government – Employees and Journalist Health Scheme: It is an initiative by Telangana Government for its employees and journalists. This scheme offers benefits to both currently working people and retired people. It is a cashless insurance scheme that can be availed by the beneficiaries for certain treatments.
9. Yeshasvini Health Insurance Scheme: It is an initiative by the Karnataka Government. This scheme is for farmers and peasants who are associated with a cooperative society. It provides health insurance coverage across 30 districts of Karnataka. Beneficiaries of this scheme are required to pay Rs. 300 for Rurak Yeshasvini and Rs. 710 for Urban Yeshasvini to avail of the benefits of the scheme. The benefits of the schemes are extended to the whole family.
10. West Bengal Health Scheme: It is an initiative by the Government of West Bengal. It provides cashless healthcare services to pensioners, employees, and officers of the West Bengal state government. This scheme covers surgeries and OPD of individuals and their families. The sum insured under the scheme is Rs. 1 lakh.
There are many exclusions in each policy and the schemes may vary from each other. It is better to examine the features of these schemes thoroughly before opting for it.
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