All about National Health Insurance Schemes

 The Government of India (GOI) offers a number of health insurance schemes to those with no accessibility to or who can't afford to buy insurance policies offered by private players. Most of these health insurance plans are designed to provide coverage to BPL (Below Poverty Line) families, the worker community, the rural population, and senior citizens. 

Rashtiya Swasthiya Bima Yojana, Employment State Insurance Scheme, Central Government Health Scheme, Aam Aadmi Bima Yojana, Universal Health Insurance Scheme, and Ayushman Bharat are various National Health Insurance Schemes offer by the central government.

Different National Health Insurance Schemes

  • Rashtiya Swasthiya Bima Yojana (RSBY)

Rashtiya Swasthiya Bima Yojana or RSBY offers health insurance coverage to BPL families. Families who are covered under this scheme get a maximum of up to Rs.30,000 on hospitalisation. RSBY coverage is available for almost all diseases, pre-existing conditions (without a waiting period), and there is no upper cap on age to avail of the benefits. This scheme covers a maximum of five members from a family with a registration fee of Rs.30, and the Central and State Governments will pay the premium.

Essential features of RSBY are: 

  • Liberty to select hospital: Policyholders can choose the hospital of their choice, either private or government. The hospitals will get payments based on the treatment, and the insurer monitors the activities of these participating hospitals to make sure that they are not carrying out unnecessary procedures.
  • Smartcards: Each enrolled family gets a biometric-enabled smartcard, which they need to produce to benefit from the health insurance scheme.
  • Cashless benefits and paperless transactions: All the policyholders of RSBY get cashless treatments in the designated hospitals. The claim process is 100% paperless, i.e., the participating hospitals need to send all bills and other records online to the insurer to get paid.
  • Easy portability: Policyholders can use their smartcards anywhere in India, which is a blessing for migrant workers. 

 

  • Employment State Insurance Scheme (ESIS)

ESIS is designed to give socio-economic protection to workers and their families. This insurance scheme has no waiting period, i.e., policyholders will get all benefits from day one. ESIS offers cash benefits to its policyholders in case of any disabilities, both permanent and temporary, that can impact their earning ability. If the insured person passes away due to industrial accidents /employment injury/ occupational hazard, then their dependents get a monthly pension.

ESIS scheme is applicable only for non-seasonal factories with at least 10 employees. This scheme is also applicable to hotels, shops, restaurants, cinema theatres, newspaper establishments and road motor transport undertakings with more than 20 employees.

Even educational and private medical institutions are also eligible for the ESIS scheme if they employ at least 20 people.

 

  • Central Government Health Scheme (CGHS)

Central Government Health Scheme or CGHS offers comprehensive health insurance to central government employees and pensioners, as well as their families. Currently, CGHS is operational in most of the major Indian cities. The beneficiaries can avail of medical facilities from wellness centers and polyclinics that offer Allopathic, Ayurveda, Yoga, Unani, Sidha and Homeopathic.

Important features of the Central Government Health Scheme are: 

  • Hospitalisation cover
  • Domiciliary care
  • Specialised consultation at hospitals, dispensaries, and polyclinics
  • Medical tests 
  • Health education to beneficiaries

 

  • Aam Aadmi Bima Yojana (AABY)

Aam Aadmi Bima Yojana or AABY is a social security scheme designed for the landless households living in the hinterlands of India. This scheme covers either one earning member or the head of the family between 18 and 50 years of age. 

In case of the natural death of the insured member, the family is eligible to get a compensation of Rs. 30,000.

In case of accidental death or permanent disability of the insured member, a compensation of Rs. 75,000 will be provided.

On partial disability of the insured member, a compensation of Rs. 37,500 will be offered to them.

Read More: Avail Max Bupa health insurance in India.

 

  • Universal Health Insurance Scheme (UHIS)

Universal Health Insurance Scheme is implemented to improve the healthcare access of impoverished families. In addition to the health cover, the scheme offers compensation in case of accidental death of the earning head of the family and loss of earning ability of the breadwinner of the family due to an accident. This health insurance is available only for the members of BPL families and whose age is between 5 and 70. 

Universal Health Insurance Scheme offers hospitalisation expenses of up to Rs.30,000 to a family, including maternity expenses. Excluding maternity benefits, the upper limit of hospitalisation expenses is Rs.15,000. The benefits of UHIS are available only to one child. 

In case of the accidental death of the earning head of the family, a compensation of Rs. 25,000 will be given to the family members.

Suppose the breadwinner of the insured family loses earnings due to hospitalisation because of an accident or any disease. In that case, the policyholder will receive Rs.50 per day for 15 days after a survival period of three days. 

 

  • Ayushman Bharat

Launched by the recommendation of the National Health Policy 2017, Ayushman Bharat is the flagship health insurance scheme of the GOI. Designed to meet Sustainable Development Goals (SDGs), the motto of this scheme is 'leave no one behind.'

Ayushman Bharat has two inter-related components- Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojana (PM-JAY) 

  • Health and Wellness Centres (HWCs): HWCs will deliver Comprehensive Primary Health Care (CPHC) to people. The GOI plans to create 1,50,000 HWCs in the country by converting the existing Sub Centres and Primary Health Centres (PHCs). These centres will focus on non-communicable diseases as well as maternal and child health services. The services of HWC also include diagnostic and free essential drugs.
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY): Widely known as PM-JAY, Pradhan Mantri Jan Arogya Yojana is the world's largest health insurance scheme financed by the government. It has a target to cover 10.74 crore low-income families, i.e., around 40% of the Indian population. PM-JAY aims to provide a health insurance cover up to Rs.5 lakh for each family. It includes 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses. Other important features of PM-JAY are: 
    • No waiting for pre-existing diseases
    • No restriction on family size and age
    • Cashless treatment at the point of service
    • Beneficiaries can avail of the benefits of the scheme anywhere in India.
    • Benefits of this health insurance scheme are available in government hospitals and private empanelled hospitals across India.

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