What is a Government Health Insurance Scheme?
A government health insurance scheme is simply a medical policy curated by the Government of India that insures you or your family from bearing the heavy cost of healthcare. However, many people in India are not even aware that they have multiple options provided by the government when it comes to medical care.
A medical emergency can happen anytime, anywhere and to anyone. This makes it extremely important for everyone to keep an active health insurance policy.
Who is it for?: Government health schemes are more suited for people belonging to lower and middle income strata. This is done to ensure that people from all walks of life have access to healthcare and medical facilities at affordable rates.
Difference between Regular Health Insurance Plans and Government Health Insurance Scheme
Regular health insurance schemes and government health insurance schemes strive to achieve the same goal: providing accessible healthcare and keeping you insured if you have a medical emergency. However, there are many differences in the offerings of both the types of policies.
Let’s compare a regular health insurance scheme with a government health insurance scheme.
Premium: Arguably the deciding factor of insurance schemes is the premium one must pay to stay insured. Government health schemes usually have lower premiums as compared to private health insurance schemes.
Medical Coverage: Many government plans provide a range of medical coverage facilities such as pre and post hospitalization charges, examination and lab tests coverage as well as accidental damage or death cover, and that too at very budget friendly premiums. In this case, if you are eligible for a government health policy, there’s no harm in purchasing it for safe-keeping during emergencies.
Sum insured amount: Government health policies are often targeted to middle and lower income groups thereby the policies are super affordable but the sum insured is comparatively lower than what private insurance firms offer.
Hospitals: It is worth noting that government health insurances mostly provide medical care in governmental hospitals while regular health schemes offered by private insurance firms have tie-ups with private hospitals. In many states, the experience of getting treatment at government hospitals could disappoint you. It is often better to opt for regular health insurance schemes to ensure comfortable medical experiences.
Learn More: Best Health Insurance
List of 19 Government Health Insurance Schemes in India
Ayushman Bharat Yojana
Launched by the Ministry of Health and Family Welfare, the Ayushman Bharat Yojana aims at providing universal and free health insurance facilities. This is aimed to benefit people who are at the lowest rung of the socio-economic strata.
The scheme offers a coverage of INR 5 lakh and also provides medicines, diagnostic expenses, medical treatment costs as well as pre-hospitalization expenses.
Pradhan Mantri Suraksha Bima Yojana
The Pradhan Mantri Suraksha Bima Yojama is specifically crafted to protect Indian citizens, between the age of 18 – 70 who have an active bank account, from medical charges related to disability or death arising from accidents.
The policy ensures an annual coverage of INR 2 lakh in cases of disability or death due to accidents and INR 1 lakh in cases of partial disability. The premium gets automatically debited from the policy holder’s bank account.
Aam Aadmi Bima Yojana (AABY)
Formulated in 2007, the Aam Aadmi Bima Yojana was created to solve the problems of people living in the Indian countryside or developing towns. The policy also includes provisions of providing scholarships to underprivileged children in India as a means to promote education.
Anyone between the age of 18 – 59 can avail this policy and it specifically extends to people who do not own lands and are living as tenants in urban or rural areas.
The policyholder is usually the head of the family who pays a premium of INR 200/- annually. Upon natural death, the family is compensated with INR 30,000 while in cases of death due to permanent disabilities, the family is compensated with INR 75,000.
Janshree Bima Yojana
Launched together under the aegis of the Government of India and the Life Insurance Corporation, the Janshree Bima Yojana insurance to people living below the poverty line in urban or rural areas. The policy is aimed at the working class of India who are categorized in different occupations. The policy is currently offered to 45 varied occupational groups.
The general benefits of the policy include financial compensation to the legal heir on death due to natural or accidents of the policy holder. It also includes financial compensation in cases of total or partial disabilities. Most notably, the policy includes benefits made specially for women. This spans maternity benefits to treatment fees for female critical illness.
Mukhyamantri Amrutam Yojana
Launched by the government of Gujarat in 2012, the Mukhyamantri Amrutam Yojana initially catered to families and individuals living under the poverty line. However, after many considerations and amendments, the benefits of the policy were also extended to people belonging to the lower income group.
The major benefit of this scheme is that it covers the complete medical expenditure from diagnostic examinations to post-hospitalization care. The best part is that this scheme does not require any enrollment amount or insurance premium to be paid. It also covers a wide range of medical ailments whose treatments will be fully funded by the government.
A sum insured of INR 3 lakh is provided to all policyholders, however in cases of special treatments such as kidney, liver or pancreas transplant, the sum insured increases to Rs. 5 lakhs. An important thing to note is that a maximum of five people in every family can enroll for this scheme.
Mahatma Jyotiba Phule Jan Arogya Yojana
The Mahatma Jyotiba Phule Jan Arogya Yojana was curated by the government of Maharashtra for the domiciles of the state. The primary goal is to provide cashless medical facilities and quality healthcare to people of lower income groups.
The policy covers an extensive list of 971 medical procedures with additional 120 post therapy packages. These also include orthopedic surgeries, gynecologic and obstetric treatments, cardiac surgeries, radiation surgeries, as well as plastic surgeries among many others.
While the sum insured amount per family is just Rs. 1.50 lakhs for every year which is low, the benefits of the scheme are diverse. The insurance premium is borne by the state. Medical benefits also cover consultation charges along with diagnostic care expenses. Apart from government hospitals, there are several private hospitals that consider the policy and offer treatments to the beneficiaries.
Bhamashah Swasthya Bima Yojana
Catering to the people of Rajasthan, the government of Rajasthan formulated the Bhamashah Swasthya Bima Yojana. The primary beneficiaries for this policy are those belonging to low income families who are permanent residents of Rajasthan.
The benefits of the policy include a sum insured of INR 5 lakh for treatments and emergencies. It also has special advantages for women policyholders as they can use their Bhamashah Swasthya Bima Yojana policy cards to purchase rations from authorized PDS outlets. This is a unique feature added by the government of Rajasthan to promote healthcare awareness in women.
Rashtriya Swasthya Bima Yojana
Categorized as a family floater health insurance policy, this is a government sponsored health insurance policy for people living under the poverty line. The policy has a very low premium and no age limit to enroll. The sum insured is up to INR 3 lakh.
Apart from the regular benefits offered by the government in their health insurance policies, the Rashtriya Swasthya Bima Yojana takes a few steps ahead by incorporating dental care, daycare treatments, transportation expenses, maternity benefits and newborn coverage alongside pre and post hospitalization cover.
Central Government Health Scheme (CGHS)
The Central Government Health Scheme was launched in 1954 and primarily caters to officials working with the central government such as supreme court judges and central railway officials. The policy also includes pensioners.
The policy aims to provide hospitalization and domiciliary care including medication from allopathy as well as homeopathy. This scheme also provides free X-ray and laboratory examination facilities to central government officials.
The Central Government Health Scheme has 35 lakh beneficiaries and is active in 71 cities presently.
Universal Health Insurance Scheme (UHIS)
Another one of the central government’s flagship health insurance schemes, the Universal Health Insurance Scheme is curated to cater a wide range of people living below the poverty line and just above the poverty line. The policy includes hospitalization coverage and also maternity coverage.
The policy largely covers medical treatment costs as well as accident coverage to the primary income earner of the family. In cases of death due to an accident, the family will receive the insurance amount.
West Bengal Health Scheme
West Bengal has been commended many times for its prioritization of bettering public health infrastructure. In this regard, taking the West Bengal health scheme could be a life-saver. However, this can only be availed by people in All India Services or pensioners.
This scheme provides treatment costs for at least 1014 medical ailments including OPD treatments. The key features of the policy include cashless claims, reimbursements for treatments in non-empanelled hospitals, OPD treatment coverages, and out of hospitalization charges coverage.
Registration and enrollment for the policy can also be done online on the official portal of West Bengal Health Scheme.
Yeshasvini Health Insurance Scheme
Considering the plight of farmers, lower income and middle income groups in the state of Karnataka, the state government along with development co-operatives sponsor the Yeshasvini Health Insurance Scheme. This policy is meant to provide high quality yet affordable care in Karnataka.
The sum insured for policyholders is INR 5 lakh along with an added advantage of cashless claims at network hospitals. The scheme also includes claim benefits for 1,650 diseases and one can also get discounts on certain diagnostic or treatment costs.
Karunya Health Scheme
The Karunya Health Scheme focuses on providing healthcare access for people of Kerala facing critical illness. People of the lower income groups can avail this policy to get medical facilities for chronic ailments including cancer, cardiovascular issues and palliative care amongst many.
The sum insured for the Karunya Health Scheme is INR 5 lakh per family. The coverage includes expenditures for diagnostic care, consultations, pre and post hospitalization charges, and intensive care treatments.
AWAZ Health Insurance Scheme
Another one of the Government of Kerala’s brainchild, the AWAZ health insurance scheme focuses on providing insurance for migrant workers.
Migrant workers living in the state of Kerala and between the age of 18-60 can avail this policy. Each policyholder can avail free medical care of up to Rs. 15,000/- in government hospitals across the state. The scheme also includes health impacts due to accidents for the migrant workers.
Telangana State Government Employees and Journalists Health Scheme
A unique insurance policy curated by the Telangana state government is the EJHS or Employees and Journalists Health Scheme. The policy, as the name suggests, promotes healthcare and welfare for its professionals including journalists and their families. The policy entitles them to avail cashless hospitalization coverage across network hospitals in the state.
The benefits include in-patient and out-patient treatment, hospital stay, as well as follow up services. The coverage in the policy does not have any upper limit.
Employment State Insurance Scheme
One of the oldest health insurance policies formulated by the government of India, the Employment State Insurance Scheme provides coverage for working professionals. Usually, a company with more than 10 employees should register itself for the ESI scheme.
This scheme includes a wide range of health-related contingencies and also offers pension options to the family in cases of death or disablement due to occupational hazards. The policy includes coverage for sickness, maternity, disability, unemployment, funeral costs, and old age medical care amongst others.
Dr YSR Aarogyasri Health Care Trust
An initiative by the government of Andhra Pradesh, the Dr YSR Aarogyasri Health Care Trust insures the people of the state who fall in lower economic strata. This health care insurance includes a variety of benefits including maternity coverage, rehabilitation services, cashless claims, as well as continuity of care from diagnosis to post treatment care.
The policy has a strong focus on preventive measures of healthcare which includes free health check-ups and screenings for certain ailments. The policy also covers treatments for numerous chronic diseases including chemotherapy, radiation therapy and dialysis.
Chief Minister’s Comprehensive Insurance Scheme
The Chief Minister’s Comprehensive Insurance Scheme is doing wonders in its home state of Tamil Nadu with almost 65% of the population of the state enrolled under this scheme. Low income families can now opt for this scheme and avail the full range of medical facilities with benefits.
The sum insured to the families is Rs. 5 lakhs per year. The policy opens doors to a huge number of network hospitals. Empanelled hospitals also conduct free health check up camps often and policyholders have a dedicated 24 by 7 helpline to get support if needed.
Rajiv Aarogyasri Community Health Insurance Scheme (RACHI)
One of the most popular government health insurance schemes, the Rajiv Aarogyasri Community Health Insurance Scheme (RACHI) was launched by the government of Andhra Pradesh using a unique and innovative social approach.
The policy works on a private-public partnership to ensure economically backward people also receive quality healthcare services without any hassles. The people living below poverty line and possessing a ration card are automatically enrolled in this scheme.
The list of network hospitals also includes private hospitals along with government hospitals. The premium price is moderately low. There are more than 900 medical procedures that are covered under this policy.
Features And Benefits of Government Health Insurance Plans
Government health insurance plans are mostly curated with special considerations for the economically and socially backward people. For them, taking a government health insurance plan can offer many benefits apart from heavy financial liabilities related to treatments.
Let’s recap the features and benefits of government health insurance plans:
Features & Benefits:
- Easy Access to Government Hospitals: The government of India is constantly working to improve and expand public health infrastructure. Policyholders can quickly reach out for treatments.
- Premiums: Many times, the government health insurance policies do not include any insurance premium. All of that is funded by the state. This further reduces the burden on people living in poverty.
- Holistic Care: Policies have been developed by the government ensuring that holistic care, from diagnostic expenses to post medical care charges are covered by insurance policies.
- National and local Relevance: Many policies are formed by state governments by keeping in mind the local infrastructure and requirements of the people. This makes
Bottom Line
One of the major priorities of governments is to ensure its citizens can avail high quality and accessible healthcare. In a developing country like India with a huge population unable to afford costly medical treatments, the government of India is curating health care policies on the basis of local and national requirements.
It is important to know about these policies to access affordable healthcare as well as educate other people for whom this could be a life-saving wonder that also saves them from financial burdens.
