The Government of India has implemented various health insurance schemes over the years. The aim is to provide financial coverage and access to healthcare services for its citizens. Introducing some of the notable health insurance schemes initiated by the Government of India:
Government Health Insurance Schemes in India – Pradhan Mantri Jan Arogya Yojana (PM-JAY) – upto 5 Lakh Per Family
Also known as Ayushman Bharat or the National Health Protection Scheme, PM-JAY is a government-funded health insurance scheme. It aims to provide health coverage to economically vulnerable families. Under this scheme, eligible beneficiaries can avail cashless treatment for specified secondary and tertiary medical procedures at empaneled hospitals. The coverage extends to pre-existing diseases from the date of enrollment.
PM-JAY is implemented by the National Health Authority (NHA) at the national level. State Health Agencies (SHA) at the state level are responsible for the implementation and management of the scheme.
Rashtriya Swasthya Bima Yojana (RSBY) – up to ₹30,000 per family
RSBY is one of the significant government health insurance schemes in India targeted towards below-poverty-line (BPL) families. It provides cashless health insurance coverage to BPL households, providing financial protection against various medical expenses, including hospitalization costs, surgeries, diagnostics, and follow-up treatments. RSBY is implemented at the state level, with state governments coordinating and managing the scheme’s operations. State Health Agencies (SHA) are responsible for empaneling healthcare providers and ensuring the smooth functioning of the scheme.
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Central Government Health Scheme (CGHS):
CGHS is a comprehensive health care scheme for central government employees and pensioners. It provides access to medical facilities, including outpatient, inpatient, and diagnostic services, through empaneled government and private hospitals. CGHS aims to promote preventive healthcare, provide access to specialized treatments, and reduce out-of-pocket medical expenses. Eligible dependents include spouse, children, and dependent parents.
Employees’ State Insurance Scheme (ESIC):
ESIC is a social security scheme for employees working in certain sectors, including factories and establishments with a specified number of employees. It provides health insurance coverage for employees and their dependents, offering cashless medical treatment and benefits such as sickness, maternity, and disablement benefits.
Under the current ESIC scheme, individuals earning above Rs.21,000 per month are not eligible for coverage. However, for individuals with disabilities, the maximum monthly wage limit is set at Rs.25,000.
Aam Aadmi Bima Yojana (AABY):
AABY aims to provide social security and financial support to workers in the unorganized sector and their dependents in case of accidental death or disability. The scheme intends to offer a safety net to vulnerable individuals and ensure their financial well-being during unforeseen circumstances. The scheme covers individuals between 18 to 59 years of age, belonging to the below-poverty-line (BPL) category. The spouse and children between 5 to 25 years of age are also covered under AABY. In the event of accidental death, a lump sum amount is paid to the nominee.
In case of permanent disability due to an accident, a specified amount is provided as compensation. Partial disability due to an accident entitles the insured individual to receive a partial compensation amount. Funeral expenses are covered under the scheme in case of the insured’s demise.
National Rural Health Mission (NRHM):
The National Rural Health Mission (NRHM) is a flagship program launched by the Government of India to address the healthcare needs of rural areas and improve the overall health indicators of the rural population. NRHM focuses on key areas such as maternal and child health, reproductive health, immunization, prevention and control of communicable diseases, and non-communicable diseases. It emphasizes the provision of essential healthcare services, including antenatal care, institutional deliveries, immunization, and access to primary healthcare facilities.
These government health insurance schemes in India have been implemented to promote health equity, improve access to healthcare, and provide financial protection to vulnerable populations. The specific eligibility criteria, coverage, and benefits vary for each scheme. It’s advisable to refer to the official websites or relevant government sources for detailed information on these schemes.
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