National Health Insurance Schemes by Indian Government

National Health Portal is a government of India initiative that serves as a single point of access to receive legitimate health information for every Indian citizen. The portal has been set up by the Indian Government with the support of the Health and Family Welfare Ministry as well as the National Knowledge Commission.  The portal offers information on multiple plans of national insurance schemes in India to serve specific needs of different people.

In this post, we will discuss some national insurance schemes and their details.

National Health Insurance Schemes in India

Below are some important National Health Policy Schemes offered by the Indian government:

Plan Name	Key Highlights
Rashtriya Swasthiya Bima Yojana (RSBY)	– Portable – Safe and secure – Cashless and paperless transaction – Included public hospitals – Better coverage
Employees’ State Insurance Scheme (ESIS)	– Plan applies to small non-seasonal business employing over 10 people – Scheme extends to other businesses employing over 20 people, such as shops, hotels, other establishments – Scheme also covers private medical institutes in some states/UTs
Central Government Health Scheme (CGHS)	– Allow domiciliary care within the dispensary services – Offer specialist consultancy services – Include laboratory examinations – Hospitalization – Beneficiary higher education
Aam Aadmi Bima Yojana (AABY)	– Compensation of INR 30,000 is offered to nominee in case of natural death – Compensation of INR 75,000 is offered to nominee in case of accidental death/permanent disability – Add-on advantage of children scholarship is available under the scheme
Janashree Bima Yojana (JBY)	– Janashree Bima Yojana has been merged with Aam Aadmi Bima Yojana and has been made one scheme
Universal Health Insurance Scheme (UHIS)	– Cover families living below poverty line – Cover medical cost of every family member – Insurance cover is offered for nominees of people dying in accidents – Covered by four public sector general insurance companies – Offer medical expenses up to INR 30,000 in case of hospitalization
Ayushman Bharat Yojana	– Scheme offers a health cover of Rs 5 lakh – covers medicines, diagnostic expenses, medical treatment, and pre-hospitalization costs – Poor families of India can benefit from this healthcare scheme

 

7 National Insurance Schemes and Their Details:

1. Rashtriya Swasthiya Bima Yojana (RSBY)

RSBY, an initiative of the Ministry of Labour and Employment, Government of India, was introduced to offer health insurance facilities to families living Below Poverty Line (BPL). The scheme was introduced with the objective of protecting the BPL families from monetary liability arising because of health emergencies that require hospitalization.

Under the RSBY scheme, nominees are entitled to receive a coverage of up to INR 30,000 in case the individual is hospitalized due to ailments and other reasons like accidents. In many hospitals, the government has set treatment package costs for numerous interventions.

The RSBY national health policy has no age limit and it covers pre-existing health conditions from day one. The coverage is extended to 5 family members including the head earning member of the family, his/her spouse, and three dependents. The plan is available with a registration fee of INR 30, while the government pays the premium on behalf of the insured to the insurer.

2. Employees’ State Insurance Scheme (ESIS)

ESIS plan is designed to offer social and economic security to workers (industrial workers) and their dependents in India. This plan is regarded as a social security system, which is customized to enable the industrial working class of hazardous occupations with different benefits including medical care for the insured individuals and their dependents.

Further, the plan allows many cash benefits during medical emergencies causing disability and loss of income options. Also, the program allows a monthly pension to the nominee of the insured in case of disability and death of the person due to industrial accidents.

3. Central Government Health Scheme (CGHS)

Under the CGHS plan, the central government employees as well as pensioners are offered comprehensive healthcare facilities. The plan also extends to the dependents of the policyholders. The scheme was introduced in 1954 in New Delhi by the Central Government and is now operational in most of the States/UTs in India. The healthcare facilities under this scheme are provided via wellness centers and polyclinics under various medical systems such as  Allopathic, Homeopathic, Unani,  Ayurveda, Sidha etc.

4. Aam Aadmi Bima Yojana (AABY)

The AABY is a program initiated to give social security to the landless households in rural India. The scheme was introduced on 2nd October, 2007 and it covers the earning head in the family. Under this scheme, a premium of INR 200 is equally shared by both central and state governments on a per person and per annum basis. The eligibility age of the insured should be between 18 to 59 years.

5. Janashree Bima Yojana (JBY)

The JBY plan was introduced on August 10, 2000 to replace the Social Security Group Insurance Scheme (SSGIS) and Rural Group Life Insurance Scheme (RGLIS). The plan covers almost 45 different occupational groups within this scheme and offers life insurance to BPL families as well as families that are marginally above the poverty line. Individuals between the age group of 18 to 59 years coming under the 45 occupational groups are eligible under this plan for coverage.

You may also like to note that effective from January 1,2013 the Aam Admi Bima Yojana and Janashree Bima Yojana have been merged into one scheme and renamed as Aam Admi Bima Yojana.

6. Universal Health Insurance Scheme (UHIS)

The UHIS plan is offered by four major government run general insurers aiming at improving the healthcare access to poor families. Under the scheme, the insured individuals receive reimbursement of healthcare expenses for up to INR30,000 in case of hospitalization. The coverage, under this scheme, floats amongst all members of the family. If there is an accidental death, the family is offered INR25,000, while in case of loss of income due to disability, a compensation INR 50/- per day for a duration of 15 days is offered.

The scheme was redesigned to cater to the BPL families only. The subsidy of premium under the policy has been enhanced from:

INR 100 to INR 200 – individual

INR 300  –  5 member family

INR 400 – 7 member family

7. Ayushman Bharat Yojana

Ayushman Bharat is a flagship program of the Ministry of Health and Family Welfare, Government of India. This national health care scheme was introduced to realize the government’s vision of offering Universal Health Coverage (UHC) to every Indian. The plan allows a comprehensive and need-based  healthcare facility with a health cover of INR 5 Lakh. It involves two main components, Pradhan Mantri Jan Arogya Yojana (PM-JAY) and Health and Wellness Centres (HWCs)

The scheme covers medicines, diagnostic expenses, medical treatment, and pre-hospitalization costs to help poor families.

There is not much difference between the public and private insurance schemes. In case of government healthcare, the treatment is done typically in a government hospital. In case of private health insurance, the treatment is provided in private hospitals. Below are some differences between public and private health insurance schemes in India.

Regular Health Insurance Plans vs. National Health Plans  

Here are some points of difference between government and private health insurance schemes:

Features	Government Plan	Regular plan
Eligibility	Available to lower-income people only	Available to everyone alike
Premium	Minimal premium or fully paid by the government(depending on the plan)	Premium is charged as per the plan selected
Network Hospitals	Offer a large number of public as well as private hospitals	A wide network of private hospitals
Sum Insured	Maximum sum insured can go up to INR 5 lakh	Maximum sum insured can be up to INR 1 Crore
Coverage	Allow narrow coverage	Allow greater coverage
Private Hospital Room	May or may not be available	Available (depends on plan)
Ambulance Charges	Available under a few plans	Available under most plans
Maternity Benefits	Available (Only for a single child under some cases)	Available (as per plan)
Policy Purchase	Policy purchase may take time	Policy can be purchased instantly
Tax Benefits	Not available	Available
Online Renewal	May or may not be renewed online	Can be renewed online
Monthly Premium Installment Facility	Not available	Available under some plans
Health Check-up	Not available	Covered under some plans
Domiciliary Hospitalization Cover	Not available	Available (depends on the plan)
Cumulative Bonus	Not available	Available on every claim-free year