Government Health Insurance Schemes in India 2024

 

Government health insurance schemes in India provide affordable healthcare services to millions of citizens. These schemes aim to ensure access to quality healthcare facilities and services for all individuals, especially those belonging to economically disadvantaged sections of society. 

 

What are Government Health Insurance Plans?

Government health insurance plans refer to medical insurance plans that are sponsored and supported by the government, whether at the central or state level. Recognizing the challenges in healthcare access and health insurance coverage, especially in rural areas, governments have taken the initiative to launch and endorse various health insurance policies to cater to the diverse healthcare needs of the population.

 

Top 10 Government Health Insurance Schemes

Here are the top 10 government health insurance schemes that include Ayushman Bharat Yojana (ABY),  Pradhan Mantri Suraksha Bima Yojana (PMSBY), Aam Aadmi Bima Yojana (AABY), etc, with its coverage amount, and eligibility criteria to apply.

 

Scheme Name	Coverage Amount	Eligibility
Ayushman Bharat Yojana (ABY)	Up to Rs. 5 lakh per family per year	Below poverty line (BPL) families as identified by Socio-Economic Caste Census (SECC) data, or any other state-specific SECC equivalent data.
Pradhan Mantri Suraksha Bima Yojana (PMSBY)	Rs. 2 lakh for accidental death and total disability, Rs. 1 lakh for partial disability	Age 18-70 years with an active bank account and linked RuPay debit card.
Aam Aadmi Bima Yojana (AABY)	Rs. 75,000 for accidental death, Rs. 37,500 for permanent partial disability, Rs. 75,000 for permanent total disability, Rs. 30,000 for natural death	Head of the family/earning member aged 18-59 years
Central Government Health Scheme	Varies depending on treatment and hospital	Central government employees and pensioners and their dependents
Employment State Insurance Scheme	Up to Rs. 2.5 lakh per year	Employees earning up to Rs. 21,000 per month
Janshree Bima Yojana (JBY)	Rs. 1 lakh for accidental death, Rs. 25,000 for partial disability, Rs. 50,000 for total disability	Below-poverty line (BPL) families in rural areas
Chief Minister’s Comprehensive Insurance Scheme	Varies depending on the state	Varies depending on the state. Usually BPL families or specific categories.
Universal Health Insurance Scheme	Varies depending on the state	Varies depending on the state.
West Bengal Health Scheme	Up to Rs. 5 lakh per family per year	Families identified under SECC data or other state-specific data.
Yeshasvini Health Insurance Scheme	Up to Rs. 2 lakh per family per year	Below poverty line (BPL) families and economically weaker sections

 

1. Ayushman Bharat Yojana

Ayushman Bharat Yojana, initiated by the Ministry of Health and Family Welfare, Government of India, stands as a comprehensive universal health insurance scheme. Launched with the primary objective of extending free healthcare services to over 40% of the nation's population, this initiative, also known as Pradhan Mantri Jan Arogya Yojana (PMJAY).

The core feature of Ayushman Bharat Yojana is its provision of a substantial health cover amounting to Rs 5 lakh. It covers medical expenses such as medicines, diagnostic procedures, medical treatments, and pre-hospitalization costs. 

 

2. Pradhan Mantri Suraksha Bima Yojana

Pradhan Mantri Suraksha Bima Yojana is a government-sponsored initiative with the primary objective of offering accident insurance coverage to the citizens of India. This scheme is designed to provide financial protection in the event of accidental injuries or fatalities. It is accessible to individuals falling within the age group of 18 to 70 years, who hold an active bank account.

Under this policy, beneficiaries are eligible for an annual insurance cover of Rs 2 lakh for total disability and death, and Rs 1 lakh for partial disability. A different feature of Pradhan Mantri Suraksha Bima Yojana is its convenient premium payment structure. The policyholder's bank account is linked to the scheme, and the premium is automatically debited, simplifying the process for individuals and ensuring the continuity of coverage. 

 

3. Aam Aadmi Bima Yojana (AABY)

Aam Aadmi Bima Yojana (AABY), introduced in October 2007, stands as one of the latest National Health Insurance schemes in India. Specifically, to cater to the needs of individuals aged between 18 and 59 years, this insurance initiative is particularly targeted at residents residing in rural and upcountry areas. However, it extends its coverage to include landless citizens, covering both urban and rural tenants.

A key aspect of Aam Aadmi Bima Yojana is its wider approach, not only focusing on health insurance but also incorporating the provision of scholarships for underprivileged children. The primary beneficiary under this scheme is the head of the family or the primary earner, thereby ensuring financial protection for the key contributors to households in these regions.

The financial structure of the scheme involves a nominal premium of 200 rupees per annum, with an equal contribution from both the state and central governments. In the unfortunate event of natural death, the family is eligible for a compensation of 30,000 rupees. In cases where death results from permanent disability, the compensation is higher, amounting to 75,000 rupees. 

 

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4. Central Government Health Scheme (CGHS)

Established in 1954, the Central Government Health Scheme (CGHS) has started an initiative that offers comprehensive healthcare services to central government officials and pensioners residing in select cities across India. Operational in urban centers such as Kolkata, Mumbai, Lucknow, Delhi, Nagpur, and Pune, this scheme plays a crucial role in ensuring the well-being of its beneficiaries.

Eligibility under CGHS requires individuals to be residents of India, and the scheme operates through a National Health Company Online Renewal program, incorporating the added benefit of health education for its beneficiaries.

The scheme covers all dispensary-related services, including domiciliary care. Importantly, beneficiaries are eligible for hospitalization each time they fall ill. The scheme further provides free X-ray and laboratory examinations, relieving individuals of the financial burden associated with diagnostic procedures.

One of the main advantages of the CGHS is its provision of free specialist consultations, both at the hospital level and in dispensaries. This ensures that beneficiaries have access to expert medical advice without incurring additional costs, enhancing the overall quality of healthcare provided under the scheme.

 

5. Employment State Insurance Scheme

The Employment State Insurance Scheme is a comprehensive National Health insurance initiative, offering a multidimensional approach by providing both social security and socio-economic protection to all workers across India. This scheme not only protects the well-being of the covered workers but also extends its privileges to their dependents.

Commencing from the first day of insurable employment, the scheme offers full medical care insurance not only for the workers themselves but also for their families. This inclusive coverage aims to address the healthcare needs of the entire household, ensuring a holistic approach to health security.

Beyond medical care, the scheme provides a range of cash benefits for the covered workers. These benefits provide financial support during periods of physical distress, including sickness or disability, whether temporary or permanent. Additionally, women who lose the capacity to earn and dependents of individuals injured in occupational accidents are eligible for monthly pensions, known as dependents' benefits.

 

6. Janshree Bima Yojana

Janshree Bima Yojana is a targeted welfare program \for individuals in the economically disadvantaged category, specifically those aged between 18 and 59 years. This initiative incorporates different features, including provisions for Women Self-Help Group (SHG) members and the Shiksha Sahyog Yojana, offering a comprehensive approach to social and financial inclusion. As of now, the scheme covers a total of 45 occupational groups.

The primary aim of Janshree Bima Yojana is to extend financial security to those who fall within the low-income demographic. By focusing on a wide age range, the scheme addresses the vulnerability of individuals in economically challenging circumstances, offering them protection through insurance coverage. The inclusion of Women in SHG Groups recognizes the role of women in economic activities and aims to empower them financially. 

 

7. Chief Minister’s Comprehensive Insurance Scheme

The Chief Minister’s Comprehensive Insurance Scheme, a flagship initiative of the Tamil Nadu state government, was established in collaboration with the United India Insurance Company Ltd. Functioning as a family floater policy, this scheme was launched to ensure high-quality healthcare services to the people of Tamil Nadu. 

Under this policy, beneficiaries are eligible to claim hospitalization expenses up to Rs 5 lakh, thereby providing financial protection during medical emergencies. A different feature of this scheme is its flexibility, allowing beneficiaries to choose from a network of both private and government hospitals, enhancing accessibility to healthcare services.

Eligibility for enrollment in the Chief Minister’s Comprehensive Insurance Scheme is based on the annual income criterion, specifically targeting Tamil Nadu residents with an income of less than Rs 75,000 per year. This targeted approach ensures that the scheme effectively reaches those in need and provides financial relief to economically vulnerable segments of the population.

 

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8. Universal Health Insurance Scheme (UHIS)

The Universal Health Insurance Scheme (UHIS) stands as a crucial initiative aimed at assisting families living below the poverty line. This comprehensive scheme extends coverage to cover the medical expenses incurred by every member of such families. Additionally, in the unfortunate event of a death resulting from an accident, the scheme provides a specified cover.

When a family member requires hospitalization, the UHIS may facilitate medical expenses up to 30,000 rupees, offering an important financial lifeline during times of health crises. Hence, if the earning head of the family is admitted to the hospital, the scheme provides compensation of 50 rupees per day for a maximum of 15 days, addressing the potential loss of income during the hospitalization period.

 

9. West Bengal Health Scheme

The West Bengal Health Scheme, introduced by the Government of West Bengal in 2008, is a significant health insurance initiative catering to its employees and pensioners. Designed to ensure the well-being of the state's workforce and retirees, this scheme offers coverage on both an individual and family floater basis, with a sum insured limit of Rs 1 lakh.

The policy covers a range of healthcare provisions, covering both Out-Patient Department (OPD) treatments and medical surgeries, subject to the terms and conditions mentioned in the policy. This inclusive coverage seeks to address the diverse healthcare needs of beneficiaries, providing financial support for a wide array of medical expenses.

 

10. Yeshasvini Health Insurance Scheme

The Yeshasvini Health Insurance Scheme, started by the Karnataka State Government, is a targeted initiative aimed at providing essential healthcare coverage for peasants and farmers affiliated with cooperative societies. Launched with the primary objective of ensuring the health and well-being of those engaged in agriculture, this scheme has proven to be an important source of financial protection and medical assistance.

The Yeshasvini Health Insurance Scheme is characterized by its expansive coverage, incorporating over 800 medical procedures ranging from Neurology and Orthopaedics to Angioplasty. This broad coverage ensures that beneficiaries have access to a comprehensive range of healthcare services, addressing a diverse range of medical needs.

 

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Benefits of Government Health Insurance Schemes

There are so many benefits of government health insurance plans such as helping to pay for medical costs, giving access to healthcare services, supporting everyone, and promoting preventive care.

• Helps Pay for Medical Costs: The government helps pay for your medical expenses. So, if you get sick or need to see a doctor, you don't have to worry too much about the money.

• Accessible Healthcare: These schemes make it easier for everyone to get medical help. You can go to hospitals or clinics without stressing too much about how to pay for it.

• Supports Everyone: These plans are for everyone, especially those who might not afford private health insurance. It ensures that everyone, regardless of their financial situation, can access basic health services.

• Prevents Financial Strain: When you have health insurance from the government, you won't have to use all your savings if you get sick. It helps to avoid a big financial burden on you and your family.

• Promotes Preventive Care: These plans often encourage people to get regular check-ups and preventive care. It's like stopping health problems before they become big issues.

 

Regular Health Insurance Plans vs Government Health Insurance Scheme

There are so many differences between regular best health insurance plans and government health insurance schemes. So, we have compared both in the below table.

 

Features	Basic Health Insurance	Government Health Insurance Scheme
Eligibility	Available to all sections of society	Available to lower-income groups only
Sum Insured	Maximum sum insured of up to Rs 1 crore	Maximum sum insured of up to Rs 5 lakh
Premium	Rs 200 per month onwards (depending on the plan)	Rs 100 per month onwards or fully paid by the government(depending on the plan)
Coverage	Offers a broader coverage	Offers a narrow coverage
Private Hospital Room	Available(depending on the plan)	May or may not be available
Policy Purchase	The policy can be purchased instantly	Policy purchase may take time
Network Hospitals	Wide network of empanelled private hospitals	A large number of public and private network hospitals
Maternity Benefits	Available(depending on the plan)	Available(Only for a single child in some cases)
Ambulance Charges	Available under most plans	Available under a few plans
Domiciliary Hospitalization Cover	Available(depending on the plan)	Not available
Online Renewal	Can be renewed online	May or may not be renewed online
Cumulative Bonus	Available if no claim was filed in the previous policy year	Not available
Health Check-up	Covered under some plans	Not covered
Monthly Premium Instalment Facility	Available under some plans	Not available
Tax Benefits	Available under the Income Tax Act 1961	Not available

 

Conclusion

In conclusion, government health insurance schemes play a crucial role in providing access to affordable and quality healthcare for the population. These schemes have proven to be effective in reducing the financial burden on individuals and increasing the overall health outcomes of the country. By ensuring that everyone has equal access to healthcare services, government health insurance plans contribute to reducing health disparities and promoting social equity.  If you want an expert opinion to buy the best health insurance plans, do not forget to contact okbima expert.

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FAQs

What is health insurance by Modi govt?

Health insurance by the Modi government refers to the insurance coverage provided to individuals by the administration under various schemes and programs to ensure access to healthcare services and financial protection against medical expenses.

 

What is PM Modi's 5 lakh health insurance?

PM Modi's 5 lakh health insurance is a government program that provides medical coverage up to Rs. 5 lakh for eligible individuals in India.

 

Which is the government-free health insurance in India?

The government-funded health insurance scheme in India is called Ayushman Bharat, providing free medical coverage to over 500 million vulnerable citizens.

 

What is the government life insurance scheme in India?

The government life insurance scheme in India is a welfare program designed to provide affordable life insurance coverage to its citizens, ensuring financial security and support for their families in the event of an untimely death.

 

How can I get government health insurance in India?

To obtain government health insurance in India, individuals may need to apply through specific government schemes such as the Pradhan Mantri Jan Arogya Yojana (PMJAY) or the Rashtriya Swasthya Bima Yojana (RSBY).

 

How to apply Central Government Health Scheme?

To apply for the Central Government Health Scheme, individuals can visit the official website and follow the step-by-step instructions provided for registration and enrollment.

 

What is the purpose of launching government health insurance schemes?

Public health insurance schemes were implemented by the Indian government to enhance the well-being of its citizens. These initiatives aim to enable individuals to access medical insurance benefits at an affordable price.

 

Is there any eligibility criterion to buy public health insurance schemes?

The requirements for eligibility differ among different health plans. It is advisable to review the documentation needed for each scheme to make a well-informed choice.

 

Are there any limitations in the Government Health Insurance Schemes?

Typically, cosmetic procedures are not included in Government insurance coverage. However, the specific exclusions and exceptions may differ among different plans. It is recommended to compare various medical schemes and carefully review the policy documents to understand what is not covered as well as the benefits provided by the policy.

 

Can you buy Government health insurance schemes online in India?

While some Government medical schemes in India offer the convenience of online purchases, not all of them can be availed through this method. Additionally, certain schemes also provide the option of a direct bank debit facility.

 

What is the sum insured in the case of Government medical insurance schemes?

Different health insurance schemes offer varying coverage benefits, resulting in no fixed sum insured amount. Generally, the policy coverage amount is relatively lower compared to that offered by private insurance companies.

 

Is PMJAY & Ayushman Bharat Yojana the same?

Both Ayushman Bharat Yojana and PM-JAY share similar objectives, and they were introduced by the Government of Narendra Modi. This initiative offers health insurance coverage of Rs 5 Lakhs for a nominal premium of only Rs 30.

 

Why does the Government come up with public health insurance schemes?

The government comes up with public health insurance schemes to ensure that all citizens have access to affordable and comprehensive healthcare services.

 

Can anyone buy Government Health Insurance Plans?

Yes, anyone who meets the eligibility criteria can purchase Government Health Insurance Plans.

 

Are all Government schemes initiated by the Central Government?

No, not all government schemes are initiated by the Central Government.

 

Do I qualify for government health insurance?

To determine if you qualify for government health insurance, it is best to consult the specific eligibility criteria set by the relevant government authorities.

 

What is a national health insurance scheme?

The national health insurance scheme in India is a government initiative aimed at providing affordable and accessible healthcare services to all citizens of the country.

 

What is a state health insurance scheme?

The state health insurance scheme in India provides affordable and accessible healthcare coverage to individuals and families, ensuring that they have access to quality medical services.

 

What is a state health insurance program?

The state health insurance program in India, also known as Ayushman Bharat, aims to provide affordable and accessible healthcare coverage to millions of low-income individuals and families across the country.

 

What are the functions of a national health insurance scheme?

The functions of the National Health Insurance Scheme in India include providing affordable and accessible healthcare services to all citizens, promoting financial protection against high medical expenses, and ensuring equitable distribution of healthcare resources.

 

What are the benefits of a national health insurance scheme?

The national health insurance scheme in India provides numerous benefits such as increased access to healthcare services, financial protection against high medical expenses, and improved health outcomes for the population.