Governments work tirelessly to ensure good quality healthcare, including government health insurance, is accessible to their citizens. Healthcare is an essential pillar of any society, and authorities continuously implement welfare measures to support their people. These measures include spreading awareness about medical issues, enhancing healthcare infrastructure, and promoting health insurance schemes.
In India, the government has introduced several health insurance schemes to make healthcare affordable and accessible for all, especially for underprivileged and economically weaker sections of society. This article delves into 14 government health insurance schemes in India, their features, benefits, and eligibility criteria.
A Government Health Insurance Scheme is a program powered by either the Central or State Government, designed to offer affordable and adequate healthcare coverage. These schemes typically provide annual health coverage and cater to specific sections of society, such as individuals below the poverty line (BPL), government employees, farmers, and others.
Such policies are invaluable for people who cannot afford private health insurance. Let’s explore the major government health insurance schemes in India.
|
Features |
Basic Health Insurance |
Government Health Insurance Scheme |
|
Sum Insured |
Coverage can go up to Rs 1 crore |
Coverage can reach up to Rs 5 lakh |
|
Eligibility |
Accessible to everyone across different segments of society |
Exclusively available for low-income groups |
|
Premium |
Starts at Rs 200 per month (based on the chosen plan) |
Starts at Rs 100 per month or fully funded by the government (based on the plan) |
|
Private Hospital Room |
Accessible depending on the selected plan |
Availability may vary |
|
Policy Purchase |
Purchase policy instantly |
Policy purchase process may take longer |
|
Network Hospitals |
A large network of private hospitals included |
Extensive network of both public and private hospitals |
|
Maternity Benefits |
Accessible based on the plan selected |
Available (limited to one child in certain cases) |
|
Ambulance Charges |
Included in most plans |
Available in specific plans |
|
Domiciliary Hospitalisation |
Available depending on the chosen plan |
Not available |
|
Online Renewal |
Option to renew online |
Renewal may or may not be possible online |
|
Cumulative Bonus |
Offered if no claims were made in the previous policy year |
Not available |
|
Health Check-up |
Included in select plans |
Not covered |
|
Monthly Premium Instalment |
Offered in certain plans |
Not available |
|
Tax Benefits |
Eligible for benefits under the Income Tax Act 1961 |
Not available |
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Launched under the Ministry of Health and Family Welfare, Ayushman Bharat Yojana, also known as Pradhan Mantri Jan Arogya Yojana (PMJAY), is the world’s largest health assurance scheme. It provides free healthcare services to over 40% of India’s population.
Key Features:
Offers a health cover of up to ₹5 lakh per family per year.
Covers pre-hospitalisation, diagnostic, treatment, and post-hospitalisation expenses.
Beneficiaries can avail of cashless treatment at empanelled public and private hospitals.
This scheme ensures that the poorest families in India receive top-notch medical care without financial stress.
The Pradhan Mantri Suraksha Bima Yojana aims to provide accident insurance for individuals aged 18 to 70 years with a bank account.
Coverage Details:
₹2 lakh for accidental death or total disability.
₹1 lakh for partial disability.
The policy has a minimal annual premium, which is automatically debited from the policyholder’s bank account.
Established in 2007, the Aam Aadmi Bima Yojana focuses on rural and economically weaker populations, particularly landless households.
Key Highlights:
Covers individuals aged 18 to 59 years.
Annual premium of ₹200, shared equally by the Central and State Governments.
Offers compensation of ₹30,000 for natural deaths and ₹75,000 for accidental deaths or permanent disabilities.
Provides scholarships for children of insured members.
This scheme protects the breadwinners of low-income families, ensuring financial security in times of crisis.
This government health insurance was introduced in 1954, and the Central Government Health Scheme (CGHS) is designed for central government employees and pensioners residing in specific cities.
Key Benefits:
Comprehensive healthcare services, including domiciliary care.
Free consultations with specialists at hospitals and dispensaries.
Coverage for X-rays, laboratory tests, and hospitalisation expenses.
This scheme is highly beneficial for central government employees and their families.
The Employees’ State Insurance Scheme is a multifaceted program offering medical and social security benefits to workers employed in factories and organisations with more than 10 employees.
Key Features:
Full medical care for insured workers and their families.
Cash benefits during physical distress, such as sickness or disability.
Monthly pensions for dependents in case of work-related injuries.
The scheme also extends to employees in specific sectors, such as restaurants, shops, and motor transport businesses employing over 20 workers.
This scheme is targeted at low-income individuals aged 18 to 59 years. It provides insurance coverage under 45 occupational groups.
Special Features:
Focuses on women's Self-Help Groups (SHGs).
Includes educational scholarships for children of insured members.
Janshree Bima Yojana promotes financial security for workers in the unorganised sector.
This Tamil Nadu state government scheme, in collaboration with United India Insurance Company Ltd., offers health insurance to low-income families.
Highlights:
Coverage of up to ₹5 lakh per family.
Access to over 1,000 medical procedures in government and private hospitals.
Available for families with an annual income below ₹75,000.
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This government health insurance is designed for families below the poverty line. UHIS provides comprehensive health coverage.
Key Benefits:
Covers hospitalisation expenses up to ₹30,000 per family member.
Daily allowance of ₹50 for up to 15 days during hospitalisation of the primary earner.
Compensation for accidental deaths of the family’s breadwinner.
This scheme was introduced in 2008 for West Bengal government employees and pensioners.
Features:
Individual and family floater coverage up to ₹1 lakh.
Includes OPD treatments and surgeries.
Promoted by the Karnataka Government, this scheme benefits farmers and peasants associated with cooperative societies.
Coverage:
Includes over 800 medical procedures.
Beneficiaries can seek treatment at network hospitals.
Launched by the Maharashtra Government, this scheme benefits farmers and BPL families.
Features:
₹1.5 lakh family health cover for specified illnesses.
No waiting period for claims.
This Gujarat state scheme supports poor families with a health cover of ₹3 lakh.
Key Details:
Provides treatment in private, government, and trust-run hospitals.
Covers critical illnesses and surgeries.
Initiated by the Kerala Government, this scheme targets individuals below the poverty line suffering from chronic illnesses.
Coverage:
Treatment for diseases like cancer, cardiovascular issues, and kidney ailments.
This scheme offers cashless treatment for employees, pensioners, and journalists.
Features:
Beneficiaries can seek treatment in registered hospitals without financial stress.
Affordable Premiums: Tailored for low-income groups.
Wide Coverage: Includes treatments in private and government hospitals.
Financial Security: Ensures no out-of-pocket expenses for healthcare emergencies.
Social Welfare: Promotes better health and well-being among economically weaker sections.
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The Government health insurance schemes in India are a testament to the country’s commitment to ensuring quality healthcare for its citizens. By providing affordable and comprehensive health coverage, these schemes uplift millions of lives, especially the underprivileged.
If you’re eligible for any of these schemes, enrolling could be a significant step towards safeguarding your family’s health and financial security. Explore the options and secure a healthier future!
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