Overview

State Employees Health Insurance Scheme (SEHIS) is Jharkhand's cashless health insurance scheme for state government employees, pensioners, MLAs, advocates, and their eligible dependents. While the name sounds generic, SEHIS is specific to Jharkhand and is managed through the official SEHIS portal.

  • Coverage: Cashless treatment at empanelled hospitals with health cover of up to ₹10 lakh for eligible claims, supported by the insurer and the Jharkhand State Arogya Society (JSAS) corpus fund.
  • Contribution: Serving employees contribute ₹500 per month, while Category B beneficiaries pay ₹6,000 annually.
  • Access: Category A beneficiaries are enrolled automatically, while others can register, add dependents, and manage their benefits through the official SEHIS Jharkhand portal.

If you're a Jharkhand government employee, pensioner, MLA, or advocate, understanding your health benefits under the State Employees Health Insurance Scheme (SEHIS) can help you plan your medical expenses better. While the scheme provides cashless treatment at empanelled hospitals, the coverage structure, beneficiary categories, and contribution rules can be confusing.

This guide covers what the State Employees Health Insurance Scheme (SEHIS) is, who is eligible, the benefits and coverage it offers, how to enroll and make claims, and whether you should consider private health insurance alongside it.

Need help deciding whether SEHIS alone is enough? Book a free call or chat with a Ditto advisor on WhatsApp.

What Is the State Employees Health Insurance Scheme (SEHIS)?

The State Employees Health Insurance Scheme (SEHIS) is Jharkhand's cashless health insurance scheme for serving and retired state government employees, MLAs, advocates, and their eligible dependents. It provides cashless treatment at 1,000 empanelled hospitals, including 250 hospitals within Jharkhand, with health cover of up to ₹10 lakh for eligible claims. The scheme currently covers over 6.17 lakh beneficiaries, including 1.67 lakh primary members and 4.50 lakh dependents.

Unlike fully government-funded health schemes, SEHIS follows a contributory model. Serving employees contribute ₹500 per month (₹6,000 annually) through salary deductions, while eligible Category B beneficiaries pay the same amount annually through the official SEHIS portal.

The scheme is funded through a combination of the insurer's annual premium and the JSAS Corpus Fund. While the insurer's premium is around ₹4,850 per family per year, the remaining contribution is credited to the corpus fund to support eligible claims beyond the insurer's standard sum insured.

Note: Although several states have similar employee health insurance schemes, SEHIS in this article refers specifically to Jharkhand's State Employees Health Insurance Scheme.

SEHIS Eligibility: Category A, B, and C Beneficiaries

The State Employees Health Insurance Scheme (SEHIS) classifies beneficiaries into three categories based on their employment status and eligibility.

1) Category A (Mandatory)

Category A includes all serving Jharkhand state government employees and sitting MLAs. Enrollment under the scheme is mandatory, and beneficiaries are automatically covered through their respective departments.

2) Category B (Optional)

Category B is an optional, self-funded category. Eligible beneficiaries can enroll by paying ₹6,000 annually through the official SEHIS portal. This category includes:

    • Retired Jharkhand state government employees
    • Family pensioners
    • Former MLAs
    • Serving or retired All India Services (AIS) officers who opt in
    • Regular employees of state boards, corporations, and government institutions
    • Teaching and non-teaching staff of state universities and constituent colleges

3) Category C

Category C covers advocates registered under the Jharkhand Advocate Welfare Fund Trustee Committee.

Note: The January 2026 amendment restructured the State Employees Health Insurance Scheme (SEHIS) framework, shifting sitting and former MLAs, ministers, and their families to Category B so they can receive healthcare access on par with IAS and IPS officers. Meanwhile, Category A remains the mandatory, premium-based tier for current serving employees of the Jharkhand government.

Who Can Be Covered as Dependents?

Eligible beneficiaries can also add the following dependents under SEHIS:

    • Spouse
    • Sons (including legally adopted sons) up to 25 years of age, provided they are unemployed
    • Unmarried, widowed, or divorced daughters
    • Minor brothers and unmarried sisters
    • Dependent parents (for pensioners, only if the parent's pension is below ₹9,000 per month plus dearness relief).
    • Disabled dependents, who remain eligible regardless of age.

Note:

    • Women employees can include either their parents or their parents-in-law, but not both.
    • If both spouses are Jharkhand government employees, they cannot list each other as dependents.
    • Children can be covered under only one parent's SEHIS policy.
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Benefits: ₹5 Lakh to ₹10 Lakh Cover Under SEHIS

The State Employees Health Insurance Scheme (SEHIS) offers cashless treatment at empanelled hospitals across Jharkhand and selected hospitals outside the state. The scheme follows a two-tier coverage structure to provide financial protection against hospitalization expenses.

Coverage Under SEHIS

    • Up to ₹5 Lakh: Covers hospitalization expenses for general illnesses and medical treatments.
    • Up to ₹10 Lakh: For 25 eligible critical illnesses, beneficiaries can receive enhanced coverage through a combination of the insurer's payout and the JSAS Corpus Fund, subject to the scheme's terms and conditions.

What's Covered?

SEHIS provides cashless treatment at empanelled hospitals for a wide range of medical needs. The scheme generally covers:

    • Hospitalization expenses
    • Surgeries and major medical procedures
    • Treatment for serious and critical illnesses
    • Emergency hospitalization
    • Other approved treatments covered under the scheme

The exact list of covered procedures, critical illnesses, treatment packages, and applicable limits may be updated by the Jharkhand government from time to time. Before planning treatment, beneficiaries should check the latest guidelines on the official SEHIS portal or consult their department.

Note: If the cost of an eligible treatment exceeds the insurer's standard sum insured, additional financial assistance may be available through the JSAS Corpus Fund, subject to the scheme's terms, conditions, and approvals.

How to Enroll on the SEHIS Portal?

Category A beneficiaries, including serving state government employees and sitting MLAs, are enrolled automatically through their respective departments. Once the monthly salary deduction is initiated, there's usually no separate application required apart from verifying and updating dependent details.

Category B and Category C beneficiaries must register through the official SEHIS portal. Before starting the application, keep the following documents ready:

    • Aadhaar of the applicant and eligible dependents
    • Service ID, GPF/CPF/PRAN, PPO, or Employee ID (as applicable)
    • Passport-size photographs
    • Documents proving the age and relationship of dependents

Steps to Register on the SEHIS Portal

  1. Visit the official SEHIS portal and create an account using your name, email address, mobile number, and a password.
  2. Log in and select a new application.
  3. Choose your beneficiary category (A, B, or C) and enter your employee or pension details. The portal will automatically fetch your basic information where applicable.
  4. Complete the application by filling in any remaining details.
  5. Add eligible dependents by providing their Aadhaar details, photographs, and supporting documents.
  6. Submit the application. Category B beneficiaries must also pay the annual contribution through the portal's payment gateway.

After submission, the application is forwarded to the concerned Drawing and Disbursing Officer (DDO) or approving authority for verification. Once approved, you can download your SEHIS cashless health card from the portal and use it to avail cashless treatment at empaneled hospitals.

Note: If you face technical issues during registration or data retrieval, you can raise a grievance through the SEHIS portal or contact the official toll-free helpline at 1800-3455-027.

SEHIS vs. Private Health Insurance: Do You Need Extra Cover?

The State Employees Health Insurance Scheme (SEHIS) provides cashless treatment and health cover of up to ₹10 lakh, making it a valuable safety net. However, it covers only a defined list of dependents and may not be enough for high-cost treatments or families needing higher coverage.

Since SEHIS is a government-sponsored scheme, its benefits and coverage are fixed and cannot be tailored to individual healthcare needs.

Ditto's Take: If you need coverage beyond ₹10 lakh or want to insure family members who aren't eligible under SEHIS, consider buying a private health insurance policy. It doesn't replace SEHIS. Instead, it complements your existing cover by providing higher coverage and broader protection.

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Conclusion

SEHIS is a valuable health insurance scheme that helps reduce the financial burden of medical emergencies for Jharkhand's government employees, pensioners, MLAs, advocates, and their eligible dependents. With cashless treatment at empanelled hospitals and coverage of up to ₹10 lakh, it offers meaningful financial support for a wide range of medical expenses.

Before relying solely on the scheme, review your healthcare needs and check whether its coverage limit and dependent eligibility are sufficient for your family. If you identify any gaps, adding a private health insurance plan can provide broader protection and greater peace of mind.

Frequently Asked Questions

What is the State Employees Health Insurance Scheme (SEHIS) and which state runs it?

The State Employees Health Insurance Scheme (SEHIS) is Jharkhand's cashless health insurance scheme for state government employees, pensioners, MLAs, advocates, and their eligible dependents. It offers cashless treatment at empanelled hospitals and health cover of up to ₹10 lakh for eligible claims.

Who is eligible for SEHIS as a Category A, B, or C beneficiary?

SEHIS covers serving state government employees and sitting MLAs under Category A, retired employees and other eligible groups under Category B, and registered advocates under Category C. Eligible family members can also be included as dependents, subject to the scheme's eligibility rules.

How much health cover does SEHIS provide for critical illness?

SEHIS provides up to ₹5 lakh for general hospitalization and up to ₹10 lakh for 25 eligible critical illnesses. The enhanced coverage is supported through a combination of the insurer's payout and the JSAS Corpus Fund, subject to the scheme's terms and conditions.

How do you enroll for SEHIS online in Jharkhand?

Category A beneficiaries are enrolled automatically through their departments. Category B and C beneficiaries must register on the official SEHIS portal, submit the required documents, add eligible dependents, and complete the application. Category B applicants must also pay the annual contribution online.

Are family members covered under a Jharkhand government employee's SEHIS policy?

Yes. SEHIS allows beneficiaries to add eligible dependents, including a spouse, eligible children, dependent parents, minor siblings, and disabled dependents. Coverage is subject to age, dependency, and relationship conditions prescribed under the scheme.

Do Jharkhand government employees still need private health insurance with SEHIS?

SEHIS provides comprehensive financial protection, but some families may still benefit from a private health insurance policy. It can provide higher coverage and protect family members who aren't eligible under the scheme.

Can retired Jharkhand government employees use SEHIS?

Yes. Retired Jharkhand state government employees and family pensioners can enrol under Category B by paying ₹6,000 annually through the official SEHIS portal. Once enrolled, they can access cashless treatment and other benefits available under the scheme.

Who is the insurer and TPA for SEHIS?

Tata AIG General Insurance Company Limited is the insurer for the State Employees Health Insurance Scheme (SEHIS) in Jharkhand. It provides cashless health coverage at empanelled hospitals under the scheme. MDIndia Health Insurance TPA (Third-Party Administrator) manages beneficiary services, including cashless claim processing, health card downloads, claim status tracking, and hospital-related support. For eligible high-value claims that exceed the insurer's sum insured, additional financial assistance may be available through the JSAS Corpus Fund, subject to the scheme's terms and conditions.

How do you make a claim under SEHIS?

SEHIS is primarily a cashless health insurance scheme. For planned treatment, visit an empanelled hospital and present your SEHIS health card. The hospital will obtain pre-authorization from the Third-Party Administrator (TPA), MDIndia, and, once approved, eligible treatment will be provided without cash payment. In emergencies, the hospital can initiate the cashless claim during admission. If cashless treatment isn't available, you can pay the expenses and submit a reimbursement claim with the required documents. You can track your claim through the MDIndia SEHIS portal/app or by calling the toll-free helpline at 1800-3455-027.

What happens to your SEHIS coverage when you retire?

Your SEHIS coverage can continue after retirement, but your beneficiary category changes. While you're employed, you're covered under Category A, with a ₹500 monthly contribution deducted from your salary. After retirement, you can continue your coverage under Category B by paying the ₹6,000 annual contribution through the official SEHIS portal. Unlike many employer-sponsored health insurance plans that end after retirement, SEHIS allows eligible retirees and family pensioners to continue receiving benefits. To avoid any coverage gap, check the latest enrollment and renewal guidelines on the SEHIS portal or with your department before you retire.

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