Top Government Health Insurance Schemes in India

Much before the pandemic came into the scenario and started pointing out (indecently) the poor healthcare conditions of the global population, Governments all across the world were already brainstorming ideas to craft accessible healthcare services. The Indian government was no exception. And yet, they were failing.

So many insurance penetration initiatives from the IRDAI and increased promotion on how health insurances are actually a life-saver, and still, more than half of the population stayed vulnerable and exposed to the imminent and unavoidable future financial burden of medical expenses. Here are a few responsible candidates -

• The limited reach of health insurance to the remote areas of the country.
• Lack of awareness regarding health insurance policies and the long-term financial security that it brings.
• A belief that health insurances are expensive, and since a majority of the population fall below the poverty line, the insurance policies are not affordable for them.

So, in the act of “extending an olive branch,” the Indian Government and its state counterparts now offer the citizens a bundle of Government Health Insurance Schemes. Such schemes are intended to make health insurance an affordable affair while offering adequate funds to help meet healthcare expenses.

What is a Government Health Insurance Scheme?

A Government Health Insurance Scheme, just like the name suggests, is a health insurance policy extended by the Central or the State Government of India.

Why are Health Insurance policies required?

The rising cost of medical services, medication, and health checkups is a genuine concern. Add to this the availability of premium healthcare at high-end charges owing to cutting-edge medical advancements, and you know why the chances or probability of an ailment is a psychological and financial scare. In case one is diagnosed with a prevalent chronic ailment, they are looking at a substantial bite out of their life’s savings that may lead to a serious financial crunch, one that will be tough to overcome.

So, to shield your savings, have access to considerable funding to meet your medical expenses, enjoy tax benefits under Section 80D, have access to free annual health checkups, gain the perks of a No-Claim Bonus, and enjoy the perks of

• Daycare treatment and Domiciliary treatment coverage,
• No disease-wise sub-limits
• No room rent restrictions,
• Pre-and post-hospitalization coverage
• No copayment requirement
• Unlimited restoration benefits
• Maternity coverage
• AYUSH treatment coverage
• Senior Citizen medical savings

-health insurance policies are no longer an option nor an investment but a necessity to ensure a secured financial net for preventive healthcare service.

Why are Government Health Insurance policies required?

Rural India is yet to reap the benefits of proper healthcare services. One of the major reasons being that high-quality medical care facilities are still inaccessible in these areas. Also, when it comes to people living below the poverty line, affording such medical care is an impossible financial burden. So, they are forced to either

• choose a cheap medical alternative that has very low remedial capabilities, or
• Opt for a premium quality health care service at the expense of their savings.

To reverse such critical financial and/or medical risks being taken, the Government (both at the Central and State level) offers health insurance schemes that are intended to arrange adequate funds to meet healthcare requirements. This helps policyholders reap the benefits of quality healthcare treatments and procedures sans digging deep into one’s pocket.

Now, doesn’t Government Health Insurance Scheme sound just like the best Health Insurance Plans of 2023 from the best insurers in the market? Are they really the same? What are the differences (if any)? Let’s check it out!

What is the difference between Health Insurance Plans and Government Health Insurance Schemes?

What are the top Government Health Insurance Schemes available in India?

Government health insurance schemes are gaining rapid popularity across the nation, especially among the ones below the poverty line. As the State and Central governments launch and back such insurance schemes, the population across the nation starts losing track of the numerous schemes that they can bank on.

Here’s a list of some of the best Government Health Insurance schemes in India (6 Central Government Schemes and 9 schemes backed by different State Governments in India) -

CENTRAL GOVERNMENT SCHEMES

1. The Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PM-JAY)

• Definition: This Government mediclaim policy is designed to meet the medical expenditure requirements for the bottom 40% of the population (in regards to the income of the family and individuals).
• Coverage, Features & Benefits: The funding offered is capped at INR 5 lakhs and covers 3 days of hospitalization charges and 15 days of post-hospitalization charges. The plan offers to fund all pre-existing ailments and demands no waiting period. Policyholders can enjoy the perks of cashless treatment at network hospitals and additional coverage for ICU charges, doctor’s fees, prescription medicines, and more. The annual premium for this policy is INR 30.

2. The Employees' State Insurance Scheme (ESI)

• Definition: The ESI scheme is crafted for workers across diverse factories in India whose monthly wages are capped at INR 21,000 (and INR 25,000 for workers with disabilities). The funding offered is expected to help out the workers in meeting their medical expenses incurred during the treatment of any accidents and/or occupational hazards.
• Coverage, Features & Benefits: The plan usually calls for an equal part payment towards the premium of the plan by the employer and the employee (except in the case of workers earning less than INR 137/day, in which case the employer pays the entire premium). The plan is extended to the employee and his/her family and offers a sickness benefit of up to 91 days/year and an extended sickness benefit of up to 2 years in the case of malignant or long-term ailments. This govt health insurance also offers a disablement benefit, a 26-week maternity benefit, and a dependents’ benefit due to workplace hazards.

3. The Pradhan Mantri Suraksha Bima Yojana (PMSBY)

• Definition: In an effort to boost insurance penetration in India, this plan was introduced by the Central Government and targeted to offer funds to its policyholders in the case of accidental disability and/or death.
• Coverage, Features & Benefits: The plan offers a sum insured of INR 2 lakhs in the case of accidental complete disability or death and INR 1 lakh in the case of partial disability. All that the policyholder needs is their Aadhar Card and a bank account from where the premium for Pradhan Mantri Suraksha Bima Yojana (PMSBY) will be automatically deducted.

4. The Rashtriya Swasthya Bima Yojana (RSBY)

• Definition: This Government Health Insurance Scheme was designed for individuals working in unorganized sectors across India.
  *Coverage, Features & Benefits: The plan offers INR 30k for workers and their families that cover the expenses involved in hospitalization, treatment of pre-existing ailments, and transportation expenses (capped at INR 1k). At a premium of INR 30/year, the plan offers cashless benefits too.

5. Janani Suraksha Yojana

• Definition: Much like its private counterpart, the Maternity Health Insurance Policy, the Janani Suraksha Yojana is targeted to ensure healthy pregnancy treatments for both mothers and newborns. The targeted policyholder, in this case, is the expecting women who are economically disabled and need the funding to undergo a healthy delivery of quality healthcare services.
• Coverage, Features & Benefits: This plan’s coverage envelops funding required for the delivery process as well as post-delivery care assistance. The policyholders get completely free treatment in Government medical facilities along with some cash assistance (for the Low Performing States: INR 2000 or INR 700 and for the High Performing States: INR 1200 or INR 600, based on whether they are located in the rural areas or the urban ones).

6. Universal Health Insurance Scheme (UHIS)

• Definition: This is the government version of a family floater health insurance plan that offers medical coverage for the entire family, specifically the ones considered economically disabled.
• Coverage, Features & Benefits: This government mediclaim policy is one that funds the medical expenses for the entire family up to INR 30k. This funding caters to the expenses incurred in cases of doctor’s consultation fees, hospitalization, maternity, room rent, and medical supplies. The policy also offers a cover of up to INR 25k for accidental death.

STATE GOVERNMENT SCHEMES

1. The Mahatma Jyotiba Phule Jan Arogya Yojana (MAHARASHTRA)

• Definition: A health insurance policy extended by the Maharashtra government body to those living below the poverty line. The cashless benefit of this plan can be availed by any and all less privileged populations (families included) -Those with an Annapurna ration card, Antyodaya Anna Yojana ration card, and a yellow, orange, or red ration cardholder
  The residents of governmental Mahila Ashrams and Senior Citizen Homes
  The children living in government orphanages
• Coverage, Features & Benefits: The plan extends its coverage to the entire family of the policyholder. It offers a sum insured of INR 2.5 lakhs in case of renal transplants and INR 1.5 lakhs for hospitalization expenses.

2. The Bhamashah Swasthya Bima Yojana (RAJASTHAN)

• Definition: The plan is intended for the rural population of Rajasthan and the beneficiaries under the National Food Security Act and the Rashtriya Swasthya Bima Yojana.
• Coverage, Features & Benefits: Extended by the Government of Rajasthan, it is a comprehensive health insurance plan bringing a host of features and perks to the table of the policyholders - pre and post-hospitalization coverage for 7 and 15 days, respectively; sum insured of INR 3 lakhs for critical ailments; coverage of INR 30k for general illnesses; cashless treatment options; and OPD treatment coverage.

3. Chief Minister’s Comprehensive Insurance Scheme (TAMIL NADU)

• Definition: Launched by the Tamil Nadu Government in association with United India Insurance Company Ltd., the Chief Minister’s Comprehensive Insurance Scheme is a family floater health insurance policy that is offered to individuals with an annual income of less than INR 75,000.
• Coverage, Features & Benefits: Under this policy, individuals can claim up to INR 5 lakhs for their hospitalization expenses and can opt to get treated in either private or public healthcare facilities. This government health insurance scheme offers to fund 1000+ medical procedures.

4. West Bengal Health Scheme (WEST BENGAL)

• Definition: Launched in 2008, this Government mediclaim plan is offered to government employees and pensioners to meet the financial strain caused by any and all medical treatments.
• Coverage, Features & Benefits: The West Bengal Health Scheme can be an individual and family floater policy depending on the choices made by the policyholder. The sum insured offered under this policy is capped at INR 1 lakh, which also offers coverage for OPD treatments and medical surgeries.

5. Yeshasvini Health Insurance Scheme (KARNATAKA)

• Definition: In an effort to boost health and wellness across the state of Karnataka, the state government launched the Yeshasvini Health Insurance Scheme, intended specifically for peasants and farmers. This helps them safeguard their life savings and yet be able to have access to quality healthcare services.
• Coverage, Features & Benefits: This policy can be availed by any individual under 75 years of age and offers funding for 823 surgical procedures across its close to 600 network hospitals.

6. Mukhyamantri Amrutam Yojana (GUJARAT)

• Definition: This family floater health insurance policy offers a policyholder the chance to avail of medical treatments across trust-based, public, and private hospitals sans any worries of financial hassle and burden.
• Coverage, Features & Benefits: The sum insured under this policy goes up to INR 3 lakhs and caters to the medical requirements of the poor and lower middle sections of society.

7. Karunya Health Scheme (KERALA)

• Definition: Karunya Health Scheme is a Critical Illness Health Insurance cover offered by the state government of Kerala for the economically backward population (annual income < INR 3 lakhs).
• Coverage, Features & Benefits: To aid those suffering from critical ailments (cancer, kidney ailments, hemophilia, respiratory diseases, palliative care, cardio ailments, transplant surgeries, liver surgeries, brain surgeries, and more), the government extends adequate coverage of INR 5 lakhs to fund their medical treatments. This coverage caters to their secondary and tertiary hospitalization care. Under this policy, the policyholders can claim hospitalization charges, surgical charges, ICU room rents, medicines charges, crucial diagnostics tests, and doctor’s fees. Potential policyholders need to keep in handy their medical history, Aadhar Card, and Income Certificate.

8. Dr YSR Aarogyasri Health Care Trust (ANDHRA PRADESH)

• Definition: launched by the Andhra Pradesh government, along with the Dr YSR Aarogyasri Trust, 4 different health insurance schemes were launched
  Arogya Raksha scheme - for those above the poverty line.
  Dr YSR Aarogyasri scheme - for those below the poverty line.
  Employee Health Scheme - for the state government employees.
  Working Journalist Health Scheme - for the funding of selected medical procedures
• Coverage, Features & Benefits: Available both as Individual Health Insurance Policies and as family floater plans, this government health insurance scheme offers coverage of INR 5 lakhs/annum for the family. This funding can be utilized for hospitalization expenses, cashless treatments for 30 days after discharge for those undergoing therapy, treatment of pre-existing ailments, post-hospitalization treatment coverage for 20 days, follow-up treatments, and checkups. It also offers outpatient care for its policyholders at government hospitals and health camps.

9. Telangana State Government Employees and Journalists Health Scheme (TELANGANA)

• Definition: In an attempt to extend premium healthcare services to government employees and the state’s journalists, the Telangana State Government Employees and Journalists Health Scheme was launched.
• Coverage, Features & Benefits: For the retired, current, and pensioners of the state government, the plan offers substantial funding to meet their medical requirements. This prevents the policyholders from banking on their savings for their emergency medical requirements. There is no upper limit to the offered sum insured, and no contributions need to be made by either the pensioners or the employees.

A Quick Overview of the Top Government Health Insurance Schemes

Frequently Asked Questions: