Government Health Insurance Schemes in India

Top 5 Government Health Insurance Schemes

The top 5 health insurance schemes offered by the Government are explained below:

1. Aam Aadmi Bima Yojana (AABY): This scheme was launched on 2nd October 2007 and is a social security scheme that offers group insurance cover to people belonging to specific groups. Under this scheme, an individual gets coverage against accidental/ natural death and partial /permanent disabilities.

Key Features of the Scheme

The key features of Aam Aadmi Bima Yojana (AABY) is as follows:

• The entry age to avail this scheme is minimum 18 years and maximum 59 years.
• Insurance coverage offered under the scheme includes accidental death, natural death, partial/permanent disability, caused due to an accident.
• Lump sum coverage amount is paid if any claim arises.
• An add-on benefit is offered under this scheme as scholarship to the policyholder’s children.
• The amount of coverage is fixed and it depends upon the contingencies suffered.

2. Central Government Health Scheme: This scheme is specifically designed to offer comprehensive health coverage to the employees of central government and their dependent family members living in areas covered under CGHS. The medical facilities are offered through Ayurveda, Yoga, Sidha, Unani, Allopathic and homeopathic systems of medicine.

Key Features of the Scheme

The key features of Central Government Health Scheme is as follows:

• All central government employees are eligible to avail CGHS, who get paid from Central Civil Estimates (except Delhi administration and railways) along with their dependents, who are living in the areas covered under CGHS.
• Cashless facility can be availed under network hospitals and diagnostic centres.
• Family healthcare services and maternity child health are covered under this scheme.
• Domiciliary care and dispensary services are covered.
• Beneficiaries under the scheme are entitled to receive health education.

3. Pradhanmantri Surakhsha Bima Yojana: It is an accident insurance scheme backed by the government that provides coverage against accidental death, partial disability and permanent disability. This scheme was specifically launched to offer personal accident insurance to individuals who fall under the high risk category like labourers, mechanics, truck drivers, etc.It is a very affordable insurance cover with annual premium of Rs 12 (excluding service tax).

Key Features of the Scheme

The key features of Pradhanmantri Surakhsha Bima Yojana is as follows:

• This scheme can be availed by individuals aged between 18 to 70 years and they should have a bank account.
• Under this scheme, the insured gets an accidental death cover that can be renewed on an yearly basis.
• The nominee of the insured gets Rs 2 Lakh cover in case of death/ total disability/ partial disability due to an accident.
• The payable premium gets automatically debited from the bank account of the insured.
• The insured gets an option to avail the scheme for long term or get it renewed each year.

4. Chief Minister's Comprehensive Health Insurance Scheme: This scheme offers health insurance benefits to people belonging to financially weaker sections of the society in Tamil Nadu. All the beneficiaries are allowed to avail cashless medical and surgical treatment from private and public sector hospitals. Under this scheme, coverage includes healthcare expenses incurred due to critical illnesses, ailments, additional diagnostic procedures, follow-up treatment, etc.

Key Features of the Scheme

The key features of Chief Minister's Comprehensive Health Insurance Scheme is as follows:

• Households that are eligible to avail benefits under this scheme should not earn an yearly income of more than Rs. 72,000.
• Under this scheme, the sum assured for each beneficiary household is Rs 1 Lakh per year for a duration of four years.Therefore, total sum assured towards the end of this duration is Rs. 4 Lakh.
• There are under 250 network hospitals that provide their services to beneficiaries enrolled under this scheme.
• The beneficiary would get a biometric enabled identity card and in order to avail the coverage and benefits offered under the plan, he/she needs to produce the same at a network hospital, wherein they are seeking treatment.
• This scheme covers 1016 treatment procedures including 113 follow up procedures and 23 diagnostic procedures.

5. Universal Health Insurance Schemes: This scheme was launched by the Ministry of Health and Family Welfare in 2003 across the nation to cover healthcare expenses of the financially weaker section of the society. The key objective of this scheme is to provide access to free healthcare facilities, specifically to poor sections of the society. Other than this, it also offers benefits like personal accident insurance to the main breadwinner of the family and offers compensation to the family members in the event of their death.

Key Features of the Scheme

The key features of Universal Health Insurance Schemes is as follows:

• Universal Health Insurance Schemes can be availed by both individuals as well as groups.
• The scheme would be under the name of the main earning person of the family and the names of the rest of the family members would be contained in the scheme.
• In case it is a group plan, then it would be in the group’s name, institution or association. The plan would contain the member's name and their family.
• Under a group health insurance plan, the members cannot constitute a part of various group health schemes.
• Maximum claim expenses are limited to Rs. 15,000 after excluding maternity expenses.