This blog post delves into a crucial aspect of India’s healthcare landscape – government health insurance schemes. In a nation as diverse and dynamic as India, ensuring accessible and affordable healthcare remains a monumental challenge. Various government health insurance schemes in India, launched by the state as well as the central governments, have emerged as powerful tools in addressing this challenge, aiming to provide financial protection and medical support to millions across the country.
Join us as we explore the intricacies, impact, and significance of these schemes in transforming the healthcare paradigm of India, ultimately working towards a healthier and more secure future for its citizens.
What does the term “government health insurance scheme” mean?
A government health insurance scheme refers to a program established and operated by a governmental body to provide citizens with healthcare coverage. These schemes aim to ensure that individuals can receive medical treatment and services without facing excessive financial burdens.
Typically, the beneficiaries are entitled to various healthcare services, such as doctor visits, hospital stays, prescription medications, and preventive care. Government health insurance schemes play a crucial role in promoting universal healthcare access, especially for those who might not have access to private insurance options. Such initiatives vary widely in scope, design, and eligibility criteria, often reflecting the priorities and resources of the governing administration.
How do Government Health Insurance Schemes Differ from Private Health Insurance Schemes?
Government and private health insurance schemes differ in various ways, including their sources of funding, coverage options, eligibility criteria, costs, and management. Here are some key differences between these two kinds of health insurance schemes:
1. Source of Funding
Government Health Insurance Schemes: These are funded by the government through taxpayer contributions.
Private Health Insurance Schemes: These are funded by individuals or organisations who purchase insurance plans.
2. Coverage Options
Government Health Insurance Schemes: These schemes often aim to provide basic healthcare coverage, essential medications, and preventive care to a broader population, especially those who may not be able to afford private insurance.
Private Health Insurance Schemes: They often offer a range of plans with different levels of coverage, including more comprehensive options and access to a wider range of medical services.
3. Eligibility Criteria
Government Health Insurance Schemes: Eligibility for government schemes is often determined by factors such as income level, employment status, age, and other demographic criteria. These schemes may prioritise vulnerable populations and those without access to private insurance.
Private Health Insurance Schemes: Eligibility for private insurance is generally open to anyone willing to pay the premiums, regardless of income or employment status. Some plans may have certain medical underwriting or restrictions based on pre-existing conditions.
Government Health Insurance Schemes: The costs of government schemes are often subsidised to a bare minimum by the government, making them accessible to the lower-income group.
Private Health Insurance Schemes: The costs of private insurance are higher due to the broader range of services covered and the involvement of private companies.
What are the benefits offered by Government Health Insurance Schemes?
The benefits can vary depending on the specific health insurance scheme, but here are some common advantages:
- Universal Access: Offers healthcare coverage to a vast population, ensuring everyone can access medical services.
- Financial Protection: Guards individuals against high medical costs by covering a significant portion of expenses.
- Preventive Services: Emphasises early detection and prevention through regular check-ups and screenings.
- Improved Outcomes: Ensuring timely medical attention leads to better health outcomes.
- Choice of Providers: Allows individuals to select healthcare providers they trust.
- Equal Access: Reduces disparities by providing equitable healthcare for all citizens.
- Support for Vulnerable: Addresses healthcare needs of the elderly, children, and low-income groups.
- Emergency Coverage: Provides coverage for emergencies and catastrophic events.
Top 20 Government Health Insurance Schemes in India
India’s 20 prominent government health insurance schemes revolutionising healthcare accessibility and affordability:
1. Aam Aadmi Bima Yojana (AABY)
Aam Aadmi Bima Yojana (AABY) was launched in 2007. Under this scheme, the head of the family or the earning member is covered against accidental death and disability. The scheme also provides coverage for natural death at a reduced premium rate.
The insured person is covered for INR 30,000 in case of natural death, INR 75,000 in case of accidental death, Rs. 37,500 for permanent partial disability, and Rs. 75,000 in case of permanent total disability that occurred due to an accident.
2. Central Government Health Scheme (CGHS)
The Central Government Health Scheme (CGHS) is a comprehensive health care scheme for registered employees and pensioners of the Central Government of India and dependent family members living in CGHS-covered areas. Launched in 1954, CGHS aims to provide quality medical services at affordable rates. The premium for serving government employees and pensioners varies depending on their pay grade.
Under this scheme, eligible individuals can avail of medical facilities through empanelled government and private hospitals. The scheme ensures cashless treatment for beneficiaries. CGHS also provides access to specialist consultations and advanced medical treatments.
3. Awaz Health Insurance Scheme
This is a state-specific health insurance programme that the Government of Kerala introduced. For migrant labourers employed in Kerala, the programme offers health insurance coverage. The Awaz Health Insurance programme gives hospitalisation coverage and protection from accidental death and disability to employees.
The coverage is offered for workers between the ages of 18 and 60. The coverage cap is INR 15,000 for hospitalisation bills, INR 1 lakh for accidental permanent disability, and INR 2 lakhs for accidental death.
4. Ayushman Bharat Yojana
The Pradhan Mantri Jan Arogya Yojana (PMJAY), sometimes called Ayushman Bharat Yojana, is a prominent healthcare insurance scheme introduced by the Indian government. Due to this ambitious programme, over 50 crore economically challenged people nationwide will receive health care.
Ayushman Bharat enables eligible individuals to obtain high-quality healthcare by providing health insurance coverage of up to Rs. 5 lakhs per family each year. This initiative focuses on providing cashless and paperless treatment for various ailments, including critical illnesses and surgeries. The number of family members that may be covered under the plan is unrestricted, and the coverage is provided on a family floater basis.
5. Bhamashah Swasthya Bima Yojana
Bhamashah Swasthya Bima Yojana is a healthcare scheme initiated by the Government of Rajasthan in India. Anyone who is a citizen of Rajasthan and is signed up for the National Food Security Scheme and the National Health Insurance Scheme is eligible for Bhamashah Swasthya Bima Yojana, especially those from economically disadvantaged groups.
Cashless treatments require a Bhamashah Card to be used. The policy offers up to INR 30,000 in coverage for minor illnesses and serious conditions, up to INR 3 lakhs. Pre- and post-hospitalisation costs are also covered for 7 and 15 days, respectively.
6. Employees’ State Insurance (ESI) Scheme
In India, there is a scheme for social security and health insurance called the Employees’ State Insurance (ESI) Scheme. Employees employed in factories, facilities, and companies with ten or more employees are covered by this scheme, which is run by the Employees’ State Insurance Corporation (ESIC). The ESI Scheme offers fully covered medical treatment and financial benefits to insured people and their families.
Per this plan, employers and employees pay a portion of their salaries into the ESI Fund. Employees are covered or entitled to ESI benefits if their monthly income is less than Rs. 21,000. The employee’s contribution to the ESI plan is 1.75% of their pay, and the employer’s contribution is 4.75%. Employers will still contribute to employees whose daily average pay is less than Rs. 50 even though they are excused from making contributions to the ESI fund. The insured are eligible for medical care, hospitalisation, maternity benefits, disability benefits, and monetary unemployment compensation.
7. Chief Minister’s Comprehensive Insurance Scheme
The Government of Tamil Nadu has introduced the State-specific health insurance scheme known as the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS). The programme is an indemnity health insurance plan that pays for the insured beneficiaries’ actual medical expenses. The policy covers hospital costs up to INR 1.5 lakhs and expenses related to certain illnesses up to INR 1.5 lakhs.
The applicant, spouse, dependent children, and dependent parents are all covered under the family floater option of the plan. The scheme is open to anyone living in Tamil Nadu and earning less than INR 72,000 annually. Orphans, migrant workers, and Sri Lankan refugees are also eligible for coverage under this policy.
8. Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)
This is another state-specific health insurance scheme that is available in Maharashtra known as Mahatma Jyotiba Phule Jan Arogya Yojana. The scheme covers families in Maharashtra’s 36 districts below and above the poverty line.
Hospitalisation coverage of INR 1.5 lakhs is permitted per family on a family floater basis. A total of 971 surgeries/operations/therapies and 121 follow-up procedures are covered by this government health insurance scheme.
Families residing in any Maharashtra state who have a yellow Ration Card, an Annapurna Card, an orange Ration Card, or an Antyodaya Anna Yojana Card, as well as farmers from 14 designated districts who have a white Ration Card, are eligible for coverage under this scheme.
9. Pradhan Mantri Suraksha Bima Yojana
The Pradhan Mantri Suraksha Bima Yojana initiative is open to all Indian citizens between the ages of 18 and 70 with a bank account. The insurance covers accidental death, total and permanent blindness in both eyes, loss of both hands and legs or loss of one eye and a limb.
It also provides benefits for total disability up to Rs. 2 lakhs and for partial impairment up to Rs. 1 lakh. This plan’s annual premium of Rs. 12 is deducted from the bank account using the “auto-debit” feature.
10. Mukhyamantri Amrutum Yojana
For the welfare of the state’s poor population, the Government of Gujrat introduced the Mukhyamantri Amrutum Yojana in 2012. Families in the lower middle class and those below the poverty line are eligible for this insurance. This scheme offers Rs. 3 lakh family floater coverage for the entire year.
11. Rashtriya Swasthya Bima Yojana
One of India’s numerous government health initiatives introduced by the Ministry of Labour and Employment is the Rashtriya Swasthya Bima Yojana. This Yojana provides medical protection against health emergencies to labourers and other people working in unorganised industries who often live in poverty and are usually not protected by any insurance plan. Their family, up to a limit of five members, is also covered under this scheme. The insurance policy has a Rs. 30,000 limit. Additionally, this scheme has no upper age limit for enrollment.
12. Universal Health Insurance Scheme
One of India’s most affordable and appreciated government health insurance programs is the Universal Health Insurance Scheme (UHIS). The Universal Health Insurance Scheme, introduced nationally in July 2003, aims to provide healthcare to the most underprivileged groups. The programme, introduced as a component of the ministry’s Universal Health Assurance Mission (UHAM), is available to families below and above the poverty line (BPL and APL).
The poorest of the poor, between the ages of 5 and 70, are eligible to use this programme. Health insurance is available through the Universal Health Insurance Scheme for individuals and groups. Up to 15,000 INR in medical costs, excluding maternity charges, are reimbursed for accidental disability, hospitalisation, and treatment.
13. West Bengal Health Scheme
The West Bengal government introduced this scheme in 2008 for its employees and their families. Additionally, it includes pensioners. It was updated in 2014 and named West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme.
The insured amount is Rs. 1 lakh, and the policy is for individuals and their families. According to the terms and situations, the insurance covers OPD and surgeries.
14. Yeshasvini Health Insurance Scheme
The Karnataka State Government introduced the Yeshasvini Health Insurance Scheme, also known as the Yeshasvini Co-operative Farmers Health Care Scheme, in 2002. The primary objective of the scheme is to provide ryots (tenant farmers or peasants) who are members of cooperative societies in Karnataka with health insurance coverage.
Each beneficiary in this scheme must pay a certain annual member contribution fee. For Rural Yeshasvini, this amount is Rs. 300, while for Urban Yeshasvini, it is Rs. 710. This insurance covers over 800 operations, including orthopaedic, neurological, and angioplasties at the network hospitals. The scheme also provides advantages to the principal beneficiary’s family members.
15. Dr YSR Aarogyasri Health Care Trust Andhra Pradesh State Government
The Dr YSR Aarogyasri Health Care Trust, which promotes health care, and the government of Andhra Pradesh have developed four advantageous welfare schemes:
- Dr YSR Aarogyasri: This scheme is devoted to the well-being of the underprivileged.
- Aarogya Raksha Scheme: People over the poverty line (APL) benefit from this scheme.
- Working Journalist Health Scheme: The Andhra Pradesh state government provides journalists and staff with full medical coverage. This policy also applies to former or retired employees and current workers.
- Employee Health Scheme: This programme benefits those who work for the state government.
16. Karunya Health Scheme
This initiative was started by the Kerala government in 2012. The goal of the Karunya Health Scheme is to offer health insurance for conditions that are categorised as chronic. It is a critical illness plan for the poor that covers serious illnesses like cancer, kidney problems, heart conditions, etc.
The recipient must be a resident of Kerala. Those below or near the poverty line can sign up for this coverage. An Aadhaar card and the relevant Income Certificate are required for this scheme. All BPL and APL families can obtain health coverage of Rs. 5 lakhs annually for secondary and tertiary care hospitalisation under this programme if their yearly income is less than Rs. 3 lakhs.
17. Rajiv Aarogyasri Community Health Insurance Scheme (RACHI)
The RACHI programme is a health insurance scheme by the Government of Andhra Pradesh for its underprivileged citizens. The scheme offers BPL (Below Poverty Line) families free health insurance coverage. The plan provides coverage for hospitalisation and treatments up to INR 2 lakhs. Coverage is offered on a family floater basis to ensure every family member can enrol in the programme.
18. Janashree Bima Yojana
In 2000, the Life Insurance Corporation and the Central Government introduced the Janashree Bima Yojana to provide life insurance for India’s below-poverty-line urban and rural citizens.
Currently, 45 distinct occupational categories are granted coverage under this programme. A person must be between 18 and 59 to qualify for the Janashree Bima Yojana insurance plan and belong to a profession or occupational group approved by the nodal agency.
In the event of a beneficiary’s natural death, they are entitled to Rs. 30,000; in the event of a beneficiary’s permanent disability or death due to an accident, Rs. 75,000; and in the event of any partial disability due to an accident, Rs. 37,500 under this scheme.
19. AB-MGRSBY: Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana
Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana (AB-MGRSBY) was established by the administration of Chief Minister Ashok Gehlot to offer the people of Rajasthan access to high-quality medical care.
This plan offers cashless hospitalisation, a wide range of insured sums, a vast hospital network, and health insurance on a family floater basis. The launch of AB-MGRSBY in Rajasthan is intended to help lower-income group families that lack access to high-quality healthcare. Families must be inhabitants of Rajasthan and be enrolled in the Ayushman Bharat Scheme to qualify for the AB-MGRSBY.
20. Swasthya Sathi Scheme
On December 30, 2016, the West Bengal Chief Minister unveiled the Swasthya Sathi Scheme. This government health insurance programme enables policyholders to seek cashless hospitalisation by offering a baseline health insurance coverage of 5 Lakh per family. Beneficiaries of the Swasthya Sathi Scheme are not required to pay any premiums for the insurance coverage.
Bridging the Gap: Ketto’s Role in Accessible Medical Care for All
Ketto is the most reliable and trusted crowdfunding platform in India. By leveraging the power of the internet and social networks, Ketto has empowered individuals, families, and organisations to raise funds for various medical needs, making healthcare more accessible and affordable.
Here’s how Ketto’s role in accessible medical care works:
Medical treatments, surgeries, and procedures can often be expensive, and not everyone has the financial means to cover these costs. Ketto provides a platform for individuals to create fundraising campaigns for their medical needs, allowing friends, family, acquaintances, and even strangers to contribute financially. This democratises healthcare by spreading the financial burden across a wider network of people.
Traditional methods of fundraising might be limited by geography and personal networks. Ketto’s online platform enables campaigns to reach a global audience, potentially attracting donations from people who resonate with the cause, regardless of location.
Transparency and Accountability
Ketto ensures transparency by providing regular updates on the campaign’s progress and the utilisation of funds. This level of accountability helps build trust among donors and beneficiaries, ensuring that funds are used for their intended purpose.
Diverse Medical Needs
Ketto’s platform caters to various medical needs, from emergency medical expenses and life-saving surgeries to treatments for chronic illnesses and rare diseases. This inclusivity ensures that people with various medical requirements can find support.
Ketto’s platform can also be used for emergency medical fundraising, where time is of the essence. The ability to quickly mobilise resources can be life-saving in critical situations.
Reducing Healthcare Disparities
Ketto contributes to reducing healthcare disparities due to economic and social factors by providing a platform for individuals from marginalised backgrounds to raise funds.
Like the Government of India, Ketto also believes everyone should have access to the medical treatments they need, regardless of their financial situation. Start a crowdfunding campaign on Ketto in simple steps and transform challenges into triumphs.