National Health Insurance Scheme in India

The Government has taken some initiatives to provide basic healthcare facilities to the
people of India. National health insurance schemes are health insurance programs that are
launched by the Union Government, to provide and make health insurance schemes,
accessible to the poor and vulnerable government employees and the unorganized sector
in India.

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National Health Insurance Scheme In India

Given below are some of the health insurance schemes and their benefits:

1. Rashtriya Swasthiya Bima Yojana (RSBY):

Rashtriya Swasthiya Bima Yojana is a social security scheme, launched by the Ministry of
Labour And Employment, Government of India, for providing health insurance cover to
families living below the poverty line. The aim of this scheme is to provide health insurance
cover to BPL families (Below Poverty Line) and help them avail healthcare facilities by
providing them monetary aid and reducing out of pocket expenses.

The scheme is funded by the Central and State Government. About 75% of the funding
comes from the Government of India, while the remaining part is paid by the State
Government. Beneficiaries must pay the Rs 30 registration fees.

Under this scheme, the government has fixed the hospitalization limit at Rs 30,000. The
government has specifications on the hospital package rates as well. The scheme is a family
health insurance policy, where the specified limit can be used to cover 5 members
including self, spouse and 3 dependents of a family. The scheme also provides health cover
for pre-existing diseases without any age limit. Rashtriya Swasthiya Bima Yojana also
covers the following groups of people:

 Building and other construction workers registered under the welfare board.
 MNREGA workers who have worked for more than 15 days during the previous
financial year.
 Street vendors.
 Licensed railway porters.
 Auto drivers.
 Rickshaw pullers.
 Workers in mines
 Sanitation workers.
 Domestic workers.
 Beedi workers.

Key Features of RSBY:

The scheme provides health insurance coverage for the BPL families and the key features of
the scheme are listed below:

Beneficiary: the scheme offers beneficiaries the facility to avail treatment at both private
and public hospitals. The empanelment of hospitals is done based on prescribed criteria.
The insurer must empanel hospitals in the district, so that beneficiaries need not travel
very far to avail heath care services. The scheme helps beneficiaries enjoy quality
treatment under this scheme.

Insurers: State Governments engage in a competitive public bidding process and select a
public or private insurer, licensed to provide health insurance by the Insurance Regulatory
Development Authority (IRDA). The government pays the insurance premium on behalf of
the insured.
Hospitals: The government encourages the hospital authorities to participate in the
National Healthcare Programs, by providing them certain incentives. The hospitals must
also have the requisite hardware and software facilities for online and cashless
transactions through smart cards. Both private and public hospitals may get enlisted under
this scheme. The process is supervised by the insurer to bring transparency in the process.

Cashless and Paperless Facilities: the beneficiaries of this scheme can avail cashless
treatment at any RSBY enlisted hospital across India. After availing the services, the
hospitals must send the e-report to the insurer. The payments will be done via smart card
and the claims settled electronically.

Government: The government is able to offer quality healthcare services with a sum of Rs
750 a year per BPL family. It will promote healthy competition among private and public
healthcare providers, which improves the functioning of public health care services.

Pan India Coverage: The beneficiary can avail health care facilities at any RSBY
empanelled hospital across India. He only needs to carry the smart card given to him. This
facility is useful for laborers and workers who migrate to other cities for work.

Information Technology: The beneficiaries of this scheme are offered smart cards. These
smart cards contain the biometric details and a photograph of the beneficiary. The claims
are settled by swiping the smart card and providing biometric details, helping the
beneficiary avail cashless treatment without an ID proof.

Safe and Secured: The scheme is safe and the records of insurance availed can be easily
tracked by the government. The use of smart cards and biometric details allows the insurer
track claims, transfer funds to hospitals and investigate suspicious claim patterns through
on-site audits.

SEE ALSO: Advantages Of Buying A Health Insurance Plan

2. Employment State Insurance Scheme:

Employment State Insurance Scheme is a social security scheme that is specifically made to
offer social security and economic protection to workers and their family members. The
scheme offers medical cover for the beneficiaries, which can easily be accessed as well as
various cash benefits in times of emergency like sickness, temporary or permanent
disability resulting in loss of earning capacity. The scheme is valid for factory employees
provided the number of workers is more than 10. The scheme also encompasses employees
of hotels, shops, cinemas and restaurants, drivers and workers provided they work in
organisation having more than 20 employees.

3. Central Government Health Scheme:

Central Government Health Scheme (CGHS) is a Health Insurance Scheme, initiated by the
Government to provide comprehensive healthcare services to Central Government
Employees and Pensioners. The scheme encompasses pensioners and their dependents,
living in cities that are covered under the CGHS scheme.

The scheme includes Domiciliary Care, F.W and M.C.H services along with specialist
consultation services at dispensaries, polyclinics and hospitals. The scheme also provides a
host of other benefits to help government employees and retirees avail medical benefits
and cut down out of pocket expenses.

4. Aam Aadmi Bima Yojana:

Aam Aadmi Bima Yojana is an initiative taken by the Government to offer financial aid and
social security to rural households and is a part of rural development schemes in India. The
scheme is designed to encompass the rural landless households, where the access to
healthcare facilities like hospitals and pharmacies are limited. The scheme provides
coverage only to the earning member/ head of the family.

Any individual falling in the age bracket of 18- 59 years can enrol in the AABY scheme. The
contribution is made by both the Central and the State Governments, so that beneficiaries
don’t have to pay premiums.

5. Universal Health Insurance Scheme:

The Universal Health Insurance Scheme is a health insurance plan, initiated by 4 public
sector general insurance companies, to provide healthcare facilities to poor families. This is
a comprehensive scheme that provides medical expenses reimbursement of up to Rs
30,000 towards hospitalization of self or dependents, accidental death cover (Rs 25,000) to
the earning head of the family, and per day compensation of Rs 50 for loss of earning of the
breadwinner during hospitalization for up to 15 days. The scheme is specially designed to
provide health insurance benefits to BPL families.

6. Janashree Bima Yojana:

The Janashree Bima Yojana was launched on 10 th of August 2000, to provide life insurance
to people in rural and urban areas, who are below and marginally above the poverty line.
This scheme is a joint venture by the Government of India and the life insurance
corporation (LIC), which includes a total of 45 occupational groups. Any individual of age
group 18-59 years can enroll in this scheme. However, the policy holder must be a member
of the vocational group/ occupation approved by the nodal agency.

The benefits of this scheme are the compensation given under the insurance plan. These
are outlined below:

 The nominee will receive Rs 30,000 as death benefit in case of death of the policy
holder.
 On permanent disability due to an accident, the policy holder receives a sum of Rs
75,000.
 On partial disability the insured would receive Rs 37,000.

7. Ayushman Bharat - National Health Protection Mission:

Ayushman Bharat is a National Health Protection Scheme, initiated by the Union

Government to offer Health Insurance Cover to the poor and the vulnerable families in
India. The scheme offers coverage of up to Rs 5 Lakhs a year for secondary and tertiary
care hospitalization. The benefits of this scheme can be used across India and the
beneficiaries covered under this scheme will be allowed to avail cashless benefits from any
public/ private hospital empanelled under this scheme. The scheme offers coverage to all
members of the family and beneficiaries access quality health care facilities and medication
by enrolling in this scheme.

SEE ALSO: Best Health Insurance Plans in India

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