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Government Health Insurance Schemes in India

Health Insurance refers to a contract between an insurance company and the policyholder where the insurance company, covers and pays for costs and expenses related to medical treatment by the life insured. The insurance company either provides reimbursement up to certain limits for any medical expenses incurred by the insured individual or offers cashless transactions for illnesses and treatments covered by the policy, where the insurance company directly covers the individual.

As health care costs in India are continually rising, there are several health insurance schemes initiated by the Government of India. These are called National Health Insurance Schemes. These government health insurance schemes and government medical insurance policies provide medical coverage for the poor and impoverished.

According to the National Health Policy, almost 63% of the population pays for medical expenses out of their own pockets. To curb this issue and help lower the burden on individuals, the Government of India has decided to provide certain health insurance policies. Some of these Government health insurance plans include:

  • Rashtriya Swasthya Bima Yojna (RSBY)
  • Universal Health Insurance Scheme
  • Janashree Bima Yojna
  • Central Government Health Scheme (CGHS)
  • Employment State Insurance Scheme (ESI)
  • Aam Aadmi Bima Yojna

What is a Government Health Insurance Scheme?

Government Health Insurance Schemes

Since healthcare costs are constantly on the rise, people should invest in good health insurance policies and mediclaim to avoid bearing the burden of high medical expenses. However, the population in India finds health insurance policies to be an expensive affair. As such, the Government of India has decided to provide economic and affordable health insurance policies and government mediclaim policies to aid the poor in the country. Government Mediclaim policies benefit everyone in the country. State or Central Government usually pays the premiums for these government health insurance policies, and registration fees for the policies can be as low as Rs.30. However, the waiting period to enrol can be a few years.

List of Government Health Insurance Plans:

Here’s a rundown to the National Health Insurance Schemes in India:

Rashtriya Swasthya Bima Yojna:

Launched by the Ministry of Labour and Employment, this health insurance scheme is available for those below the poverty line in India.

Employee State Insurance Scheme:

The Employee State Insurance Scheme is designed to protect workers and their families. It is applicable to non-seasonal factory employees and those employed in hotels, shops, restaurants, cinemas, newspaper establishments, and road transport enterprises, employing more than 20 people.

Central Government Health Scheme:

This scheme provides comprehensive medical coverage to employees and their dependents who are employed by the Central Government.

Aam Aadmi Bima Yojna:

This social security health scheme aims at the rural population, landless households. In this scheme, the head of the family or the breadwinner is covered.

Janashree Bima Yojna:

This health insurance scheme covers individuals specifically in any one of the listed 45 professions by the Government of India.

Ayushman Bharat:

National Health Protection Mission: This is a national health protection scheme that covers approximately 10 Crore households under the poverty line.

Universal Health Insurance Scheme:

Four public insurers are implementing this government Mediclaim to provide health coverage and Mediclaim benefits to low-income families.

How to apply for Government Health Insurance Plans?

Now that we have a little detail about Government Health Insurance Plans, here you can know how to apply for these schemes:

RSBY:

The district-level officials in each village help to compile an enrollment schedule and specific dates for enrollment for each village. A digital list of all eligible BPL (Below Poverty Line) household is determined using a pre-specified data format and is provided to the insurance company. As per the enrollment schedule compiled by district officials, the schedule is posted in each village at enrollment stations, essential locations, and public areas such as schools, well before the enrollment date.

Mobile enrollment stations are set up at each local centre, including public schools. Enrollment stations are equipped with a list of all eligible BPL households, biometric facilities to take fingerprints, a photo scanner, and a printer to print smart cards that are issued for the insurance policy.

A smart card, as well as an information brochure, is immediately provided to an individual who registers after paying a fee of Rs 30. The concerned Government officer is required to authenticate the smart card. The entire process of registration usually takes less than ten minutes for each individual.

The smart card is an essential part of the plan as it enables cashless transactions based on the information it carries across partner hospitals in the country. Since the policy also benefits dependents and spouses besides self, photographs of family members are also stored in the smart card chip for verification later on.

ESI Plan:

Any company that has more than 20 employees with a salary of Rs 15,000 has to compulsorily apply with the government for the Employee State Insurance Plan. The employee has to provide the employer with a duly filled form and photographs, including his family member's. Once the company does the registration, the employee receives an ESI card.

CGHS:

The application process can be done online from the Central Government Health Scheme website or through a prescribed form. In the case of current employees, they need to provide proof of residence, proof of age of the son, and disability certificate of a son if it applies.

If pensioners are applying, then they need to provide a copy of surrender certificate of CGHS card, transaction receipts for CGHS subscriptions, certificate of Non-withdrawal of Fixed Medical Allowance, and one photograph of individuals and family members signed by the beneficiary on the back and another set of photographs attested by Gazetted officer in charge of the administration.

Aam Aadmi Bima Yojna:

The individual can apply at their respective nodal agency with documents such as family smart card, Aadhaar card, and extract from the birth register, school certificate, voter's list, and identity card issued by the reputed employer or government authority.

Janashree Bima Yojna:

This health insurance is offered by certain public insurers such as Life Insurance Corporation of India. The application can be sent through to the government with the help of Nodal agencies by providing all the required documents.

Ayushman Bharat:

On the Ayushman Bharat website, one has to enter their mobile number on the home page. After entering ‘Captcha’ and generating OTP, an OTP will be received on the registered mobile number. After entering the OTP, one needs to fill in all the required details to get benefit from this scheme.

Universal Health Insurance Scheme:

Since this policy benefits BPL families, to apply and avail the benefits, one must provide a certificate as proof of BPL. This certificate should be issued by the Tehsildar of the revenue department of that particular state government.

Key Features of the Government Health Insurance Plans:

Government health insurance plans offer health insurance coverage to low-income families and households. The key features and benefits of these plans are listed below:

Beneficiary:

The beneficiary under these plans has the freedom of choice to select between public and private hospitals for his household from the selected network of hospitals provided by the insurer. The beneficiary thus becomes a prospective client for the hospital-based on the revenue it earns from the government plan

Insurers:

The beneficiary is not required to pay anything besides the initial registration fee as per the plan. The Government takes care of paying the premiums to the insurance companies that are providing the benefit, thereby ensuring that as many low-income households as possible receive this coverage. The insurance companies are also motivated to provide their services widely

Hospitals:

The beneficiary can choose between specific public and private hospitals. These public and private hospitals are given incentives to help treat members from low-income households. Besides, insurance companies constantly supervise their activities to ensure that no fraudulent claims are being made

Paperless and Cashless Transactions:

One of the most important features of government health insurance plans is that the beneficiary can benefit from a paperless and cashless transaction at any one of the partner hospitals. They only need to carry the smart card or related card issued at the time of registration and verify their identity through fingerprints. After that, the claim shall be settled online, and the payment is made electronically

Intermediaries:

Organizations such as various Non-Government organizations and MFIs are offered incentives to assistance to BPL households

Government:

The government can provide up to a certain amount for every household for offering quality health care services. This helps create a competition between public and private health care providers to improvise the performance of public health care providers

Pan India Coverage:

The Government Health Insurance plans are very beneficial for low-income households, especially migrating individuals as most of the national policies are covered across the country within a specific network of public and private hospitals

Information Technology:

The collection of digital data and the use of smart cards with biometric information enable a seamless flow of data. All partner hospitals are also IT-enabled to be able to collect and view the information on the smart card or through other identity documents in a smooth fashion

Safe and Secure:

Usage of key management systems and smart cards in combinations makes this a fool proof scheme and protects it from fraudulent claims and scams. Only the insured individual can use the smart card to maintain responsibility. The rest of the family members who are insured also have their details included in the smart card chip or embedded within the electronic database

Comparison of various Government Health Insurance Plans

Insurance Plan

No. of family members covered

Maximum Sum insured

Maximum Entry Age

Rashtriya Swasthya Bima Yojna

5 including self

Rs 30,000

None

Aam Aadmi Bima Yojna

Self and added benefit for two children

Rs 30,000

18 years

Universal Health Insurance Scheme

Self or family

Rs 25,000

5 years

Ayushman Bharat

Family irrespective of size

Rs 5 Lakh

16 years

Janashree Bima Yojna

Member of the nodal agency or vocational group

Rs 30,000

18 years

Central Government Health Scheme

Applicable only for central government employees and retirees

As per CGHS package rates

18 years

Employee State Insurance Scheme

For all employees earning less than 21,000 per month as wages and for all companies, offices, factories employing 20 persons or more

As per the guidelines of ESI

18 years

Rashtriya Swasthya Bima Yojna:

The Rashtriya Swasthya Bima Yojna plan was launched by the National Health Insurance Scheme (NHIS) to help families and households that are below the poverty line. The beneficiary under this scheme is entitled up to Rs 30,000 for medical expenses and hospitalization. There are also fixed hospital package rates. Pre-existing illnesses are also covered without any age criteria. This Mediclaim policy can cover up to 5 members of a household, including self, three dependents, and a spouse. The registration fee for the insurance policy is only Rs 30, and the premiums are paid by the Government.

Aam Aadmi Bima Yojna:

The Aam Aadmi Bima Yojna is a social security scheme for rural and landless households. A premium of Rs 200 is paid by the Central government, which is maintained by the Life Insurance Corporation (LIC) of India. The policy offers an add-on benefit in terms of a scholarship for children of the insured. The maximum sum insured is Rs 30,000 in case of natural death and Rs 75,000 in case of accidental death or severe disability such as a loss of 2 limbs or 2 eyes. The scheme offers coverage of Rs 37,500 in case of permanent disability resulting from loss of 1 limb or 1 eye. The minimum entry age is 18 years, and the maximum age is 59 years.

Universal Health Insurance Scheme:

The scheme is offered by four public health insurance companies to provide healthcare coverage for low-income households. The maximum sum assured is Rs 30,000 on family floater scheme for hospitalization. The scheme also offers coverage of Rs 25,000 to the beneficiary in case of accidents and Rs 50 per day in case of loss of income. The premiums vary depending on the size of the family. It is for Rs 200 for an individual, Rs 300 for a family of five, Rs 400 for a family of seven.

Ayushman Bharat:

This is a national protection scheme designed for the impoverished and needy.  The scheme provides up to Rs 5 Lakh coverage per family per year for secondary and tertiary medical care. The benefits covered by the scheme are applicable all over the country. Cashless transactions are possible across partner private and public hospitals across India. The scheme targets 10.74 Crore households that are below the poverty line and aim to provide beneficial cover to over 40% of the population. 

Janashree Bima Yojna:

The Janashree Bima Yojna provides life insurance cover to rural and urban people marginally above or below the poverty line. The premium is Rs 200 per individual. 50% of the premium is paid by the member or State or Nodal Agencies. The other 50% is borne out of the social security fund. To enrol, an individual must be between 18 and 59 years of age.

They should be a member of any nodal agency approved occupation or vocational group. They must be marginally above or below the poverty line, and the minimum membership size should be 25. There is a special plan for women under this scheme.

It covers education expenses for their children. There is also a term insurance plan of maximum coverage of Rs 30,000 for a premium of Rs 200 per year. Another added benefit is the Shiksha Sahyog Yojna, which offers Rs 600 to the children of parents enrolled in this scheme. The children must be studying in grades 9 through 12 or students pursuing ITI. A maximum of two children per family is offered this scholarship.

Central Government Health Insurance Scheme:

This is the oldest health insurance policy launched by the government and covers all central government employees, ex-employees who receive annuity and their families. It covers all inpatient and outpatient treatments and medical investigations, reimbursement for a medical emergency, expenses related to maternity and child health as well as family welfare.

It also covers alternative treatments like Ayurveda. Depending on the level pay, a nominal amount is deducted from the monthly salary of employees to pay for this. Corresponding to the basic pay, reimbursement, or cashless treatment is obtained from CGHS hospitals across the country.

Employee’s State Insurance Scheme:

The ESI act is a social protection system to offer security and protection for employees in different states of India. It covers any costs associated with medical care, death in the workplace, maternity, injuries, etc. Dependents are also benefitted under this scheme for employees earning less than Rs 21,000 per month, the employer has to contribute 4.75%, and the employee contributes 1.75% of the employee's wages, making it a total of 6.75%.

In the case of medical coverage, 70% of the employees’ wages are available as cash benefits for 91 days. For women, the maternity leave of 26 weeks can be extended by a month, and they get the full wage for 70 days. For unemployed individuals, they are insured for at least three years, and provided they have given details of their last workplace; they receive 50% of their wages in cash for a maximum of 2 years by the employees.

With various options offered by the Government of India for healthcare policies and Mediclaim benefits, households that are marginally above or below the poverty line can benefit from overburdening themselves with expensive healthcare. Government health insurance policies take into account the coverage, size of the family, and some even offer life insurance coverage.

Frequently Asked Questions (FAQs)

  • Q. How can I find out about various government health insurance schemes and policies in my district or village?

    Ans. Government health insurance schemes are mediated by public insurers or through Nodal agencies such as village panchayat as well as by certain NGOs. One can visit their local panchayat or NGO and ask about the best plan that is applicable for the individual and their household and the various features and benefits of each policy.

  • Q. If I have more than 3 dependents, how can I enrol them in the family floater plan offered by Rashtriya Swasthya Bima Yojna?

    Ans. Under the Rashtriya Swasthya Bima Yojna, only self, a spouse, and three dependents, which include children, parents, or siblings, are allowed to enrol. If a policyholder has more than three dependents, then the head of the household has to choose which three dependents can benefit under the policy.

  • Q. Which hospitals are parts of the network specified by these government insurance policies?

    Ans. For specific government health insurance options, one can visit the official websites and take a look at the partner network of public and private hospitals that offer paperless and cashless transactions for such government Mediclaim policies.

  • Q. Which vocational groups or organizations can apply for the Janashree Bima Yojna?

    Ans. There are total 45 occupational groups covered by the Janashree Bima Yojna. These groups and their workers that are covered include:

    • Foodstuff like Khansari
    • Textile workers
    • Manufacturers of wood products
    • Manufacturers of paper products
    • Manufacturers of leather products
    • Construction workers
    • Printing
    • Rubber and coal products
    • Chemical products such as candle manufacturers
    • Mineral products like manufacturers of earthen toys
    • Firecracker industries and workers
    • Other related cottage industries as approved by the Nodal agency.
  • Q. Who is responsible for paying the premium for such government health insurance policies?

    Ans. Individuals that are interested in enrolling in government health insurance schemes are only required to pay the registration fee, which can range from Rs 30 to Rs 400 depending on the eligibility and size of the family. The annual premiums are paid by the State or Central Government to the Insurance companies. This is a benefit that the central government extends to households below the poverty line to provide them access to healthcare.

  • Q. What is the claim procedure for Aam Aadmi Bima Yojna?

    Ans. In case of the death of the policyholder, the nominee must apply for a claim with a death certificate. The claim application must be submitted at the specified Nodal Agency as per the insurer. For any disability claims, the claims must be filed directly with the insurer. The following documents are required at the time of filing a claim:

    • Complete and accurate claim form
    • Original death certificate of the insured member along with an attested copy
    • Post-mortem report
    • FIR copy
    • Policy inquiry report
    • Documentary evidence in case of an accident
    • Medical certificate from a physician in case one is filing for a disability claim.

    Once the documents are submitted and processed, the claim filing process will begin. If all the documents and information are in order, the claim will be provided to the nominee in case of death of the insured or the insured in case of accident or disability.

  • Q. Are all government health insurance plans eligible for use across the country?

    Ans. Some of the most popular health insurance plans, as issued by the government of India, provide national coverage such as Aam Aadmi Bima Yojna or Rashtriya Swasthya Bima Yojna. Certain health insurance policies are specifically introduced for benefitting a particular state or area. For example, the Rajiv Arogya Bhagya is aimed at protecting the state of Karnataka, where over 1.4 Crore people can avail of the benefits under this scheme.

    Similarly, the Meghalaya Health Insurance Scheme (MHIS) aims to provide health care coverage for the state of Meghalaya for up to five members in a household. This is excluding State and Central Government employees. The Deen Dayal Swasthya Seva Yojna benefits the residents of Goa which offers coverage of Rs 2.5 Lakh and Rs 4 Lakh respectively for up to 3 members or less and 4 members or more households. This is only applicable to residents who have been living in Goa for five years or more.

  • Q. Will such government health insurance policies cover medical expenses and treatment costs associated with Corona Virus?

    Ans. Most Corona Virus tests conducted by the government of India are free of cost. However, hospitalization charges, room rent, medical expenses, etc. will be covered by any existing health insurance policy. Some health insurance policies also offer coverage on post-hospitalization expenses.

Written By: Paisawiki - Updated: 30 June 2020

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