Understand National Health Insurance Schemes in India

Providing health insurance coverage to families below the poverty line in India has been an ongoing initiative by the Government, ever since the Employees State Insurance Act of 1948. A number of schemes, targeted at specific sections of the society, with pan India coverage have been launched from time to time by the government. Let us look at the some major National Health Insurance Schemes available in India in detail:

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Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB – PM -JAY)

In 2018, the Government of India announced a program for Universal Health Coverage (UHC) in line with the Global Sustainable Development Goals (SDGs) to provide health insurance coverage for people below the poverty line in India. This scheme is known as the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, or Ayushman Bharat, in short. According to the National Health Authority (NHA), this scheme would provide healthcare coverage to roughly 40% of the population who are deprived of health care. The list of beneficiaries was prepared by the Government based on its Socio-Economic Caste Census of 2011. 

The scheme was a successor to an earlier Government funded healthcare scheme known as Rashtriya Swasthya Bima Yojana (RSBY), hence beneficiaries of the RSBY scheme were also included in the Ayushman Bharat scheme. 

This scheme is entitlement based and the insured doesn’t need to pay for the premium which is funded by the Governments (Centre and State).

Central Government Health Scheme (CGHS)

CGHS provides comprehensive, open-ended healthcare coverage to more than 35 lakh beneficiaries which include Central Government employees and pensioners, as well as beneficiaries from legislative, executive, judiciary and press. This scheme has been in effect for almost 60 years.

Currently this scheme provides coverage to its beneficiaries in 71 cities across India with plans of extending it to additional cities. AYUSH treatment as well as standard Allopathy and Homeopathy treatments are provided under this scheme

Employees’ State Insurance Corporation (ESIC) scheme

Under the ESIC Act, this health insurance scheme provides coverage to employees working in factories and other establishments with a wage ceiling of Rs. 15, 000 per month (enhanced to Rs. 21, 000). Employees working in establishments employing more than 10 people (20 under certain conditions) are eligible. This provides coverage to people working in hotels, shops, restaurants, transport agencies, etc. It initially started from 2 locations in India and has now extended to most parts of the country.

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Aam Aadmi Bima Yojana (AABY)

The AABY scheme was launched keeping in mind the head of the household in poor families. For a low premium of Rs. 200 which is shared by Central and State Government, a coverage of Rs. 30000 was provided to cover for death and disability of the bread-earner of the family. An additional provision for scholarship for children between 9th to 12th standard is also included.

This scheme was merged with the Janashree Bima Yojana (JBY) and a merged Aam Aadmi Bima Yojana scheme came into effect from January 1, 2013.

Universal Health Insurance Scheme

This scheme was launched in 2003 under the Government of India’s Ministry of Health and Family Welfare’s Universal Health Assurance Mission (UHAM) for the poorest of Indian society falling into both sections - Below Poverty Line (BPL) as well as Above Poverty Line (APL).

This policy was provided for the bread-earner of the family on individual basis as well as a group benefit provided by institution or association. It included hospitalisation, personal accident and disability cover at a low premium.

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Conclusion

There are many health care initiatives that have been launched from time to time by various Governments in India. Most of them have coverage for specific groups. Certain schemes were primarily aimed at providing coverage to the working class. Subsequently schemes like Ayushman Bharat are a big step in extending the benefits of healthcare to the poorest Socio-economic level of our society.

Disclaimer: This article is issued in general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.