National Health Insurance Scheme & Their Features

Health insurance is necessary for all. It helps you get the much-needed financial cushion against medical emergencies.With medical inflation growing rapidly, health care is becoming more and more expensive every year. In such a situation, many people find it challenging to cover their medical expenses without robust medical insurance.Over the years, as awareness among people about the importance of health insurance coverage has increased, especially after the COVID-19 pandemic, there is a significant demand for health insurance policies. The prices of health insurance policies have also increased, and many people, especially those below the poverty line, cannot afford to buy health insurance.Keeping in mind the importance of health insurance for all, the Government of India started the National Health Insurance Scheme. It is specially designed to cater to the healthcare needs of poor citizens and make health insurance affordable to all.The Government of India, with the help of the Ministry of Health and Family Welfare and the National Knowledge Commission, has set up the National Health Portal to provide accurate and relevant information about healthcare to all Indian citizens.Let us look at the various health insurance options offered under the National Health Insurance Scheme and their features.

The CGHS offers an all-inclusive healthcare service to the Central Government employees. It also includes the retired employees or pensioners and their dependent family members living in specific cities.The Central Government started this healthcare protection service for the employees in 1954. The services offered are through the wellness centres, and it includes the AYUSH treatment, i.e., Ayurveda, Yoga, Unani, Siddha, and Homeopathy.The major components of this scheme include:

• Domiciliary care
• Dispensary services
• Hospitalisation cover
• Medicines
• Health education
• Consultation with a specialist
• Diagnostic tests such as X-Ray, ECG, blood tests, etc.

Four public health insurance companies have implemented Universal Health Insurance Scheme or UHIS to provide health insurance to poor families.Under this scheme, the policyholders get coverage of up to Rs. 30,000 on a family floater basis for hospitalisation expenses. Besides, policyholders get an accidental death cover of Rs. 25,000, and in case of loss of income due to hospitalisation, they get a compensation of Rs. 50 per day.Apart from all these benefits, the government also offers a subsidy on the premium up to Rs. 400 if you purchase the policy for seven members, for five members, the subsidy is Rs. 300, and for individuals, the subsidy is Rs. 200.

AABY was started in October 2007 for the rural population. This National Health Insurance Scheme covers the earning members of the house who are aged between 10-59 years. It provides the following compensation:

• In case of natural death, the family members of the deceased policyholder get a compensation of Rs. 30,000
• In case of accidental death or permanent disability like loss of limbs, the policyholder is entitled to get a compensation of Rs. 75,000
• In case of partial permanent disability due to accident, the policyholder gets a compensation of Rs. 35,000

The ESIS is a government health insurance scheme that is customised to provide socio-economic security to workers and their dependent family members.Apart from getting full health insurance coverage for themselves and their family members, the scheme beneficiaries can get cash benefits in case of an emergency, temporary and permanent disabilities due to accident, and death due to occupational hazards or injuries at the workplace.One of the significant highlights of the Employment State Insurance Scheme is that it is also valid for non-season factory employees. However, the factory must have at least 10 employees or more. It is applicable to restaurants, newspaper establishments, hotels, cinemas, and road transport companies that employ more than 20 people.This National Health Insurance Scheme is implemented in most states across India except states like Manipur, Mizoram, Sikkim, Arunachal Pradesh and all Union Territories.

The Government of India launched the Jana Shree Bima Yojna in August 2000. It caters to the needs of the people aged between 18-59 years belonging to the 45 specific professional groups.

The Ministry of Labour and Employment and the Government of India launched the RashtriyaSwasthyaBima Yojana specially to cater to the needs of the families who are below the poverty line (BPL). The scheme aims to offer health insurance coverage to BPL at an affordable price.Under this National Health Insurance Scheme, the government has fixed the hospitalisation cover limit at Rs. 30,000 and has also fixed the hospital package rates. The scheme also covers pre-existing illnesses for all eligible members, irrespective of their age.The eligible beneficiaries for this health insurance policy can get coverage for five members in their family, including self, three dependent children and spouse. The registration fee for the policy is capped at Rs. 30, and the Government of India pays the premium to the insurance company.

• The scheme gives the beneficiary the flexibility to choose between public and private hospitals for treatment purposes.
• The government pays the insurance premium to the insurance company on behalf of all the registered BPL households. It also motivates the insurance companies to provide coverage to as many people from the BPL list as possible.
• The government offers incentives to both public and private hospitals to offer treatment to the insured members, and the insurance companies are tasked with the duty to supervise the participating hospitals to prevent fraudulent claims.
• The beneficiaries of the scheme get full cashless treatment in all of the network hospitals. The beneficiaries must only carry the cashless smart card and verify with their fingerprint. This is why the National Health Insurance Scheme is helpful for poor families who migrate to different places for work.
• The various intermediaries like NGOs (Non-government organisations) and non-profits are paid to offer assistance to the families of the people belonging to BPL households.
• Since the smart cards use key management systems and biometrics, the scheme is foolproof. Only the eligible beneficiary or the card recipient can use it. This helps prevent fraud and maintain accountability.

The National Health Insurance Schemes discussed above are not exhaustive, but these schemes are specially designed to provide healthcare services to all. People can choose any of these schemes to suit their family’s healthcare needs.

The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.