Updated on - 21 Apr 2026
The National Health Insurance Scheme (NHIS) is a government-led initiative that provides affordable healthcare services to citizens, especially low-income groups. The scheme ensures essential medical services are available to all, reducing the financial burden of health care costs. Through various initiatives, the NHIS seeks to develop a robust healthcare system that meets the diverse needs of Indians. Let’s learn more about this system.
National Health Insurance Schemes in India (NHIS)
India has launched several national health insurance schemes to cater to the healthcare needs of its citizens. Given below are some of the major national health insurance schemes in India:
1. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY):
Frequently considered to be the largest government-sponsored health insurance policy, PMJAY provides up to Rs 5 lakh per family per year for secondary and tertiary hospitalisation. The scheme targets over 10 crore poor and vulnerable families, providing cashless and paperless access to healthcare in empaneled hospitals across India. Beneficiaries are determined on the basis of data from the Socio-Economic and Caste Census (SECC).
2. Rashtriya Swasthya Bima Yojana (RSBY):
Launched in 2008, RSBY was an earlier project aimed at providing health insurance to below-the-poverty-line (BPL) families. It provides up to Rs 30,000 per family per annum for most diseases requiring hospitalisation. Five family members, including the primary beneficiary, three dependents and a spouse, can be covered in this scheme. Although PMJAY has largely taken over, RSBY still plays an important role in those states where PMJAY is not fully implemented.
3. Central Government Health Scheme (CGHS):
This scheme presents complete healthcare facilities to central government personnel, pensioners, and their dependents. CGHS offers a wide variety of services, including:
- Dispensary services
- Outpatient care
- Specialist consultations
- Medical assessments, including X-rays, ECG, and laboratory tests
- Hospitalisation
- Supply of medicines
The scheme operates via wellness centres spread across the country, offering cashless offerings to its beneficiaries.
4. Employees’ State Insurance Scheme (ESIS):
ESIS is a self-financed social safety and medical insurance scheme for Indian employees. It offers hospital treatment and cash benefits for illness, maternity, disability and death resulting from employment injury. ESIS also extends medical benefits to the workers’ families. The scheme is managed by the Employees’ State Insurance Corporation (ESIC) under the Ministry of Labour and Employment. It applies to organised sector employees earning below a wage threshold.
5. Universal Health Insurance Scheme (UHIS):
This scheme was introduced to enhance access to healthcare offerings for people and families living below the poverty line. The scheme gives coverage on a family floater basis with a sum assured of up to Rs. 30,000 for hospitalisation charges. Additionally, the scheme provides an accidental death cover of Rs. 25,000 to the policyholder. If the policyholder reports a loss of earnings because of hospitalisation, they may be compensated with Rs. 50 per day. This was replaced by newer initiatives like PMJAY.
6. Aam Aadmi Bima Yojana (AABY):
Aam Aadmi Bima Yojana (AABY) is a social security scheme launched on October 2, 2007, for rural, landless families. The scheme consists of medical insurance benefits that offer a lump-sum payment in the event of accidental loss of life or disability. It covers the earning members of these families aged 10 to 59 years. The scheme offers:
- 30,000 for natural death
- 75,000 for accidental demise or full permanent disability (loss of two limbs or eyes)
- 37,500 for partial permanent disability (lack of one limb or eye)
These benefits provide vital economic assistance to vulnerable households in times of need.
Conclusion
The National Health Insurance Scheme (NHIS) in India performs an important role in making healthcare accessible and affordable for all. Through various schemes, the government ensures that even the most vulnerable populations can access vital medical services without financial strain.
Understanding and using these health insurance plans can help individuals and families protect themselves from the high costs of medical treatment, leading to a healthier and more secure life.
FAQs
1. Is cataract surgery covered by national insurance?
Yes. Cataract surgery is generally covered by government health insurance in India, but the extent of coverage depends on the specific scheme and eligibility criteria.
2. Do national health insurance schemes in India offer senior citizen health insurance?
Yes. But it is not available as a separate ‘senior citizen health insurance plan’ in the way private insurers offer. In India, government health insurance schemes like PMJAY, CGHS, and ESIS cover senior citizens based on eligibility, not age alone.
3. What is the waiting period for national health insurance?
Most government schemes like Pradhan Mantri Jan Arogya Yojana have no rigid waiting period, and medical coverage starts immediately for eligible users. But this is not the case for all. For instance, some schemes like the Employees’ State Insurance Scheme may require a certain contribution period, and the Central Government Health Scheme begins once membership is active.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.