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Health insurance just got 18% cheaper – no GST applicable!

Government Health Insurance Schemes in India

Affordable healthcare for masses

Covers basic hospitalisation expenses

Cashless facility at government hospitals

What is a government health insurance scheme?

A government health insurance scheme is a state or centre-sponsored and powered health insurance policy for citizens. There are many government health insurance schemes in India that offer affordable healthcare to Indian citizens. In government health insurance plans, citizens typically don’t need to pay premiums, as the entire cost is covered by the government.

Regular health insurance plans vs government health insurance scheme

While the primary objective of regular health insurance policies and government health insurance schemes is the same, they differ in several aspects (see table):

Aspect Regular health insurance Government health insurance
Sum insured High. Can go up to ₹ 1crore or more. Low and varies across schemes. Can range to a few lakhs of rupees.
Premium Borne by the policyholder and varies across plans. Generally borne by the government offering the scheme.
Hospital network Has an extensive network of private hospitals where you can receive cashless treatment. Has a network of government hospitals where you can receive cashless treatment. May involve private hospitals too.
Tax benefits Premiums you pay towards regular health insurance qualify for tax exemption under section 80D of the Income Tax Act, 1961 under the old tax regime. No tax benefits are available as the schemes are government-funded.
Accessibility Available for a large population. Anybody can pay a premium and buy the policy. Often limited to a specific population and may involve income-based criteria.

Detailed comparison between regular health insurance plans vs government health insurance schemes

Here’s a detailed comparison between regular health insurance policies and government health insurance plans:

Eligibility

Anyone, whether an individual or a group, can purchase a regular health insurance policy if they meet the eligibility criteria set by the insurance company. On the other hand, eligibility for government health insurance plans depends on factors such as income level, age, and employment status, among others.

Coverage offered

Regular health insurance policies can offer significantly higher coverage than government health insurance schemes in India. The coverage in the former can be as high as ₹1 crore while it is in lakhs for the latter.

Hospital choice

A regular health insurance scheme provides a wide range of hospitals from which you can choose to get yourself treated. However, the choice of hospitals is quite narrow in the case of government health insurance schemes.

Waiting period for pre-existing diseases

The waiting period for pre-existing ailments in regular health insurance policies may range from a few months to years. However, waiting periods for such ailments are generally low in the case of government health insurance plans.

List of government health insurance schemes in India

There are several government health insurance schemes in India that aim to provide affordable care to the masses. Some of the popular government health insurance plans in India are:

Ayushman Bharat Yojana

Ayushman Bharat Yojana, also called the Pradhan Mantri Jan Arogya Yojana, is the flagship health insurance scheme of the Indian government. Launched to achieve the vision of Universal Health Coverage (UHC), the scheme provides coverage of ₹5 lakhs per family per year for secondary and tertiary care hospitalisation. It also covers expenses for up to 3 days of pre-hospitalisation and 15 days of post-hospitalisation.

Swasthya Sathi

Swasthya Sathi is a government health insurance scheme offered by the Government of West Bengal for people of West Bengal. Launched in 2016, it offers basic health coverage for secondary and tertiary care up to ₹5 lakhs per family per annum. It covers all pre-existing diseases and the entire premium is borne by the state government.

Aam Admi Bima Yojana

The Aam Admi Bima Yojana is targeted at providing healthcare to workers in the unorganised sector. The majority of workers in this sector lack health insurance and the scheme aims to bridge this gap. The scheme covers natural and accidental deaths along with permanent total disability and partial permanent disability. In a way, it also serves as a social security scheme.

Bhamashah Swasthya Bima Yojana

The Bhamashah Swasthya Bima Yojana is a government health insurance scheme offered by the government of Rajasthan. Eligible members under this scheme are provided with treatment benefits for general illnesses and critical ailments. Up to ₹30,000 is provided for general illnesses, while ₹3 lakhs is provided for treating critical ailments.

Central Government Health Scheme

Another popular government health insurance scheme, the Central Government Health Scheme or CGHS provides extensive medical care to central government employees and pensioners. It has a large beneficiary base and provides healthcare through allopathic, homeopathic and AYUSH medicine systems. The scheme covers OPD/indoor treatment at government hospitals along with cashless facilities at empanelled hospitals.

Employees’ State Insurance Scheme

Financed by contributions from employees and employers, the Employees’ State Insurance Scheme (ESIS) aims to provide health insurance and social security to employees in hotels, restaurants, cinemas, shops, and other establishments where 10 or more persons are employed. In ESIS, employers contribute 4.75% of the wages they pay to employees, while employees contribute 1.75% of the wages.

Karuna Arogya Suraksha Padhathi

The healthcare scheme offered by the Kerala government, Karuna Arogya Suraksha Padhathi, provides health cover of ₹5 lakhs per family per year for secondary and tertiary care hospitalisation. Aimed at providing healthcare to poor and vulnerable families, the Karuna Arogya Suraksha Padhati covers medical expenses for medical examinations, pre-hospitalisation, diagnostics, and laboratory investigations, among others.

Mahatma Jyotirao Phule Jan Arogya Yojana

The government health scheme, the Mahatma Jyotirao Phule Jan Arogya Yojana, offered by the government of Maharashtra, aims to provide universal health coverage to all citizens of Maharashtra. It provides a health coverage of ₹5 lakhs per year on a family floater basis. Coverage is provided for surgeries and treatments requiring hospitalisation under 34 specialties.

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Benefits of government health insurance schemes

Government health insurance schemes spell several benefits for those covered by them. Some benefits offered by them are:

1

Affordable medical care

Government health insurance plans offer affordable medical care to the masses. Many individuals are unable to purchase regular health insurance due to a lack of funds. Being enrolled in government schemes helps them get basic care when confronted with any illness or ailment.

2

Coverage for family

Government health insurance plans provide coverage for the entire family. This means everyone in the family gets coverage, which comes in handy during emergencies. Doing so also helps increase health insurance penetration in the country.

3

Access to hospitals

Government health insurance schemes in India provide access to hospitals nationwide. This access ensures you get proper healthcare and access to quality doctors. This ensures quick recovery and you get back to your feet quickly.

4

Peace of mind

Government health insurance schemes offer peace of mind. You know you get financial support in case you or a family member gets hospitalised. Additionally, since it’s mostly funded by the government, you don’t need to pay anything from your pocket.

Frequently asked questions

What is the purpose of government health insurance schemes?

The primary purpose of government health insurance schemes in India is to make sure everyone has access to health insurance. These schemes are especially for the poor and needy families. They ensure the needy can get good medical treatment without worrying about large bills.

Can anyone buy government health insurance plans?

While anyone can opt for health insurance plans from the government, they are especially targeted towards the vulnerable sections of society. That said, if you fulfil the eligibility criteria, you can easily enrol in such schemes.

Are all government schemes initiated by the central government?

No. Not all government schemes are initiated by the central government. Some are initiated by the state government, too, for residents residing in that particular state.

Can a valid Aadhaar work as an identity proof to avail government health insurance scheme?

Yes. A valid Aadhaar card can serve as proof of identity to avail of government health insurance schemes in India. That said, there are certain other documents that you might be required to submit. Ensure that you submit the documents to easily avail of the scheme.

What is the sum insured in case of government health insurance schemes?

The sum insured in government health insurance plans isn't fixed. It varies across schemes.

What are the exceptions of government health insurance schemes?

Different schemes have different exceptions. It’s essential for you to read the policy wordings carefully and go through the scheme documents to understand the schemes. Understanding the exclusions in schemes is crucial to minimising the chances of claim rejection.

Where can I get more information about government health insurance schemes in India?

You can obtain more information about government health insurance schemes from the respective government portals offering the scheme (central or state). You can also get information about the scheme online.

How does a government health insurance scheme differ from regular health insurance plans?

Government health insurance schemes differ in terms of coverage offered, hospital networks under their ambit, waiting period for pre-existing ailments, tax benefits and much more. Their coverage amount is comparatively lesser than the ones offered by regular health insurance policies.

What are the main benefits of enrolling in a government health insurance plan?

Enrolling in government health insurance schemes provides access to low-cost and affordable coverage. You can access healthcare services at private and public hospitals, along with a low waiting period.

What are the most popular government health insurance schemes in India?

Ayushman Bharat Yojana, Central Government Health Scheme and Employees' State Insurance Scheme are some of the popular government health schemes in India. Some other popular ones include the Aam Admi Bima Yojana, Swasthya Sathi, and Mahatma Jyotirao Phule Jan Arogya Yojana.

Is there any eligibility criterion to buy public health insurance schemes?

The eligibility criteria differ across government health insurance schemes. Go through the respective scheme under which you want to enrol to know the specific criteria.

Are there any limitations in the government health insurance schemes?

Limitations can vary across policies. While some may not cover cosmetic procedures, others might limit coverage to daycare procedures, among others. Read the policy wording carefully to understand the limitations.

Is PMJAY & Ayushman Bharat Yojana the same?

Yes. PMJAY and Ayushman Bharat are the same. It’s a central government scheme that provides a cover of ₹5 lakhs per family per year for secondary and tertiary care hospitalisation.

Disclaimer:

The information provided in this page is for educational and informational purposes only. It is advised to verify the currency and relevance of the data and information before taking any major steps. Please read the sales brochure / policy wordings carefully for detailed information about on risk factors, terms, conditions and exclusions. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.

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