National Health Insurance Scheme in India

National Health Insurance Schemes are the health insurance programs initiated by the National government. To make health insurance accessible to the poor and destitute, our government has launched some health insurance schemes such as Rashtriya Swasthya Bima Yojana, Central Government Health Scheme, Employment State Insurance Scheme, Universal Health Insurance Scheme, Aam Aadmi Bima Yojana, and Janashree Bima Yojana among others.

Let’s check out the benefits offered by these schemes in detail-

1. Rashtriya Swasthiya Bima Yojana (RSBY)

Ministry of Labour & Employment, Government of India launched this National Health Insurance Scheme for families who are below the poverty line. The aim is to offer health insurance coverage to BPL families in an economical manner.

Under RSBY, the government has fixed the hospitalization cover limit at Rs. 30,000. The government has also fixed the hospital package rates.

Pre-existing illnesses are also covered without any age limit criterion. 5 family members including self, three dependents, and spouse can be covered.  The registration fee for the recipients is only 30 rupees and the premium is paid by the government to the insurance company.

Key Features of RSBY

The scheme offers health insurance coverage to low-income groups and its features are listed below:

Beneficiary -

The scheme offers freedom of choice to the beneficiary BPL household to select between the private and public hospitals. It makes them a prospective client on account of the revenues earned by the hospitals through the RSBY scheme.

Insurers -

The government pays the insurance premium to the health insurance providers on behalf of each household registered for RSBY. It further motivates the insurer to provide coverage to as many people from the Below Poverty Line list.

Hospitals -

Both public and private hospitals are given incentives to offer treatment to the insured members. And the Insurance companies supervise the participating hospitals to prevent fraudulent claim procedures.

Paperless and Cashless Transactions -

Beneficiaries can get cashless treatment in any of the network hospitals. The beneficiary only needs to carry the smart card and verify through the fingerprint. It is a paperless scheme as claims can be settled online and payment can be made electronically.

Intermediaries -

Intermediaries like MFIs and NGOs are paid for offering assistance to the BPL households.

Government -

The government is able to offer quality healthcare services with a sum of Rs. 750 per BPL family in a year. It will promote a good competition between private and public providers that will improvise the functioning of the public health care providers.

Pan India Coverage -

The beneficiary can use his/ her smart card to avail treatment in any of the network hospitals across India. That is why National Health Insurance Scheme is helpful for the poor families migrating to different places.

Information Technology -

The use of IT applications is on a large scale in the public sector schemes as well. The beneficiaries are given a biometric smart card with their photographs and fingerprints. Even all the empanelled hospitals are IT-enabled ensuring a seamless flow of data regarding health services.

Safe and Secured -

The use of key management system and biometric enabled smart card makes this scheme foolproof. Only the recipient can use the issued smart card in their name and the accountability is maintained.

2. Employment State Insurance Scheme

• Employees’ State Insurance Scheme (ESIS) is a Government’s scheme and is customized insurance that provides socio-economic security to workers and their dependents.
• Apart from full medical cover for self and dependents, the beneficiaries can also avail cash benefits if there is any health emergency, permanent and temporary disabilities, death due to occupation hazard, employment injury etc.
• Employment State Insurance Scheme is valid for non-seasonal factory employees. But the factory should have more than 10 employees.
• The Scheme is also applicable to hotels, shops, cinemas, restaurants, newspaper establishments and road-motor transport enterprises employing more than 20 people.
• Employment State Insurance Scheme is implemented area-wise in all the States apart from Sikkim, Manipur, Mizoram, Arunachal Pradesh, and Union Territories

3. Central Government Health Scheme

CGHS or the Central Government Health Scheme offers all-inclusive health care services to the Central government employees. It includes the pensioners as well as their dependents who are living in specific cities.

It was started in 1954 by the Central Government. The healthcare services are offered through Wellness Centres (CGHS Dispensaries/ Allopathic, Yoga/Ayurveda, Siddha, Unani, and Homeopathic Centres).

The Major Components of this Scheme are-

• Dispensary services
• Domiciliary care
• Consultation with a specialist at hospital, polyclinic and dispensary’
• Medical tests including ECG, X-Ray and laboratory tests
• Hospitalization cover
• Medicines requirements
• Health education

4. Aam Aadmi Bima Yojana

Aam Admi Bima Yojana or AABY scheme was commenced on October 02, 2007 for rural, landless households. The National Health Insurance Scheme covers the earning member of a household between the age group of 10 & 59 years. Compensation provided is as follows -

• Compensation of Rs 30,000 in case of natural death
• Compensation of Rs. 75,000 in case of accidental death, partial or permanent disabilities ( loss of 2 limbs or 2 eyes)
• Compensation of Rs. 37,500 in case of partial permanent disabilities resulting from an accident (one limb or an eye)

5. Universal Health Insurance Scheme

UHIS scheme is being implemented by four public insurers to provide health insurance coverage to poor families.

In this scheme, the sum assured limit is up to Rs. 30,000 on family floater basis for hospitalization expenses. Accidental death cover offered to the policyholder is 25,000 rupees. Compensation of Rs. 50 is provided on a daily basis, if there is a loss of income.

In the case of an individual the premium subsidy is now increased to Rs. 200 from Rs.100, for 5 members it has been increased to Rs. 300 and for seven members it has been increased to Rs. 400 with the same benefits.

6. Janashree Bima Yojana

Janashree Bima Yojana or JBY scheme was launched by the Government of India in August 2000.

People between the age group of 18 and 59 years (members of the specific 45 professional groups) can get covered under JBY scheme.

7. Ayushman Bharat - National Health Protection Mission

Ayushman Bharat, a National Health Protection Scheme, will offer cover to more than 10 Crore vulnerable and poor families offering coverage up to Rs. 5 Lakh per family every year for tertiary and secondary care hospitalisation. This scheme aims at subsuming the schemes that are in progress and are sponsored by the Central Government such as Senior Citizen Health Insurance Scheme (SCHIS) along with Rashtriya Swasthya Bima Yojana (RSYB).

Ayushman Bharat - National Health Protection Mission will have benefit cover of 5 Lakh rupees per family every year. Under this scheme, the benefits can be availed at any empanelled private and public facilities by the beneficiaries.

The main principle of this scheme is to cooperative flexibility and federalism to the states. In order to implement this scheme, the states would require to have the State Health Agency (SHA).

All the above mentioned National Health Insurance Schemes were designed to offer the best medical services to the BPL families.