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HEALTH INSURANCE

Objectives of the Government Health Insurance Scheme

Jagrity Sharma Jagrity Sharma 19 July 2019

Health insurance is more of a necessity than a luxury. As it has become an integral part of our system, the Government has put its best foot forward to promote the same. Read on to know how you can benefit or contribute towards the same.

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Health Insurance is a vast industry. There are numerous companies that offer innumerable types of health insurance policies to customers. In spite of this, recent statistics portray that approximately ONLY 20% of the population in India has health insurance.

In India, medical costs are constantly escalating. There is no doubt, that people must have health insurance coverage that secures them from financial burden in such times. Hence, it is imperative that affordable Health Insurance plans that offer standard health care must be made available to the people. However, most people find health insurance premiums quite high. So to ensure that everyone benefits, the government has established various health insurance plans for the utmost benefit of the public.

Health insurance in India

More than 100 crore people in the country don’t have any kind of health insurance which can cover them against any health issue. Keeping this in mind, the Government of India has launched different health insurance schemes which are affordable and provide a moderately good cover against any medical emergency. National health insurance schemes are basically health programs initiated by government for making health facilities accessible for poor and destitute class. Government has launched some health insurance schemes like Rashtriya Swasthya Bima Yojna, Central Government Health Scheme, Employee’s State Insurance Scheme, Universal Health Insurance Scheme, Janashree Bima Yojna and Aam Aadmi Bima Yojna.

In urbanised places like cities, people have access to better health care facilities. To make Health Insurance plans affordable and accessible to the common man as well, the government has launched the following schemes, so as to incorporate the importance of health insurance in everyone.

Let’s first check what these different National Health Insurance schemes do:

Rashtriya Swasthya Bima Yojana (RSBY)

With the aim of providing health care protection and coverage to Below Poverty Line (BPL) families, the Ministry of Labour and Employment, Government of India has launched the Rashtriya Swasthiya Bima Yojana (RSBY). Their objective is to financially protect Below Poverty Line (BPL) families from monetary burdens and liabilities that are a result of unfortunate health-related situations and emergencies. Under this scheme, the beneficiaries are eligible to receive a coverage of upto Rs. 30,000 for a list of diseases that need hospitalization. There is no age limit and pre-existing conditions are also provided coverage. Beneficiaries are required to pay Rs. 30 as a registration fee. The premium is paid by the central and state government to the chosen insurance company. The insurer is selected on the cornerstone of vying bidding.

Basic features of RSBY can be mentioned as:

  • RSBY scheme has cashless and paperless transactions. The beneficiary receives cashless benefit in any of the enlisted hospitals. For this, the beneficiary is required to carry his or her smartcard along and provide fingerprint for verification. RSBY is a paperless scheme for participating providers. They are not required to send all the papers pertaining to the treatment. They can simply receive payment electronically by sending claims online.

  • The most unique characteristic of RSBY is portability, which means that although the beneficiaries enroll in a specific district, their smartcard can be used in any of the enlisted hospitals across India.

  • RSBY offers the beneficiaries with the choice between private and public hospitals. Thus, this makes the beneficiary a prospective client worth inveigling on the basis of the revenues that hospitals may earn through these schemes. So, if you know of anyone who can benefit from enrolling in RSBY, ensure that you inform them of the benefits so that they can make the most of it.

The next scheme that is worth mentioning is the ESIS.

Employees State Insurance Scheme (ESIS)

The Employee’s State Insurance Scheme (ESIS) is a multifaceted community-based security system customized to give socio-economic protection to workers and their families. ESIS provides complete medical care from the first day of employment. Besides this, insurers are also eligible for cash benefits in case of physical immobility/pain/distress, any disease or any kind of disability whether temporary or permanent that leads to inability to earn, immurement of women, dependents of the insured who can die in industrial accidents, injury caused during employment or occupational hazards are granted a pension that is paid monthly and is known as the dependant’s benefit.

The most important aspects of ESIS are:

  • This scheme is applicable to non-seasonal factories that have 10 or more employees.

  • The scheme also includes shops, restaurants, cinemas, hotels, newspaper organisations, road motor-transport enterprises and preview theatres that have 20 or more employees.

  • ESIS also involves Private Medical and Educational institutions that have 20 or more employees.

Although ESIS is quite popular and most workers are aware of the same, it makes sense to reiterate the same to them in case of any doubt.

The Central Government employees have specific and amazing health scheme that are available only for them. It is called CGHS.

Central Government Health Scheme (CGHS)

The aim of the Central Government Health Scheme is to offer unabridged health care services to former as well as current central government employees. This is also available for pensioners along with their dependants living in CGHS covered places. One can make a CGHS card from the office of the Additional Director of the City. As of now, CGHS is provided in specific areas like Hyderabad, Bhopal, Bhubaneswar, Chandigarh, Delhi, etc. These medical services are offered through wellness centres Homeopathic, Yoga, Allopathic, Ayurveda, Unani and Sidha ways of medications.

The beneficiaries of this scheme include:

  • Members of the Indian Parliament (former as well as existing)
  • Indian freedom fighters
  • Former Indian Vice-Presidents
  • Railway board workers
  • Judges of the Supreme Court and the High Court of India (Former as well as existing)
  • Journalists who are qualified with PIB (in Delhi)
  • Police Personnel (Delhi only)

This list is not exhaustive. There is complete list of eligible members on the official website of CGHS. If you come across anyone from this genre, do apprise them of the benefits. The benefits of this scheme are unparalleled!

The most talked about Government Health Scheme today is the AABY. What is that all about? Let us know that:

Aam Aadmi Bima Yojana (AABY)

The government of India established the Aam Aadmi Bima Yojana as a form of a social security scheme. This scheme provides financial protection to the family head or to one earning member of the family. The Aam Aadmi Bima Yojana and Janashree Bima Yojana have been combined with respect to the proposal made by the Ministry of Finance. In 2013, the scheme was named ‘Aam Aadmi Bima Yojana.’

The prominent features of the AABY can be summarised as:

  • Aam Aadmi Bima Yojana offers financial help and social security to rural population
  • It provides Below Poverty Line (BPL) people with social security
  • It gives social security to people with no access to health care at all
  • People between the age group of 18 to 59 years are eligible for this policy
  • Free add-on benefits as scholarship for a maximum of two children between standard 9 and standard 12th, who are mentioned as the nominees or beneficiaries of the policy holder.

Conclusion

The Government Health Insurance Schemes offer financial protection for the insurer, family members, spouse and children. A health insurance plan is a significant facility that every person must acquire. To make this possible to the poor population of the country and achieve the objective of health care facilities, the government launches such schemes.

So, if you or anyone in your known circle can avail any of the above-mentioned health schemes of the Government, let us join hands to communicate the same to them. This will not only help them to make the most of the health benefits offered by the Government, but also take our country a step towards a healthier India. Jai Hind!

Jagrity Sharma
Written by Jagrity Sharma
A bibliophile who hates alliterations, but loves cream, comics and content immensely! On another note, a content marketer who leverages the power of words to explain...almost anything!