National Health Insurance Scheme in India - (NHIS 2016)

What is National Health Insurance Scheme?

A National Health Insurance Scheme is a health insurance program initiated and maintained by the Government of India. In order to provide adequate healthcare to the poor section of the society, the Government of India along with the Ministry of Health & Family Welfare and National Knowledge Commission, has set up the National Health Portal. The purpose of National Health Portal is to provide healthcare related information to the citizens of India and to serve as a single point of access for consolidated health information. Under this portal, multiple healthcare plans have been established.

Let us learn more about each of these plans.

Note: All information has been sourced from the official website of National Health Portal.

List of National Health Insurance Schemes (NHIS)

Rashtiya Swasthiya Bima Yojana (RSBY)

RSBY has been launched by the Ministry of Labour and Employment, Government of India to provide health insurance coverage for Below Poverty Line families. The beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000/- for diseases that require hospitalization. There is no age limit under RSBY and pre-existing diseases are covered from day one. The beneficiary simply has to pay a registration fee of Rs. 30 and the premium is paid by the Central and State Government. Also, you can avail cover for the head of household, spouse and up to three dependents.

Features and Benefits

  • BPL families and households have the freedom of choice between public and private hospitals.
  • The state and central government pays the premium on behalf of the BPL household. This motivates the insurer to cover as many dependents as possible.
  • Both public and private hospitals receive incentives to treat beneficiaries under RSBY as the money from the insurer will flow directly to the concerned public hospital which they can use for their own purposes. This also prevents fraudulent claim procedures.
  • The BPL households are assisted by intermediaries such as NGOs and MFIs. In return, the intermediaries are paid for the services they render in reaching out to the beneficiaries.
  • The government is required to pay only Rs. 750 per member. With such a small amount, the government is able to provide access to quality health care to the below poverty line population.
  • Under this scheme, every beneficiary family is issued a biometric enabled smart card containing their fingerprints and photographs. This ensures a smooth data flow regarding service utilization periodically. The use of such technology makes this scheme safe and foolproof.
  • A beneficiary who has been enrolled in a particular district will be able to use his/ her smart card in any RSBY empaneled hospital across India. This facilitates easy migration. Also, the card can be split for migrant workers.
  • The entire scheme comes with a cashless benefit. The beneficiary simply needs to carry his/ her smart card and provide verification through his/ her finger print in any of the hospitals. The online claims get settled electronically.

Employees State Insurance Scheme (ESIS)

This social security scheme is designed to provide socio-economic protection to worker population and their dependents. Under this plan, the beneficiaries are allowed various cash benefits in case of physical distress due to sickness, temporary or permanent disablement etc. resulting in loss of earning capacity, the confinement in respect of insured women, dependents of insured persons who die in industrial accidents or because of employment injury or occupational hazard. Under these situations, the beneficiaries are entitled to a monthly pension called the dependents benefit.

Coverage and other details

  • The Act is applicable to non-seasonal factories employing 10 or more persons.
  • The Scheme has been extended to shops, hotels, restaurants, cinemas including preview theatres, road-motor transport undertakings and newspaper establishments employing 20 or more persons.
  • The Scheme has been extended to Private Medical and Educational institutions employing 20 or more persons in certain States/UTs.

Note: 14 State Govts. / UTs have reduced the threshold limit for coverage of shops and their establishments from 20 to 10 or more persons. Remaining State Governments/UTs are in the process of reducing the same. The existing wage limit for coverage under the Act is Rs. 15,000/- per month (w.e.f. 01/05/2010).

Central Government Health Scheme (CGHS)

The Central Government Health Scheme is designed to provide comprehensive health care facilities to central government employees/pensioners and their dependents living in CGHS covered cities. The medical facilities are provided through Wellness Centres/polyclinics under Allopathic, Ayurveda, Yoga, Unani, Sidha and Homeopathic systems of medicine.

Features and Benefits

  • Dispensary services including domiciliary care
  • F. W. & M.C.H. Services
  • Specialists’ services & medical consultation facilities both at dispensary, polyclinic and hospital.
  • X-Ray, ECG and Laboratory Examinations.
  • Hospitalization
  • Organization for the purchase, storage, distribution and supply of medicines and other requirements.
  • Health Education

Aam Aadmi Bima Yojana (AABY)

This is a social security scheme for rural landless households. It was launched on 2nd October, 2007. Under this scheme, the head of the family or one earning member in the family is covered. The cost of premium is Rs. 200 which is paid by the central and state government. The age limit is 18 years to 59 years.

Features and Benefits

  • The Aam Admi Bima Yojana Premium Fund has been set up by Central Govt. to pay the Govt. contribution and is maintained by LIC. A free add-on benefit in the form of scholarship to children is also available.
  • On natural death - Rs. 30,000.
  • On death due to accident / on permanent disability due to accident (loss of 2 eyes or 2 limbs) - Rs. 75,000.
  • On partial permanent disability due to accident (loss of one eye or one limb) - Rs. 37,500.

Janashree Bima Yojana

Launched on 10th August 2000, this scheme provides life insurance cover to 45 occupational groups. They have been mentioned below. Effective from 01.01.2013, Aam Admi Bima Yojana and Janashree Bima Yojana have been merged into one scheme and renamed as Aam Admi Bima Yojana.

  • Beedi workers
  • Brick kiln workers
  • Carpenters
  • Cobblers
  • Fisherman
  • Hamals
  • Handicraft Artisans
  • Handloom Weavers
  • Handloom & Khadi weavers
  • Lady Tailors
  • Leather Tannery workers
  • Papad workers attached to SEWA
  • Physically handicapped self-employed persons
  • Primary milk producers
  • Rickshaw pullers/Auto Drivers
  • Safai karmacharis
  • Salt growers
  • Tenduleaf collectors
  • Scheme for urban poor
  • Forest workers
  • Sericulture
  • Toddy tappers
  • Sheep breeders
  • Woman associated with SHG
  • Plantation workers
  • Kotwal
  • Aanganwadi Workers/Helpers
  • Coconut processors
  • Firecrackers workers
  • Construction workers
  • Rural poor
  • Transport karmacharis
  • Transport drivers association
  • Agriculturists
  • Mineral products like earthern toys manufacture
  • Chemical products like candle manufacture
  • Rubber and coal products
  • Printing
  • Manufacture of leather products
  • Manufacture of paper products
  • Manufacture of food products
  • Textile
  • Food stuffs like khandsari/Sugar
  • Hilly area woman
  • Power loom workers

Universal Health Insurance Scheme (UHIS)

This scheme is managed and implemented by four public sector general insurance companies. It is directed to assist poor families. Under this scheme, beneficiaries can reimburse medical expenses of upto Rs. 30,000/- towards hospitalization floated amongst the entire family or death cover due to an accident of Rs. 25,000/- to the earning head of the family and compensation due to loss of earning of the earning member Rs. 50/- per day upto maximum of 15 days. The rate of premium stands at Rs. 200 for an individual, Rs. 300 for a family of five and Rs. 400 for a family of seven.

Ayushman Bharat Health insurance - National Health Protection Mission

The Ayushman Bharat is a national health protection scheme which will cover over 10 crore BPL families (approximately 50 crore beneficiaries). The scheme will provide coverage upto Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization.

Note: Ayushman Bharat - National Health Protection Mission will subsume the on-going centrally sponsored schemes - Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

Features and Benefits

  • The benefits of this scheme are portable across the country.
  • The beneficiary can take cashless benefits from any public/private empaneled hospitals across the country.
  • It will facilitate a paperless, cashless transaction.
  • It will provide increased benefit cover to nearly 40% of the population, i.e. the poorest and the vulnerable.
  • It will target 10.74 crore poor, deprived rural families and identified occupational category of urban workers' families as per the latest Socio-Economic Caste Census (SECC) data covering both rural and urban.

Conclusion

From this article, we can clearly see that the Government of India has established many positive schemes for the health and well-being of the poor population of the country.

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