Government Health Insurance: An Introduction

Despite healthcare being one of the biggest sectors in India in terms of revenue and employee generation, health insurance penetration across the country is not at par with the total population. However, COVID-19 served as an eye-opener and diverted the attention of many people toward health insurance.

The government of India, both central and state, repeatedly makes efforts to make health insurance accessible to individuals and families belonging to the weaker economic section.

There are a bunch of government health insurance plans that are available in the market for individuals and families which will be discussed in this article. Government health insurance not only offers extensive coverage but also has affordable premium charges compared to private health insurance providers.

What Are Government Health Insurance Plans?

Before we dive into the list of government health insurance plans, let us understand what government health insurance is. Have you ever picked up a newspaper and read headlines like "Pradhan Mantri Bima Yojana launched for individuals of specific vocations"?

These are nothing but government health insurance schemes aiming to provide quality healthcare to low-income individuals and families. There are many more state and central government health insurance schemes launched to serve different purposes and improve the overall health of Indians in terms of affordable medical care.

List Of Government Health Insurance in 2024

Government health insurance is for everyone, individuals and families from all walks of life can benefit from a government health insurance plan. However, the weaker sections of society benefit the most from such health plans.

Scroll further to explore the latest government health insurance.

1. Ayushman Bharat Yojana

   Pradhan Mantri Jan Arogya Yojana (PMJAY) also known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana Scheme is a flagship National Health Protection Scheme funded by the Government of India. The scheme was launched on September-23-2018. This plan offers healthcare coverage to rural families as well as to the economically weaker section.

   The PMJAY or Ayushman Bharat Yojana offers cashless treatment at government hospitals and private hospitals. This scheme covers pre-hospitalization, hospitalization, post-hospitalization, and medication cost of the beneficiary during the treatment. The scheme offers 5 Lakh Health insurance by the government.

   Key Features

   • 1,400 procedures are covered like skull surgery, knee replacement, etc.
   • Covers the treatment of oncology with chemotherapy for 50 different types of cancers
   • A family floater scheme offering a sum insured of INR 5 Lakhs per family per year
   • Cashless hospitalisation available in public and private hospitals

2. Mukhyamantri Amrutam Yojana

   The state government of Gujarat launched the Mukhyamantri Amrutum Yojana scheme on 4th September 2012. It caters to people falling under the lowest income groups. It is one of the most beneficial Health Insurance Yojnas for low-income families, which provides health insurance to people Below the Poverty Line (BPL) or who come from a lower-income group or a middle-class family. The plan offers the sum assured of up to 3L per family per annum on a family floater basis.

   Key Features

   • Mukhyamantri Amrutum Yojana is a state-funded scheme
   • All beneficiaries can avail of cashless quality medical and surgical treatment for 698 pre-specified illnesses such as Cardiovascular diseases, Renal diseases, Neurological diseases, Burns, Poly-Trauma, Cancer (Malignancies), Neonatal (newborn) diseases, etc
   • Health Camps are held at the district level with the assistance of both private and government-affiliated hospitals under this scheme
   • In August 2014, Mukhyamantri Amrutam Yojana extended its services to lower-middle-class families which is also known as Mukhyamantri Amrutam Vatsalya Yojana

3. Dr YSR Aarogyasri Trust

   Designed for the welfare of residents of Andhra Pradesh, the Andhra Pradesh Government, and the Dr. YSR Aarogyasri Trust launched four beneficial schemes that offer medical cover to different categories of people.

   The schemes offered are the Dr. YSR Aarogyasari scheme for the welfare of the poor, the Arogya Raksha Scheme for families above the poverty line, the Working Journalist Health Scheme provides cashless treatment cover for specific procedures, and the Employee Health Scheme providing health cover to the state government employees.

   Key Features

   • Cashless services available for identified 2446 diseases
   • The scheme offers up to INR 5 Lakhs per family per annum on a floater basis
   • 4 schemes offer comprehensive coverage for medical treatments diagnostic tests, surgeries, and more
   • Includes coverage for maternity, critical illnesses, surgeries, etc.

4. Awaaz Health Insurance Scheme

   Launched by the Kerala Government in 2007, the Awaz Health Insurance Scheme is a health insurance program designed for migrant workers. It offers coverage to the families of workers who lose their lives due to accidents. The Health Insurance provides Rs.15000 health insurance coverage and Rs.2 lakh death insurance coverage. Any worker between the ages of 18 and 60 is eligible for this coverage.

   Key Features

   • Migrant labourers between the ages of 18 and 60 years are eligible for the scheme
   • The premiums of the scheme are fully subsidized by the government of Kerala
   • The scheme is valid for 1 year from the date of registration
   • A grievance redressal system is in place wherein scheme beneficiaries can lodge complaints on a toll-free number 1800-425-1076

5. Central Government Health Scheme

   Commenced in 1954, the Central Government Health Scheme provides comprehensive healthcare services to central government officials and pensioners in cities. All dispensary services, including domiciliary care, are available. Furthermore, beneficiaries have the option of being hospitalized if they are ill. On the other hand, if you require an X-ray or laboratory examination, these will be delivered free of charge. The scheme is operational in Kolkata, Mumbai, Lucknow, Delhi, Nagpur, and Pune

   Key Features

   • OPD treatments including medicines, specialist consultations, and reimbursement benefits can be availed
   • Diagnostic tests and health checkups are included in the CGHS scheme
   • Beneficiaries are offered health education
   • Cashless services are offered to the beneficiaries

6. Bhamashah Swasthya Bima Yojana

   Launched by the government of Rajasthan on 13th December 2015. Designed to provide the best healthcare facilities to the economically weaker sections of society, this health insurance scheme offers up to INR 3 lakhs for the treatment of critical illnesses.

   The citizens of Rajasthan are covered against 1715 listed ailments and are eligible for treatments including nephrology, neurology, and psychiatry.

   Key Features

   • Coverage of up to INR 30,000 for common illnesses
   • Coverage of up to INR 3 Lakhs for critical illnesses
   • The insured individual must be a resident of Rajasthan and must have a certificate of residence
   • Cover for investigation, doctor's fee, operation, etc are available with the plan

7. Chief Minister's Comprehensive Health Insurance Scheme

   CM Comprehensive Health Scheme is a health insurance product launched by the Tamil Nadu government on July 23, 2009, also known as Amma Health Insurance. The plan has been operating under the administration of United Health Insurance from January 2022 until 2027.

   This health insurance plan aims to provide high-quality medical care services to the citizens of the state by offering quality treatments, a generous sum insured, and more.

   Key Features

   • You can avail of treatments across private and government hospitals
   • Up to INR 5 lakhs per family per year on a family floater basis
   • A total of 1090 medical procedures are covered under this government scheme
   • People earning less than INR 75,000 annually in Tamil Nadu are eligible to benefit from this scheme

8. Employees State Insurance Scheme

   A large population makes up the workforce in Indian factories. The Employees State Insurance Corporation created the ESIC scheme to protect employees from the effects of sickness, maternity, illnesses, accidents, or deaths caused by work-related injuries, as well as to cover medical expenses for insured individuals and their families.

   Key Features

   • Long-term sickness coverage is available for 34 listed illnesses
   • Disablement benefit covers insured individuals against temporary disablement up to the end of the disability and permanent disablement for whole life.
   • This government health insurance plan also covers individuals for maternity benefits
   • Multiple value-added benefits are included in the scheme such as vocational training, funeral expense cover, and more.

9. Universal Health Insurance Scheme

   The Ministry of Health and Family Welfare launched the Universal Health Insurance Scheme across India for individuals and families living below the poverty line and above the poverty line in July 2003. The main goal of this scheme is to offer free medical care, especially to those who cannot afford it.

   Key Features

   • Personal accident cover is also available to cover the primary bread-winner of the family
   • The scheme is available to individuals and groups
   • Room boarding expenses are covered with a sub-limit defined as up to 0.5% of SI
   • Cost of surgeon, medical practitioners, consultants, etc with a sub-limit of 15% of SI per injury or illness

10. West Bengal Health Scheme

    The West Bengal Health Scheme is a government health welfare scheme launched by the state government of West Bengal. It was launched in the year 2008 and underwent some changes in the year 2014. The scheme is now known as 'West Bengal Health for all Employees and Pensioners Cashless Medical Treatment Scheme 2014'.

    Under this scheme, eligible individuals and families can avail of cashless medical treatments in the government-issued list of hospitals.

    Key Features

    • Avail cashless indoor treatment of up to INR 1 Lakhs in any hospital mentioned in the list of hospitals issued by the state government
    • In case treatment is availed at a non-network hospital, a certain percentage of the treatment cost will be reimbursed
    • Treatments can also be availed at 11 enlisted hospitals outside of West Bengal
    • OPD treatments for 17 listed diseases are available

11. Yeshasvini Health Insurance Scheme

    A government health insurance scheme that is community-based and designed for Karnataka's middle and lower-middle-income earning families. It was introduced in the year 2003, to help the sections of the society that are resource-poor.

    The plan extends its healthcare services to weavers, fishermen, Beedi workers, and Stree Shakti workers.

    Key Features

    • More than 1650 medical procedures are covered in the Yeshasvini Health Insurance Scheme
    • Up to INR 5 lakhs health sum insured is available
    • The scheme covers 823 surgical procedures as mentioned in the schedule
    • The Yeshasvini Health Insurance Scheme offers medical procedures at discounted rates to individuals below and above the poverty line

12. Mahatma Jyotiba Phule Jan Arogya Yojana

    The state government of Maharashtra launched the Mahatma Jyotiba Phule Yojana. This was first launched as Rajiv Gandhi Jeevandayee Arogya Yojana in July 2021. The MJPJAY was launched to provide cashless healthcare facilities for serious illnesses.

    Key Features

    • The plan covers beneficiaries for COVID-19 treatment
    • The sum insured offered under the MJPY is up to INR 1.5 Lakhs
    • The scheme covers beneficiaries for surgeries, treatments, diagnostics, and consultations
    • The scheme provides the facility to file claims for pre-existing conditions from day 1 of coverage

13. National Rural Health Mission

    The National Rural Health Mission Scheme was launched by the Prime Minister on 12th April 2005. It was designed to provide accessible, affordable, and premium-quality healthcare facilities to individuals and families residing in rural areas.

    Under the National Rural Health Mission, the government has mandated a special focus on North Eastern States, Jammu and Kashmir, and Himachal Pradesh.

    Key Features

    • Provides high-quality medical care facilities to the population residing in rural areas
    • Increasing awareness related to the harmful effects of smoking
    • Free ambulance service within 30 minutes
    • Free pre-natal and post-natal care for pregnant women

14. Swasthya Sathi Scheme

    Swasthya Sathi Scheme was launched by the Chief Minister of West Bengal on December 30, 2016. The scheme is designed to cover primary, secondary, and tertiary care costs up to INR 5 lakhs per family per year. The plan is a fully state-funded scheme and paperless.

    Key Features

    • The scheme covers all pre-existing conditions
    • No financial burden on beneficiaries as it is a fully state-funded health scheme
    • The scheme covers expenses for medical consultations, diagnostics, medical tests, etc
    • Under this scheme in-laws and any dependent physically challenged family members are covered

15. Biju Swasthya Kalyan Yojana

    The Biju Swasthya Kalyan Yojana is a state government health insurance policy launched on 15th August 2018 by the Orissa government. The scheme aims to provide universal health coverage, with a special focus on economically vulnerable families.

    Key Features

    • Free health services for all in all state government health care facilities like government medical colleges and sub-centers
    • Annual medical care coverage of INR 5 Lakhs per year
    • Women are offered coverage of up to INR 10 Lakhs per year
    • All services are free of cost including OPD, diagnostics, cancer chemotherapy, dialysis, etc

Difference Between Regular and Government Health Insurance

There are a few differences that separate government health insurance from private/regular health insurance which are mentioned below:

Benefits of Launching Government Health Insurance Plans

Conclusion

Government Health Insurance Schemes are an initiative that cater to the healthcare needs of the poor people. These programmes help the underprivileged to afford effective treatment for their medical problems.The schemes are, therefore, highly important as they assist India's underprivileged population in improving their level of living.

Health Insurance Companies