Know About all the Government Health Insurance schemes

All govenment schemes

Healthcare related costs are known to deplete the savings of families and put them under a lot of financial stress. People who are economically weaker, usually suffer the most in such circumstances. As a financial advisor, you can do your bit for the society by educating people of the various ways they can mitigate this risk. You can continue working on your career of being a successfully advisor but at the same time help people educate about the schemes available.

Fortunately, the Government of India has introduced several schemes, keeping in mind the health of the common man. Here are some of the most prominent ones. As an insurance advisor, if you are aware of these schemes, you can explain them to someone who cannot afford to buy health insurance plans with high premiums.

  1. Ayushman Bharat

Ayushman Bharat is the popular name of Pradhan Mantri Jan Arogya Yojana (PMJAY). The insurance plan aims at providing healthcare facilities for individuals who are economically vulnerable. Beneficiaries of the policy receive an e-card, with the help of which they can avail cashless treatment at public, private or empaneled hospitals.

    • The plan offers 3 days of pre-hospitalisation cover
    • The plan offers 15 days of post-hospitalisation cover
    • The plan covers more than 1,400 medical procedures
    • It offers INR 5 lakh as the coverage for a family for a year for secondary and tertiary care
    • The plan covers any sort of pre-existing conditions from day one
    • Individuals do not have to pay any premiums to avail the scheme
    • The data collected from Census 2011 is primarily used for the eligibility criteria. The scheme is predominantly for economically weaker section with some exceptions
    • There isn’t a registration form for this scheme. If you are identified as a vulnerable family as per Census 2011, you will be added to the scheme automatically.

Official Website: https://www.pmjay.gov.in/

  1. RSBY

The Rashtriya Swasthya Bima Yojana is another health insurance scheme designed for Indians working in the unorganized sector. The plan is for individuals who come under the Below Poverty Line. Here are some of the major benefits of the plan.

    • It offers a sum insured of INR 30,000 for a family on a floater basis
    • The plan offers cashless treatment facilities
    • It covers the expenses related to the transportation of the patient
    • The plan covers all pre-existing diseases
    • Beneficiaries can choose from either private or public hospitals for treatment
    • A beneficiary must pay INR 30 per annum as registration fees
    • There are enrollment centers across the country where on can apply for the scheme. The enrollment centers have data for qualifying families in the locality.

Official Website: http://www.rsby.gov.in/

  1. ESIS

The Employees’ State Insurance Scheme is another health plan that might interest some. The plan intends to offer workers a safe socio-economic environment where workers and their family members receive adequate healthcare.

    • The plan offers several cash benefits for their beneficiaries for instances such as total or partial permanent disability, sickness, etc.
    • It offers maternity benefits up to 26 weeks and it can be extended by a month
    • The plan is applicable for unemployed individuals as well, but for a period of three years
    • The benefits of the plan extend to a maximum of 70% of the total wages of an employee up to a duration of 91 days. Employees must work for a minimum of 78 days in the previous 6 months.
    • Pehchan card from your employer is essential to utilizing the benefits of the scheme.
    • The policy offers expenses for funerals limited to INR 10,000.

Official Website: https://www.esic.nic.in/

  1. CGHS

CGHS stands for Central Government Health Scheme and the scheme is exclusively for current as well as former central government employees. The health care benefits are offered at certain places only and not across the country. Places such as Dehradun, Chennai, Hyderabad, Bangalore, Bhubaneswar, Indore, Bhopal, Ahmedabad, Lucknow, Kanpur, Kolkata, Patna, Meerut, Mumbai, Allahabad, Guwahati, Pune, Jaipur, Ranchi, Nagpur, Jammu, Thiruvananthapuram, Jabalpur, Chandigarh, Delhi and Shillong are included. Here are some salient features.

    • The plan offers coverage for indoor treatment, OPD, specialist consultation, etc. at any empaneled hospital or government hospital
    • Beneficiaries can avail cashless facilities
    • The plan covers expenses under AYUSH (Ayurveda, Unani, Homeopathy and Siddha)
    • It covers OPD expenses including that of medicines
    • Employees of the central government, members of parliament, railway board employees, freedom fighters, pensioners of the central government, employees of post and telegraph department, etc. are eligible for the scheme.
    • The premium for the scheme depends on the pay grade of the beneficiary and contributions towards CGHS is made from their salary.
    • You can visit the official website to get the list of all the cities that offer the CGHS benefits.

Official Website: https://cghs.gov.in/

  1. UHIS

Universal Health Insurance Scheme aims at making healthcare affordable for all the citizens of the country. At present, the scheme covers about 25% of the total population of the country. The scheme is available for families above and below the poverty line. Here are the major benefits.

    • The plan is available for individuals as well as groups
    • The plan covers any individuals between 5 years and 70 years
    • The scheme is available for a nominal premium of INR 300 per year
    • Beneficiaries covered under this scheme cannot be a part of any other scheme
    • The policy offers coverage of INR 30,000 for hospitalization benefits, maternity benefit of INR 2,500 and caesarean benefits of INR 5,000
    • The plan offers personal accident cover of INR 25,000 for an earning family member.
  1. AABY

The Aam Aadmi Bima Yojana is another health insurance plan for citizens of the country who are a part of 48 identified groups. The scheme was introduced on the 2nd of October 2007 and is administered by the Life Insurance Corporation of India.

    • In case of the death of the beneficiary, the nominees will receive INR 30,000
    • The plan offers Scholarship as an add-on benefit
    • Head of a family or the earning member of the family between 18 to 59 years is eligible for the scheme.
    • Beneficiaries of the scheme need to pay INR 200 annually.

Official Website: https://www.licindia.in/Products/Aam-Aadmi-Bima-Yojana

Being aware of the above schemes will help you become a better insurance advisor. You can continue focusing on your career and at the same time, aid support to people who need help with the above schemes.

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