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National Health Insurance Scheme India

National Health Insurance Scheme is introduced by the National Government of India. This National Health Insurance Scheme is particularly initiated for the less fortunate people who can’t afford health insurance plans in India. Below are the individual schemes having different perspectives which are eligible and affordable to Needy people or BPL (Below Poverty Line) families.

National Government has included some types of national health insurance plans/programs under the National Health Insurance Scheme such as Ayushman Bharat - National Health Protection Mission, Rashtriya Swasthiya Bima Yojana (RSBY), Central, Government Health Scheme (CGHS), Employment State Insurance Scheme (ESIS), Aam Aadmi Bima Yojana (AABY), Janashree Bima Yojana (JBY), and Universal Health Insurance Scheme (UHIS).

What are the National Health Insurance Schemes in India?

Let us understand the advantages and disadvantages of National Health Insurance Schemes,

Ayushman Bharat - National Health Protection Mission

Ayushman Bharat – National Health Protection Scheme is for poor families considering the cost of 10 crores to all families, this covers every year each family with Rs. 5 lakhs for 2nd and 3rd care hospitalization.

In this scheme itself, the central Indian government involves Senior Citizen Health Insurance Scheme (SCHIS) with Rashtriya Swasthya Bima Yojana (RSYB). This scheme can be benefited by public health services and private recipients. The scheme is implemented to the state when the people cooperate as a union and require having a state health agency (SHA).

Benefits:
  • Pre-hospitalization expenses, Post- hospitalization expenses follow up to 15 days
  • Medical Consultation and treatment
  • Food, Accommodation Services
  • Cashless Hospitalization cover
  • Intensive and Non-intensive services
  • Complicated Treatment covers
  • ICU, Lab Investigations, and diagnostics procedures
  • Medicine expenses, etc.
Exclusions:
  • OPD expenses
  • Organ Transplants
  • Fertility Procedures
  • Drug rehabilitation procedure
  • Cosmetic Procedures

Rashtriya Swasthiya Bima Yojana (RSBY)

Rashtriya Swasthiya Bima Yojana (RSBY) is first introduced by the Ministry of Labour and Employment, India. This scheme provides health insurance coverage against medical expenses to less fortunate people due to hospitalization. The main benefit of the scheme is it gives coverage up to Rs.30, 000.

Benefits:

The scheme offers BPL families to select in between private and public hospitals.

  • Public & Private Hospitals cover
  • The government pays insurance premiums or package rates to the insurance providers on registering to RSBY and PAN India covers
  • Cashless treatment & Paperless Transactions
  • Intermediary Assistance
  • Safe Digitalization and IT (information technology) service.
Exclusions:
  • Rise of empanelled Hospitalization expenses
  • Doesn’t cover Out-patient Services
  • Cheap treatments
  • Add-on Costs by hospitals

Central Government Health Scheme (CGHS)

The Central Government health scheme was started in 1954 and is for employees who are working in Central Government. The service also provides pensions to the depending on specific area peoples. The health care services offer Wellness Centres (CGHS), Yoga/Ayurveda, Homeopathy, Siddha, and Unani.

Benefits:
  • Hospitalization Cover
  • Requirement of Medicines
  • Specialist Consultation at hospital
  • Health Education
  • X-Ray, ECG, Medical, and Laboratory tests
  • Dispensary & Domiciliary care services
  • The treatment can be done at any hospital, in case of emergency. The CGHS card is available at the registered office where reimbursement claims can only be submitted to the Additional General.
  • Limited Medical bills, Treatment at the hospital the claim amount are as per CGHS.

Employee's State Insurance Scheme (ESIS)

Employment State Insurance Scheme (ESIS) is a social security scheme that specially designed for workers and their dependents. This scheme provides full Medicare and also applies for cash tax benefits in terms of physical distress due to temporary/permanent disablement, sickness, etc.

Benefits:
  • Medical care services & Maternity healthcare expenses, Disability, Sickness, Unemployment, Old age, and Funeral Costs.
  • The scheme has been extended to hotels, shops, restaurants, cinemas (including preview theatres), road-motor transport undertakings, and newspaper establishments.
  • The ESI Scheme is implemented in some areas. Already, it has been implemented in all states except Sikkim, Manipur, Arunachal Pradesh, and Mizoram and two Union Territories, namely Delhi and Chandigarh.
  • To the unseasonal factories operating ten or more people and also for private medical and educational institutions having twenty or more people in certain states/Union Territories.
Exclusions:
  • The Employment State Insurance Scheme (ESIC) scheme currently does not cover workers or employees earning more than Rs.21, 000 per month and in the case of persons with a disability, the maximum wage is at Rs.25, 000 per month.
  • Also, in Maharashtra and Chandigarh, the current coverage is for 20 employees and not 10 employees in the case of other states/uts Union Territories.

Aam Aadmi Bima Yojana (AABY)

Aam Aadmi Bima Yojana (AABY) scheme was initiated for rural and landless households it covers the age group of 10 to 59 years. It compensates natural death covers up to Rs.30, 000, for accidental death up to Rs.75, 000, and for permanent disabilities caused by accidents covers up to Rs.37, 500.

Benefits:
  • Natural Deaths, partial disability or permanent disability due to accident
  • Affordable, Technical assistance
  • Social security to low income families
Exclusions:
  • Cost of hospitalization
  • Mental disorders
  • Suicide
  • Death due to substance abuse

Janashree Bima Yojana (JBY)

Janashree Bima Yojana (JBY) is introduced by government of India for people of age group between 18 to 59 years it covers 45 professional groups under this scheme. The Coverage is for less fortunate people.

Benefits:
  • natural death happened person family will be paid up to Rs. 30, 000.
  • Due to accident occurs lifelong disability covers up to Rs. 75, 000 and for partial disability covers up to Rs. 37, 500.
  • Premium per person is Rs. 200
  • An applicant or state government or nodal agency pays around 50% of the premium. The Socio economic Fund pays the remaining 50%.
Groups covered in this scheme:
  • Anganwadi, Beedi, Carpenters, Power loom workers, chemical factory workers
  • Rubber and coal-producing, milk, Printing, Press workers, Handloom workers, Handicraft, and Transportation workers, etc.

Universal Health Insurance Scheme (UHIS)

Universal Health Insurance Scheme (UHIS) is to provide health insurance coverage to BPL families or above it and this scheme is implemented by four public sector general health insurance companies and will work combine.

Benefits:
  • The scheme covers up to 0.5% of Sum Insured per day for Room, Boarding expenses as provided by the Hospital or Nursing Home. If the individual is admitted in the Intensive Care Unit (ICU) up to 1% of the sum insured per day can be claimed for above/below poverty line families.
  • For BPL families it also covers Maternity, Personal accident cover, disability compensation.
Exclusions:
  • Terrorism or invasion.
  • Disease or injury due to war
  • Circumcision is included only in the case of necessary treatment or disease or in case of an accident.
  • Expenses related to spectacles, hearing aids, contact lenses are not covered.

Top 10 advantages and disadvantages of National Health Insurance Scheme

National health insurance advantages and disadvantages

The below are the Top 10 advantages of National Health Insurance Scheme:

  1. Pre-hospitalization expenses, Post- hospitalization expenses follow up to 15 days
  2. Medical Consultation and treatment
  3. Complicated Treatment covers
  4. Public & Private Hospitals cover
  5. Cashless treatment & Paperless Transactions
  6. X-Ray, ECG, Medical, and Laboratory tests covers
  7. Medical care services & Maternity healthcare expenses, Disability, Sickness, Unemployment, Old age, and Funeral Costs.
  8. Natural Deaths, partial disability or permanent disability due to accident
  9. The scheme has been extended to hotels, shops, restaurants, cinemas (including preview theatres), road-motor transport undertakings, and newspaper establishments.
  10. Social security to low income families and technical assistance

below are the Top 10 disadvantages of National Health Insurance Scheme:

  1. Rise of Hospitalization expenses, Out-patient services
  2. Cheap treatments
  3. Add-on Cost by hospitals
  4. Minimum cost coverages
  5. Health insurance covers for small group of peoples
  6. Doesn’t cover for injury due to war
  7. Suicidal treatments and covers
  8. Waiting period for existing health problems
  9. Negligence and less support assistance
  10. Loss of medical consultations.

FAQs of National Health Insurance Scheme

What is the Diseases Covered under Ayushman Bharat Health Scheme?

Some of the Critical illness diseases covered under Ayushman Bharat Health Scheme is Prostate cancer, coronary ABG, Skull base surgery, double value replacement, Spine Fixation, Expand of Tissue in disfigure due to burns, etc.

What is the insurance coverage in RSBY?

Rashtriya Swasthya Bima Yojana covers for hospitalization expenses up to Rs.30, 000 for a family of five on a floater basis. Transportation charges are also covered up to a maximum of Rs. 1000 with Rs. 100 per visit.

Is CGHS operational in all cities in the country?

No, Central Government Health Scheme is operating on 37 cities in the country such as Vishakhapatnam, Shimla, Ranchi, Puducherry, Patna, Mumbai, Lucknow, Chennai, Bangalore, Hyderabad, Kolkata, etc.

How do I apply for Central Government Health Scheme (CGHS) online?

You can apply for CGHS online by giving a duly-filled application form available from the official website of cghs.nic.in and cghs.gov.in. This application form can also be availed from any of the listed health and wellness centres.

Is Janashree Bima Yojana a life insurance scheme?

No, it extends financial assistance even in case of permanent or partial disability due to an accident. So, the scheme does not only cover the death of an individual person.

What are the benefits that are covered, under maternity, which is available only for BPL families in UHIS?

Maternity Benefit means expenses include in Hospital/Nursing Home arising from or accountable to Pregnancy, childbirth including normal Caesarean Section. This also includes medical expenses incurred in respect of new born child up to 3 months.

Am I eligible for National Health Insurance Scheme in India?

The eligibility is based on each scheme and NHIS is introduced mainly for BPL families, scheduled caste and scheduled tribe households, Beggars and those surviving on alms, Families with no individuals aged between 16 and 59 years, Families with no male member aged 16 to 59 years, etc.

How to apply for National Health Insurance Scheme in India?

Go the National Health Insurance Scheme NHIS.gov.in , choose your required scheme and fill application form and apply online. If need help call? 1800-180-1104.

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