5 cost - effective government-sponsored Health Insurance Schemes in 2018

The health insurance coverage remains abysmally low in India. With rising cost treatments, even a small illness can lead to a huge expenditure. This makes it imperative that you get health insurance coverage for yourself and your family. Getting a health insurance can help you cover expenses such as doctor’s fee, and pre and post hospitalization charges, among other benefits.

While there are a number of private health insurances companies in India, many people still prefer to put their trust in government-sponsored health insurance schemes. If you are planning to get yourself a government-sponsored health insurance plan, then here are the 5 cost-effective government sponsored health insurance schemes.

The RashtiyaSwasthiyaBimaYojana(RSBY) has been launched by the Ministry of Labour and Employment, Government of India to provide health insurance coverage to Below Poverty Line (BPL) families. The basic objective of the RSBY is to provide protection to BPL families from financial liabilities arising due to health conditions involving hospitalization. Under RBSY, the beneficiaries are entitled to hospitalization coverage of up to ₹30,000. There is no waiting period for pre-existing conditions and they are covered from day one.There is also no age limit. The coverage of RSBY extends to five members of the family; the head of the household, spouse, and up to three dependents. The registration fee for RSBY is ₹30, with the premium being paid by the central and state government to the insurer selected on the basis of competitive bidding.

Employee’s State Insurance Scheme (ESIS) is a multi-dimensional insurance plan designed to provide protection to worker population and their dependents. Besides providing full medical care for self and dependent from day one, the insured persons are also entitled to various cash benefits in times of distress due to sickness, temporary or permanent disablement, etc. that results in loss of earning capacity.

The plan covers:

• Non-seasonal factories employing 10 or more persons
• Shops, hotels, restaurants, cinemas including preview theatres, road-motor transport undertakings, and newspaper establishments employing 20 or more persons
• Private medical and educational institutions employing 20 or more persons in certain States/UTs.

Areas covered:

• All states except Manipur, Sikkim, Arunachal Pradesh and Mizoram
• The Union Territories of Delhi and Chandigarh

The Central Government Health Scheme (CGHS) is tailored to provide comprehensive health care facilities to Central Government employees and pensioners and their dependents. CGHS was started in New Delhi in 1954, and is now operational in Allahabad, Ahmedabad, Bangalore, Bhubaneswar, Bhopal, Chandigarh, Chennai, Delhi, Dehradun,Guwahati, Hyderabad, Jaipur, Jabalpur, Kanpur, Kolkata, Lucknow, Meerut, Mumbai, Nagpur, Patna, Pune, Ranchi, Shillong, Trivandrum and Jammu. This health scheme provides comprehensive healthcare through wellness centers (previously known as CGHS dispensaries), and polyclinics under Allopathic, Ayurveda, Yoga, Unani, Siddha and Homeopathic systems of medicines.

The primary components of the CGHS are:

• Dispensary services
• Family Healthcare (F.W.) and Maternal Child Healthcare (M.C.H) services
• Specialists consultation facilities at dispensary, polyclinic and hospital
• Hospitalization services
• Distribution and supply of medicines
• Health education to beneficiaries

The Universal Health Insurance Scheme (UHIS) has been implemented by the four public sector general insurance companies for improving the access of healthcare to poor families. The UHIS provides reimbursement of medical expenses up to ₹30,000 towards hospitalization, death cover due to an accident of ₹25,000 to the earning head of the family, and compensation due to loss of earning capacity of an earning member @ ₹50 per day for up to maximum of 15 days. The scheme has been completely retailored to target only the BPL families. The premium subsidy has been enhanced from ₹100 to ₹200 for an individual, ₹300 and ₹400 for a family of five and a family of seven respectively, without any reduction in benefits.

The Aam Aadmi Bima Yojana is social security scheme for the rural landless households. The head of the family or one earning member in the family of such household is covered under AABY. The premium of Rs 200 per person per annum is shared equally by the Central Government and state government. The age of the member covered under the scheme should be between 18 and 59 years.

The compensation available under the scheme is as follows:

• Rs 30,000 in case of a natural death
• Rs 75,000 on death due to accident or on permanent disability due to accident
• Rs 75,000 on death due to accident or on permanent disability due to accident

A free add-on benefit in the form of scholarship to children is also available.

The upcoming health scheme announced during the budget session 2018, the Ayushman Bharat will provide medical insurance cover to poor families. Under the scheme, a cover of Rs.5 Lakh will be provided a year to 10 crore poor and vulnerable families across the country. The scheme will also promote holistic health by bringing wellness centers to the doorstep of poor families, especially in remote areas.

Like most of the health insurance plans in India offered by the private companies, government sponsored health schemes also carry certain exclusions that aren’t covered under the schemes. These are:-

Cosmetic treatments – An increasing number of people are opting for cosmetic treatments to enhance their appearance.However, these treatments are not covered by health insurance companies. Dental treatments are also excluded from the coverage, as they are considered to be cosmetic in nature.

Pregnancy and childbirth – Most of the health insurance schemes in India do not cover childbirth and pregnancy related expenditure. The costs for treating infertility and abortion are also not covered under insurance policies.