Health Insurance in India is a growing segment in India’s economy. The Indian health Insurance sector is one of the largest in the world. National Health insurance schemes are the health insurance program initiated by the National government. Health is the major factor that plays a vital role in everyone life. The affordability and accessibility of health insurance have to be ensured. High income people can always afford to medical care, however, for the below poverty population medical is neither accessible nor affordable. The healthcare insurance scheme introduced by the central government provide healthcare to all Indian citizens.

The following are the Major Health Insurance scheme introduced by the Central government:

  • Rashtriya Swasthiya Bima Yojana (RSBY)
  • Employment State Insurance Scheme (ESIS)
  • Central Government Health Scheme (CGHS)
  • Aam Aadmi Bima Yojana (AABY)
  • Janashree Bima Yojana (JBY)
  • Universal Health Insurance Scheme (UHIS)

Rashtriya Swasthiya Bima Yojana (RSBY):

Ministry of Health and Family Welfare, Government of India launched this National Health Insurance Scheme for families who are below the poverty line. The aim is to offer health insurance coverage to BPL (Below Poverty Line) families in an economical manner.

Every “below poverty line” (BPL) family holding a yellow ration card needs to pay Rs 30 for the registration fee to get a biometric-enabled smart card containing their fingerprints and photographs. This will enable them to receive inpatient medical care of up to 30,000 per family per year in any of the government or in private hospital.

Benefits of Rashtriya Swasthiya Bima Yojana Scheme (RSBYS):

  1. No age Limit and no pre-existing conditions which are covered from day one. This scheme covers five members of a family, which include the head of the family, spouse and three dependents.
  2. RSBY Scheme provides the BPL people to participate with freedom in choosing between public and private hospital and make them potential client worth for the hospital stand to earn through the scheme
  3. A hospital has incentives to provide treatment to large number of beneficiaries as it is paid per BPL people been treated.  Public hospitals have the incentive to treat beneficiaries under RSBY.
  4. The insurer is paid premium for each household enrolled for RSBY. Therefore, the insurer has the motivation to enrolled for RSBY scheme. Therefore, it also motivates the insurer to make them treat as many households from BPL list.
  5. Intermediaries like MFIs and NGOs are paid for offering assistance to the BPL households.
  6. The use of key management system and biometric enabled smart card makes this scheme foolproof. Only the recipient can use the issued smart card in their name and the accountability is maintained.

Employment State Insurance Scheme (ESIS):

 The Central Government creates Employment State Insurance Scheme (ESIS) provides socio-economic protection to the working population and their dependents. It is considered as Multidimensional social security system. If any employee meets any physical distress, temporary or permanent disablement. Monthly benefits are also available for the beneficiaries who die due to injuries or accidental deaths during their employment term time. The available coverage limit is Rs.15,000/- per month. 

ESI scheme is valid for non-seasonal employees. But factor should have more than 10 employee. The scheme is also applicable to hotels, shops, cinemas, restaurants, newspaper establishments and road-motor transport enterprises employing more than 20 people. ESI is applicable to all states apart from Sikkim, Manipur, Mizoram, Arunachal Pradesh, and Union Territories

Central Government Health Scheme CGHS:

Central Government Health Scheme offers all- inclusive healthcare services to the central government employees and pensioners in the CGHS covered cities.

This scheme CGHS started by the Central Government in1954. The healthcare services are offered    through Wellness Centres (CGHS Dispensaries/ Allopathic, Yoga/Ayurveda, Siddha, Unani, and Homeopathic Centres).

  • Dispensary services
  • Domiciliary care
  • Consultation with a specialist at hospital, polyclinic and dispensary
  • Medical tests including ECG, X-Ray and laboratory tests
  • Hospitalization cover
  • Health education for beneficiaries

Aam Aadmi Bima Yojana (AABY):

Aam Admi Bima Yojana or AABY scheme was commenced on October 02, 2007 for rural, landless   households. The head of the family or one earing member of the family of such households is covered under this scheme. The National Health Insurance Scheme covers the earning member of a household between the age group of 10 & 59 years.

Compensation under the insurance plan is as follows:

  • Compensation of Rs 30,000 in case of natural death
  • Compensation of Rs. 75,000 in case of accidental death, partial or permanent disabilities ( loss of 2 limbs or 2 eyes)
  • Compensation of Rs. 37,500 in case of partial permanent disabilities resulting from an accident (one limb or an eye)

A separate fund called Aam Admi Bima Yojana Premium Fund is maintained by LIC to receive the amount that deposited by the Central government. A free add on benefits in the form of scholarship to the children is available under this scheme.

Janashree Bima Yojana (JBY):

The Life Insurance Corporation and the Central Government Corporation together launched the Janashree Bima Yojana (JBY) on August 10, 2000. JBY is sponsored by the government. The scheme is used to provide life insurance cover to rural and urban people below and marginally above the poverty line.

The launch of JBY Scheme has replaced Social Security Group Insurance Scheme (SSGIS) and Rural Group Life Insurance Scheme (RGLIS).

Compensation under the insurance plan is as follows:

  • On Natural death of Rs.30000/-
  • On Death/Total permanent disability due to accident is RS.75000/-
  • On partial  and permanent disability due to accident Rs.37500/-

The JBY Scheme is covered for the workers in:

  • Foodstuffs like khandsari
  • Textile
  • Manufacture of wood products
  • Manufacture of paper products
  • Manufacture of leather products
  • Printing
  • Rubber and coal products
  • Chemical products like candle manufacture
  • Mineral products like earthern toys manufacture
  • Fire cracker’s workers
  • Construction workers
  • Cottage industries

Universal Health Insurance Scheme (UHIS):

The Public sector general insurance companies have been implementing Universal Health insurance Scheme for Improving the access of health care to poor families. The Universal Health Insurance Scheme (UHIS) has been redesigned targeting only the BPL families. The premium subsidy has been extended from Rs.100 to Rs.200 for an individual, Rs.300 for a family of five and RS.400 for a family of seven without any reduction


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