Install our App to get easy Access toBuy, Link, Renew, Claim and More
GetA Quick Look at Some Government Health Insurance Schemes
Feb 7, 2022
India is the world’s largest democracy with a population of 1.4 billion. However, very few people have a comprehensive health insurance policy . The reasons for this coverage gap include lack of awareness and the inability of the many to afford insurance. To cope with this gap, the Government of India has rolled out several schemes to make health care more accessible than ever.
Central Government Health Insurance Schemes
1. Pradhan Mantri Jan Arogya Yojana (PM-JAY) Under Ayushman Bharat
Launched in 2017 by the National Health Policy, PM-JAY is the largest govt. health insurance scheme across the globe that is fully funded by the government. The scheme is meant to provide health care to the bottom 40% of the Indian population, i.e., households under the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas.
- PM-JAY provides Rs. 5 Lakhs cover per family for secondary and tertiary care hospitalization in public and private empanelled hospitals.
- You avail cashless treatment at the point of service, i.e., the hospital.
- Cover includes approximately 1393 procedures covering all treatment costs such as drugs, physician fees, room charges, diagnostic charges, 3 days of pre-hospitalization, 15 days of post-hospitalization, Operation Room, ICU charges, etc.
- The scheme covers all pre-existing conditions from day 1.
2. Universal Health Insurance Scheme
The Universal Health Insurance Scheme is a product of the United India Insurance Company Ltd that increases health care access to families at or below the poverty line.
- This government health insurance scheme covers medical expenses up to Rs. 30,000 upon hospitalization.
- An earning member of the family receives Rs. 50 daily for up to 15 days for being hospitalized.
- Applicants aged 5 to 70 years can avail of this scheme.
- The policy also covers accidental disability and reimbursement of illnesses/diseases.
3. Rashtriya Swasthya Bima Yojana (RSBY)
This scheme is meant to cover labourers working in the unorganized sectors who also happen to constitute about 93% of the nation’s workforce. Backed by the Ministry of Labour and Employment, the RSBY scheme provides health care to Below Poverty Line (BPL) families.
- The RSBY scheme covers up to 5 members, including the unorganised sector worker.
- The sum insured given would be Rs. 30,000 per family per year on a family floater basis.
- Cashless covers enable expedited claims against hospital expenses and common illnesses, including transportation costs with Rs. 100 limit per visit and the overall limit of Rs. 1000.
- All pre-existing diseases are covered under this scheme from day 1.
4. Aam Aadmi Bima Yojana (AABY)
The Aam Aadmi Bima Yojana (AABY) provides health care to individuals of select professions such as carpentry, fishing, handloom weaving, salt-production, sericulture, and other select vocations.
- AABY scheme offers Rs. 30,000 as a basic cover and half the amount is subsidized by the Social Security Fund.
- Applicants aged 18 to 59 can apply for this scheme.
- The AABY government health insurance scheme applies to only one family member who must also be either the head or the earning member of the family.
- Coverage includes accidental death, disability, death due to natural causes, and sometimes even scholarship benefits.
5. Employee’s State Insurance Scheme
The Employee State Insurance Scheme is applicable to an individual employed in a non-seasonal factory that consists of more than 10 employees, as described under section 2 (12) of the Employee State Insurance Act, 1948.
- The scheme covers individuals working in hotels, shops, cinemas, restaurants, road-motor transport undertakings, and the wage limit of the employee is set to Rs. 21,000 per month.
- Covers include medical expenses, disability as well as the death benefit.
- Women employees enjoy maternity benefits such as 100% daily wages for 26 weeks from the time the woman goes into labour and 6 weeks in case of a miscarriage.
- Employees receive a cash allowance for 24 months if the employee is unable to work due to injury or involuntary unemployment.
6. Pradhan Mantri Suraksha Bima Yojana (PMSBY)
The PMSBY scheme is offered by public sector general insurance companies or, sometimes, by privatized institutions like banks. With an annual premium as low as Rs. 12, the scheme is extended to cover personal high-risk accidents.
- The scheme is available to individuals holding a bank account who fall in the age range of 18 to 70 years.
- The nominee receives Rs. 2 lakhs if the primary applicant of the scheme is fully disabled or dies in an accident.
- Partial disability is covered at Rs. 1 lakh.
- Applicants are eligible to can claim tax deduction under Section 80C of the Income Tax Act, 1961.
7. Central Government Health Scheme (CGHS)
The Central Government offers CGHS to the Central Government employees and pensioners. The scheme spread across 71 cities, covering beneficiaries undertaking allopathy, homeopathy, or any Indian medicine treatment.
- Widows or children of ex-Central Government employees eligible under family pension can avail CGHS.
- Few out of many facilities include outpatient department treatments, diagnostic tests, or medical consultations.
- You can also get reimbursement of expenses for emergency treatments or purchasing hearing aids, artificial limbs, etc.
- The CGHS scheme extends to family welfare as well as maternity and child health services.
8. Janshree Bima Yojana (JBY)
Launched collectively by the Central Government and the Life Insurance Corporation (LIC), JBY provides life insurance to rural and urban marginalized individuals working in any of the 45 occupational groups approved by LIC and the Nodal Agency.
- The premium to be paid is Rs.200 per member, wherein the State Government/Nodal Agency pays 50%, and Social Security Fund pays the remaining 50%.
- Women under Self-Help Groups (SHG) can avail of term insurance with Rs. 30,000 coverage.
- The Shiksha Sahyog Yojana (SSY) covers children whose parents are covered under JBY. Up to 2 children get a scholarship of Rs. 600 each paid every 6 months, conditions apply.
- On demise or total permanent disability due to an accident of the applicant, nominees receive Rs. 75,000 as compensation.
State Government Health Insurance Schemes
1. Mahatma Jyotiba Phule Jan Arogya Yojana
This scheme by the Maharashtra Government offers medical insurance to individuals below the poverty line. Applicants can claim up to Rs. 1.5 lakhs against diseases from the first day of the policy.
2. Employees and Journalists Health Scheme, Telangana
Offered by the Telangana Government, this scheme provides medical coverage to the state government’s employees and journalists with coverage extended to retired employees as well.
Conclusion
The aforementioned schemes for health insurance by Indian Government ensure that citizens of the country do not face financial difficulties in times of ill health. health insurance plans can help reduce the burden of expensive medical treatments. This way, one can focus on recovery and not worry about the cost.
This blog is intended solely for educational and informational purposes. The content may include outdated information regarding the topic discussed. Readers are encouraged to confirm the accuracy and relevance of the data before making any significant decisions. SBI General Insurance disclaims responsibility for any errors or consequences arising from the use of outdated information provided herein.
Recent Blogs
General Insurance
Ayushman Bharat – a noble but challenging initiative
In the Union Budget announced in 2018, the Finance Minister Mr Arun Jaitley announced what is probably the Central government’s most ambitious programmes, Ayushman Bharat, aimed at providing universal healthcare to all Indians, especially the underprivileged.
This scheme aims to cover more than 10 crore poor and vulnerable families with an insurance cover of Rs. 5 lakh per family.
Ayushman Bharat expects to lead to standardised treatment guidelines for surgical and non-surgical procedures, with extensive use of data analytics to monitor implementation. The programme will also have a positive impact on allied industries such as pharma, medical devices, and diagnostics among others.
Some of the other key benefits of the programme includes:
Low premium high penetration will benefit Universal Health Care.
Mandatory cover to healthy young population will help lower Claim Ratio so that lower insurance premium will benefit all and as there is alternate payment mechanism available that will divert substantial patient flow towards private health care facilities, with the increased volumes reducing the processes for services.
Quality of Health Care will improve as a number of initiatives are being undertaken – for example, NABH accreditations etc. specifically for quality in Healthcare Delivery Systems.
Higher number of patients who are able to afford treatment will lead to better volumes for the pharma and device industries, with enhanced patient loads will lead to economies of scale for hospitals further leading to reduction in costs, making treatments more affordable.
Access to affordable healthcare will mean that fewer people fall below the poverty line and debt traps as a result of health-related concerns.
Initiatives like drug price control policies and capping the costs of Stent, Orthopaedic prosthesis etc is bringing in transparency in processes while ensuring that quality treatment can be provided at affordable pricing.
Universal Health coverage can be a Win- Win situation for Insurance, Pharma, Devices as well as other related Health Care industries.
Though a laudable initiative, the scheme is not without its challenges. To begin with, universal healthcare on this scale will not be easy to execute, and more importantly fund. Within one year of its launch, one has already seen some challenges with regards to funding, and the contribution of states and the Centre.
While patients in urban areas may get access to healthcare, despite Ayushman Bharat, they may not be able to afford the costs of private hospitals. Additionally, rural India which largely lacks medical infrastructure will not benefit in the short-term. And, even if the state/ Central government were to build physical infrastructure, staffing them with qualified medical personnel would remain a challenge.
Despite economies of scale being an incentive, private hospitals may not necessarily agree to the prices prescribed by the government for treatment of patients under the programme. Similarly, with prices capped, it will lead to lower profits for pharma and device companies, who may become loath to offer their cutting edge advanced products and technologies in this market, depriving even those patients who can afford to pay for them with access.
Additionally, Integration of the Central programme with those launched by several state governments will remain contentious, and finally, while funding agencies may fund the programme, the money still has to be repaid and tax payers may well feel saddled by an additional burden.
General Insurance
National Consumer Rights Day: Know Your Insurance Rights
Consumers are essential for the nation's economy. Without consumers, there would be no buying and selling of goods and services. Therefore, consumers must be given certain rights. Plus, with the increased popularity of e-commerce industries, the need to protect consumer rights is higher than ever. As a consumer and policyholder, you hold certain rights when it comes to insurance. This National Consumer Rights Day, let's find out what those rights entail.
What is National Consumer Rights Day?
Celebrated on 24th December every year, National Consumer Right Day promotes the rights of consumers across the country. People participate in campaigns to raise awareness about consumer rights. As a consumer, you can talk about fraudulent incidents on social media platforms to call out the violators.
Understanding consumers' insurance rights
Today, insurance should be an integral part of your financial planning. Insurance provides financial protection against unwarranted circumstances. As a policyholder, you should be aware of the following rights:
Right to information
Before buying any policy, you have the right to ask the insurer everything you wish to know about the policy. Per the Insurance Regulatory and Development Authority of India (IRDAI), the insurance provider must communicate all policy-related information to you. Information includes inclusions, exclusions, waiting periods, deductibles, add-on riders etc.
Right to terminate the insurance policyYou can cancel a policy within the free look period and receive a full refund of the paid premium amount. If applicable, the insurance provider may deduct any surrender charges or service fees. However, you should not have filed any claims during the free-look period.
Premium payment rights
Typically, you pay a lump sum annual premium towards most insurance policies. However, IRDAI has allowed insurance providers to accept premiums via monthly, quarterly or half-yearly instalments. This offers relief to policyholders. You can conveniently change the frequency of the premium payments during policy renewals.
Right to seek redressal
You can file a complaint against an insurance company. You can approach the insurer's grievance redressal cell. If you are dissatisfied with the response, you can voice your issues with the grievance redressal cell under the IRDAI's Consumer Affairs Department. You can also file complaints about delayed maturity payments and claim denials.
Insurance claiming rights
Per IRDAI, an insurer must settle your insurance claims within 30 to 45 days of receiving the last necessary document. If there's a delay, the insurer pays 2% interest from the day the insurer receives the last document until finally paying the claim amount. Also, an insurer cannot reject your claim if you have held a policy with the insurer for eight consecutive years without a break.
Buy general insurance
All non-life insurance policies come under the ambit of general insurance. You can pay for expensive medical treatments with health insurance and pay for repairing accidental damage to your vehicle with motor insurance. Home insurance keeps your home and its content protected from the aftermath of natural and human-made disasters. Lastly, you can finance unforeseen expenses during your international trips with travel insurance.
This National Consumer Right Day, take a moment to understand your insurance rights before buying your general insurance policies.
Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.
General Insurance
FAQs on COVID-19
"What is coronavirus"? This was the most asked question of 2020. As COVID-19, the illness caused by a new kind of coronavirus is spreading fast, you must be armed with the correct information about it and how you can prevent it. While fear is normal during these testing times, staying informed from reliable sources is a great way to allay your doubts. Thus, it is critical that you know everything there is to know about COVID-19.
Here are the answers to most frequently asked questions on COVID-19.
What is COVID19?
COVID-19 is a contagious illness that is caused by a newly discovered coronavirus. It can spread from one infected person to another healthy person. Coronaviruses are viruses that are found among animals with some of them also known to infect humans.
How does it spread?
It spreads just like the common cold. It mainly spreads from one person to another person, especially when they are in close contact. It also spreads through the respiratory droplets produced when an infected person sneezes or coughs.
What are the symptoms of COVID-19?
Some of the common COVID-19 symptoms are:
Cough
Fever
Exhaustion
Breathing difficulty
Nausea
Runny nose
Sore throat
Diarrhea
How can I protect myself?
There are several ways in which you can reduce your chances of getting infected or spreading COVID-19. Here are some simple precautions that you should follow
Wash your hands regularly and thoroughly, for at least 20 seconds, using soap and water
Use a hand sanitizer
Practice social distancing. Keep 3 feet distance between yourself and others, especially anyone showing signs of illness such as coughing or sneezing.
It is best not to touch your eyes, nose and mouth with dirty hands. Before touching them, make sure you wash your hands because your hand touches many surfaces and can pick up the virus.
Make sure people around you use a tissue, mask & hanker-chief to properly cover their mouth when they cough or sneeze.
Stay indoors
Avoid large gatherings
Teach your children to wash their hands regularly and thoroughly. Make sure they stay indoors
Who is at risk?
People who are above the age of 65 and those who have weak immune systems are at higher risk of developing severe complications from COVID-19. Also, people of all ages with medical conditions like chronic lung disease, diabetes, asthma, heart conditions and liver diseases are also at high risk of falling severely ill after contracting COVID-19.
Is it true that garlic and saltwater can prevent COVID-19?
There are several myths that are circling on social media. However, we advise you not to fall for them. Some of the common myths are: parcels from China can spread COVID-19, home remedies can cure COVID-19 and you can catch coronavirus by eating Chinese food. All these are unfounded myths. If you want to keep yourself updated with coronavirus related news, it is best to follow trusted websites.
At, SBI General Insurance, we urge you to stay indoors, stay informed and alert. It is just as essential that you take the necessary precautions of updating your Health Insurance Plans, ensuring you have adequate coverage. Remember to consult your doctor if your notice any coronavirus symptoms.
Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.
General Insurance
Global Handwashing Day 2022: How Handwashing Prevents Diseases?
If the pandemic has taught us anything, it would be the importance of basic hygiene practices. Not all surfaces we touch are clean. You never know what germs, bacteria or viruses can enter your body. This Global Handwashing Day, let’s increase awareness and understand the importance of handwashing.
Global Handwashing Day – History & significance
Founded by the Global Handwashing Partnership, Global Handwashing Day is celebrated on the 15th of October every year. In 2008, over 120 million children across 70 countries washed their hands with soap to commemorate the first–ever Global Handwashing Day. The initiative aims to implement creative ways to encourage people to wash their hands with soap. National leaders can take this opportunity to demonstrate the simplicity of handwashing by building sinks and tippy taps. The theme for Global Handwashing Day 2022 is ‘Unite for Universal Hand Hygiene’.
Why You Shouldn’t Take Handwashing Lightly?
Disease–causing bacteria and viruses are present all around us. Here’s how these germs can spread:
By touching your mouth or nose with unclean hands
By touching things or people without cleaning your hands after sneezing or coughing
By eating food without washing your hands
By touching contaminated surfaces unknowingly
Washing your hands with water alone is not enough. The soap’s molecular structure traps dirt and germs in tiny bubbles known as micelles. These get washed away with water. Hence, handwashing with both soap and water is crucial to prevent diseases from spreading.
Ways to Maintain Hygiene?
While handwashing is the best line of defence, you should also practice essential hygiene habits to minimise the risk of contracting diseases. These include:
Bathing regularly: The human body sheds skin constantly. The build-up of dead skin is a breeding ground for bacteria that can make their way into the body through the mouth or nose. Ensure you regularly clean your body and hair with soap and water.
Trimming nails: Dirt can build up between fingernails. Even with thorough handwashing, getting rid of infected nail beds can be difficult. It helps to trim your finger and toenails frequently. Remember to lather soap under your nails while washing your hands.
Covering your mouth while sneezing or coughing: Covering your cough or sneeze is an effective way to stop the spread of germs. You could unintentionally spread germs by expelling microscopic water droplets. The right way to sneeze or cough is into a handkerchief. Ensure you wash your hands right away. It also helps to carry hand sanitiser in your bag.
Prevent Financial Losses with Health Insurance
Handwashing can reduce the risk of contracting diseases through physical contact. Unfortunately, you may also be at risk of air–borne or water–borne diseases. However, health insurance helps cover the expenses of treating such illnesses and numerous other conditions. A health insurance plan is simply a contract between you and your insurance company, wherein the insurer promises to cover your medical costs up to a predetermined sum insured. Insurance provides you peace of mind and allows you to concentrate on getting the best treatment.
This Global Handwashing Day, ensure you secure your health financially with health insurance.
Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.
Access and manage all your Insurance Needs in one place, right at your Fingertips.
4/5*
Access and manage all your Insurance Needs in one place, right at your Fingertips.
Vision
Our vision is to become the most trusted general insurer for a transforming India.
Mission
Our mission is to provide simple and innovative general insurance solutions, be responsive to our customers' needs and build a sustainable business for the future.
We're socially active!
