“Health is a Human Right”. The affordability and accessibility of health insurance have to be ensured. Higher incomed population can access and afford medical care, however, for the below poverty population medical care is neither accessible nor affordable. The Central Government launched the national health insurance schemes to provide healthcare support to all Indian citizens from private sectors, to government staff and specifically for the below poverty line people such as cobblers, fisheries and such occupations.
The list of national health insurance schemes by the central government are as follows:
- 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)
Ministry of Labour and Employment launched the RSBY to provide health insurance for the below poverty line (BPL) population. BPL families under RSBY will be benefited with hospitalization coverage of Rs.30,000/- for most diseases that require hospital admission. The benefits of RSBY are: 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. There is a registration fee of Rs.30/- and the payment to the insurers will be paid by the central and state government.
Comparing RSBY with other schemes, RSBY is unique and provides some unique features mentioned below:
- Empowers the beneficiaries by giving a choice between public and private hospitals.
- Inclusion of intermediaries such as Non Governmental Organizations (NGOs) and Micro Financial Institutions (MFIs) to assist BPL households.
- Each family pays a maximum of Rs.750/-, per year to access quality healthcare to the BPL.
- Biometric enabled smart cards and key management systems make RSBY a safe and foolproof scheme.
- The smart card can be used by the beneficiary at any of the RSBY enlisted hospitals across India.
- Cashless and paperless transactions with the beneficiary’s smart card and fingerprint verification are used to approve cashless transactions.
Employment State Insurance Scheme (ESIS) provides socio-economic protection to the working population and their dependents. It is regarded as a multidimensional social security system. This scheme covers various cash benefits like physical distress, temporary or permanent disablement. Monthly pension called dependents benefit is also available for beneficiaries who die due to injuries or accidental deaths during their employment term time. The available coverage limit is Rs.15,000/- per month.
There is also a coverage applicability for this scheme. It covers non-seasonal factories with 10 or more employees. It also includes shops, hotels, cinemas, newspaper establishments and road-motor transport establishments hiring 20 or more employees. Private medical and educational establishments in specific states/union territories recruiting 20 or more employees are covered under this scheme. ESIS is available in all states except Sikkim, Arunachal Pradesh, Manipur and Mizoram. It is only available in the Union Territories of Delhi and Chandigarh. The government has plans to implement this scheme in other Union Territories and states, where ESIS is unavailable.
The central government first initiated the Central Government Health Insurance Scheme (CGHS) in 1954 at New Delhi. This scheme is precisely tailored to provide comprehensive health care support to central government employees and pensioners including their dependents living in cities that cover CGHS. This central government scheme is now active in the cities of Allahabad, Ahmedabad, Bangalore, Bhubhaneshwar, Bhopal, Chandigarh, Chennai, Delhi, Dehradun, Guwahati, Hyderabad, Jaipur, Jabalpur, Kanpur, Kolkatta, Lucknow, Meerut, Mumbai, Nagpur, Patna, Pune, Ranchi, Shillong, Trivandrum and Jammu. Wellness centers/polyclinics offer medical facilities under Ayurveda, Yoga, Unani, Siddha, Homeopathic (AYUSH) systems. This scheme also consists of components like dispensary services-domiciliary care, hospitalization and health education to beneficiaries.
Aam aadmi bima yojana launched on 2nd October 2017 is a social security scheme for people living in rural households. This scheme either covers the head or the earning member of the family within the age group of 18 to 59 years. The central and state government shares a premium of Rs.200/- annually. A premium of Rs.30,000/- is paid for natural deaths, Rs.75,000/- for death due to accidents and Rs.35,000 for partial permanent disability due to accidents.
The central government has set a separate fund called “Aam Aadmi Bima Yojana Premium Fund” to pay its contribution, and LIC maintains the fund resources.
This scheme was introduced on 10th August 2000 to yield protection to below poverty or marginally above poverty line people. JBY replaced two insurance schemes such as Social Security Group Insurance Scheme (SSGIS) and Rural Group Life Insurance Scheme (RGLIS).
|1||Beedi workers||24||Hilly area woman|
|2||Brick kiln workers||25||Foodstuffs products like khandsari/sugar|
|4||Cobblers||27||Manufacture of food products|
|5||Fisherman||28||Manufacture of paper products|
|6||Hamals||29||Manufacture of leather products|
|8||Handloom weavers||31||Rubber and coal products|
|9||Handloom and Khadi workers||32||Chemical products like candle manufacture|
|10||Lady Tailors||33||Mineral products like earthen clay toys|
|11||Leather tannery workers||34||Agriculturists|
|12||Pappad workers attached to SEWA||35||Transport drivers association|
|13||Physically handicapped self employed persons||36||Transport karmacharis|
|14||Primary milk producers||37||Rural poor|
|15||Rickshaw pullers/ Auto drivers||38||Construction workers|
|16||Safai karmacharis||39||Fire crackers workers|
|17||Salt growers||40||Coconut processors|
|18||Tendu leaf collectors||41||Anganwadi workers/ Helpers|
|19||Scheme for urban poor||42||Kotwal|
|20||Forest workers||43||Plantation workers|
|21||Sericulture||44||Woman associated with SHG|
|22||Toddy tappers||45||Sheep breeders|
|23||Power loom workers|
People between the age group of 18 to 59 years and members of the above mentioned occupational groups are eligible for this scheme. Since 2013, Aam Aadmi Bima Yojana and Janashree Bima Yojana are incorporated into one scheme as “Aam Aadmi Bima Yojana"
Universal health insurance scheme is implemented by four public general health insurance companies like LIC, etc,. UHIS aims to focus on improving healthcare access for low-income families. This scheme has been revamped to meet the needs of below poverty line (BPL) families. It includes individuals, families and groups. The scheme price ranges from Rs.100/- to Rs.200/- for an individual, Rs.300/- for a family of five and Rs.400/- for a family of seven. Regardless of the premium, there are no reductions in benefits.
The UHIS covers a reimbursement of Rs.30,000 for medical expenses during hospitalization floated among the entire family and Rs.25,000/- death cover due to an accident of the earning family head. A compensation of Rs.50/- per day is paid to a person with job loss for maximum up to 15 days.
- National Health Insurance Schemes – Employment State Insurance Schemes - (https://www.nhp.gov.in/national-health-insurance-schemes_pg#Employment State Insurance Scheme (ESIS))
- Employees State Insurance Corporation - (http://www.esic.nic.in/about-us)
- Table - List of occupational groups covered under Janashree Bima Yojana (JBY) - (https://www.nhp.gov.in/national-health-insurance-schemes_pg#Janashree Bima Yojana)
Latest Publications and Research on National Health Insurance Schemes
- Implementing a sustainable health insurance system in Cambodia: a study protocol for developing and validating an efficient household income-level assessment model for equitable premium collection. - Published by PubMed
- Electronic medical record systems: A pathway to sustainable public health insurance schemes in sub-Saharan Africa. - Published by PubMed
- The year 2020, a milestone in breaking the vicious cycle of poverty and illness in China. - Published by PubMed
- The political economy of universal health coverage: a systematic narrative review. - Published by PubMed
- The impact of National Health Insurance upon accessibility of health services and financial protection from catastrophic health expenditure: a case study of Savannakhet province, the Lao People's Democratic Republic. - Published by PubMed
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