Health Insurance for Government Employees

The government has taken major initiatives to ensure basic healthcare facilities to government employees and their families. The ESIS and CGHS scheme are the two initial forms of health insurance introduced in India to bring the working population under social security schemes. Listed below are some popular health insurance schemes which cover medical expenses of employees and pensioners and reduce out-of-pocket expenses.

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Health Insurance for Government Employees

ESIS: Employee State Insurance Scheme:

The Employee State Insurance scheme is a comprehensive health insurance plan, designed to offer social security to the employees of the State government.

The scheme aims to provide socio-economic protection to employees and their dependents. The scheme ensures full medical cover to the policyholder and dependents and the beneficiary is entitled to a variety of cash benefits in case of ailments, partial or total disability and so on, resulting in loss of income.

Cover is offered in case of industrial accidents and occupational hazards. The ESIS schemes are applicable to government employees working in an organisation having more than 10 employees.

See Also: National Health Insurance Scheme in India

Benefits of the Employee State Government Scheme:

• The scheme not only covers the insured, but also his dependents.
• The scheme offers benefits in case of loss of income in an accident resulting in partial or total disability after being insured for 3 or more years.
• The scheme starts from the time of employment (first job) and offers insurance cover for medical expenses of the insured.
• The scheme also encompasses medical benefits for industrial accidents and occupational hazards leading to loss of income.

Areas Covered:

States: All States excluding Manipur, Sikkim, Arunachal Pradesh and Mizoram.

Union territories: Delhi and Chandigarh.

See Also: Best Health Insurance Plans in India

CGHS: Central Government Health Scheme:

The Central Government Health Scheme is a social security scheme which offers health care facilities to central government employees and pensioners along with their dependents. This scheme has been launched by the central government to provide comprehensive coverage to pensioners and reduce out-of-pocket expenses. The scheme covers pensioners living in cities covered under the CGHS scheme. The scheme offers medical insurance for domiciliary, F.W and M.C.H services.

The beneficiaries can avail speciality services and consultation at dispensaries, hospitals and polyclinics. The beneficiaries are entitled to a host of other facilities and benefits which helps avail medical attention and care.

Benefits of Central Government Health Scheme:

• Helps to avail dispensary services including domiciliary, F.W and M.C.H services.
• Encompasses medical insurance for services and consultation at dispensaries, hospitals and polyclinics.
• Covers the cost of hospitalization and medical /laboratory tests.
• Provides health education to the beneficiaries.

See Also: Government Health Insurance Schemes In India

Central Government Employee and Pensioners Health Insurance Scheme (CGEPHIS):

This is a government initiative that was introduced to offer health insurance to government employees and pensioners, based on the recommendations made by the sixth pay commission.

The scheme is customized to offer social security benefits to current central government employees and pensioners. The beneficiaries of this scheme are all central government employees including officers, government office employees and staff who are covered under the CGHS scheme.

The scheme offers insurance up to Rs 5 lakhs for beneficiary and his dependents. The insured can avail cashless facility using smart cards. The scheme offers insurance cover to a maximum of 6 members (This is for government employees) and covers a maximum of 3 members for pensioners.

Insurance Coverage Under CGEPHIS:

• Pre-existing disease
• Maternity benefit
• Domiciliary hospitalization
• Coverage for new-born baby
• Pre-hospitalization coverage up to 30 days
• Post-hospitalization coverage for up to 60 days

Features of the CGEPHIS scheme:

• The scheme is compulsory for new joiners to central government jobs.
• The scheme will cover new pensioners.
• The scheme is available voluntarily for the existing central government employees and pensioners who are covered under the CGHS scheme. However, to enrol under this scheme, you must opt-out of the CGHS scheme.
• All the beneficiaries receive insurance coverage across lifetime.

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