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National Health Insurance Scheme in India Research Team | Posted On Monday, April 08,2019, 02:21 PM

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National Health Insurance Scheme in India



The Government has taken some initiatives to provide basic healthcare facilities to the people of India. National health insurance schemes are health insurance programs that are launched by the Union Government, to provide and make health insurance schemes, accessible to the poor and vulnerable government employees and the unorganized sector in India.

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National Health Insurance Scheme In India

Given below are some of the health insurance schemes and their benefits:

1. Rashtriya Swasthiya Bima Yojana (RSBY):

Rashtriya Swasthiya Bima Yojana is a social security scheme, launched by the Ministry of Labour And Employment, Government of India, for providing health insurance cover to families living below the poverty line. The aim of this scheme is to provide health insurance cover to BPL families (Below Poverty Line) and help them avail healthcare facilities by providing them monetary aid and reducing out of pocket expenses.

The scheme is funded by the Central and State Government. About 75% of the funding comes from the Government of India, while the remaining part is paid by the State Government. Beneficiaries must pay the Rs 30 registration fees.

Under this scheme, the government has fixed the hospitalization limit at Rs 30,000. The government has specifications on the hospital package rates as well. The scheme is a family health insurance policy, where the specified limit can be used to cover 5 members including self, spouse and 3 dependents of a family. The scheme also provides health cover for pre-existing diseases without any age limit. Rashtriya Swasthiya Bima Yojana also covers the following groups of people:

  • Building and other construction workers registered under the welfare board.
  • MNREGA workers who have worked for more than 15 days during the previous financial year.
  • Street vendors.
  • Licensed railway porters.
  • Auto drivers.
  • Rickshaw pullers.
  • Workers in mines
  • Sanitation workers.
  • Domestic workers.
  • Beedi workers.

Key Features of RSBY:

The scheme provides health insurance coverage for the BPL families and the key features of the scheme are listed below:

Beneficiary: the scheme offers beneficiaries the facility to avail treatment at both private and public hospitals. The empanelment of hospitals is done based on prescribed criteria. The insurer must empanel hospitals in the district, so that beneficiaries need not travel very far to avail heath care services. The scheme helps beneficiaries enjoy quality treatment under this scheme.

Insurers: State Governments engage in a competitive public bidding process and select a public or private insurer, licensed to provide health insurance by the Insurance Regulatory Development Authority (IRDA). The government pays the insurance premium on behalf of the insured.

Hospitals: The government encourages the hospital authorities to participate in the National Healthcare Programs, by providing them certain incentives. The hospitals must also have the requisite hardware and software facilities for online and cashless transactions through smart cards. Both private and public hospitals may get enlisted under this scheme. The process is supervised by the insurer to bring transparency in the process.

Cashless and Paperless Facilities: the beneficiaries of this scheme can avail cashless treatment at any RSBY enlisted hospital across India. After availing the services, the hospitals must send the e-report to the insurer. The payments will be done via smart card and the claims settled electronically.

Government: The government is able to offer quality healthcare services with a sum of Rs 750 a year per BPL family. It will promote healthy competition among private and public healthcare providers, which improves the functioning of public health care services.

Pan India Coverage: The beneficiary can avail health care facilities at any RSBY empanelled hospital across India. He only needs to carry the smart card given to him. This facility is useful for laborers and workers who migrate to other cities for work.

Information Technology: The beneficiaries of this scheme are offered smart cards. These smart cards contain the biometric details and a photograph of the beneficiary. The claims are settled by swiping the smart card and providing biometric details, helping the beneficiary avail cashless treatment without an ID proof.

Safe and Secured: The scheme is safe and the records of insurance availed can be easily tracked by the government. The use of smart cards and biometric details allows the insurer track claims, transfer funds to hospitals and investigate suspicious claim patterns through on-site audits.

SEE ALSO: Advantages Of Buying A Health Insurance Plan

2. Employment State Insurance Scheme:

Employment State Insurance Scheme is a social security scheme that is specifically made to offer social security and economic protection to workers and their family members. The scheme offers medical cover for the beneficiaries, which can easily be accessed as well as various cash benefits in times of emergency like sickness, temporary or permanent disability resulting in loss of earning capacity. The scheme is valid for factory employees provided the number of workers is more than 10. The scheme also encompasses employees of hotels, shops, cinemas and restaurants, drivers and workers provided they work in organisation having more than 20 employees.

3. Central Government Health Scheme:

Central Government Health Scheme (CGHS) is a Health Insurance Scheme, initiated by the Government to provide comprehensive healthcare services to Central Government Employees and Pensioners. The scheme encompasses pensioners and their dependents, living in cities that are covered under the CGHS scheme.

The scheme includes Domiciliary Care, F.W and M.C.H services along with specialist consultation services at dispensaries, polyclinics and hospitals. The scheme also provides a host of other benefits to help government employees and retirees avail medical benefits and cut down out of pocket expenses.

4. Aam Aadmi Bima Yojana:

Aam Aadmi Bima Yojana is an initiative taken by the Government to offer financial aid and social security to rural households and is a part of rural development schemes in India. The scheme is designed to encompass the rural landless households, where the access to healthcare facilities like hospitals and pharmacies are limited. The scheme provides coverage only to the earning member/ head of the family.

Any individual falling in the age bracket of 18- 59 years can enrol in the AABY scheme. The contribution is made by both the Central and the State Governments, so that beneficiaries don’t have to pay premiums.

5. Universal Health Insurance Scheme:

The Universal Health Insurance Scheme is a health insurance plan, initiated by 4 public sector general insurance companies, to provide healthcare facilities to poor families. This is a comprehensive scheme that provides medical expenses reimbursement of up to Rs 30,000 towards hospitalization of self or dependents, accidental death cover (Rs 25,000) to the earning head of the family, and per day compensation of Rs 50 for loss of earning of the breadwinner during hospitalization for up to 15 days. The scheme is specially designed to provide health insurance benefits to BPL families.

6. Janashree Bima Yojana:

The Janashree Bima Yojana was launched on 10th of August 2000, to provide life insurance to people in rural and urban areas, who are below and marginally above the poverty line. This scheme is a joint venture by the Government of India and the life insurance corporation (LIC), which includes a total of 45 occupational groups.  Any individual of age group 18-59 years can enroll in this scheme. However, the policy holder must be a member of the vocational group/ occupation approved by the nodal agency.

The benefits of this scheme are the compensation given under the insurance plan. These are outlined below:

  • The nominee will receive Rs 30,000 as death benefit in case of death of the policy holder.
  • On permanent disability due to an accident, the policy holder receives a sum of Rs 75,000.
  • On partial disability the insured would receive Rs 37,000.

7. Ayushman Bharat - National Health Protection Mission:

Ayushman Bharat is a National Health Protection Scheme, initiated by the Union Government to offer Health Insurance Cover to the poor and the vulnerable families in India. The scheme offers coverage of up to Rs 5 Lakhs a year for secondary and tertiary care hospitalization. The benefits of this scheme can be used across India and the beneficiaries covered under this scheme will be allowed to avail cashless benefits from any public/ private hospital empanelled under this scheme. The scheme offers coverage to all members of the family and beneficiaries access quality health care facilities and medication by enrolling in this scheme.

SEE ALSO: Best Health Insurance Plans in India 

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