Health Insurance Government Scheme I

 

In this Post, I am discussing some more  Health Insurance  Government Scheme I  run by Central Government

 Some of the Schemes are as follow

• Pradhan Mantri Suraksha Bima Yojana
• Central Government Health Scheme
• Employment State Insurance Scheme
• Aam Aadmi Bima Yojana

Pradhan Mantri Suraksha Bima Yojana

As the name suggest “Suraksha Bima Yojana”, So It basically covers accident insurance to the country people age between group 18 and 70 years who have an account and can take benefit from this.

This Scheme provides an annual cover of Rs. 2 Lakh for total disability and death cover and Rs. 1 Lakh for partial disability. There is a premium of Rs, 12 per annum is deducted from the account holder’s bank account.

Central Government Health Scheme (CGHS)

This Scheme (Health Insurance  Government Scheme I )was started on 1954 for Central Government employees and Pensioners residing in cities. The operations of this scheme take place in cities like Kolkata, Delhi, Mumbai, Lucknow, Nagpur and Pune. The people covered in this scheme should be living/residing in India.

This has an Online Renewal Program and gives the Privileges of Health Education to the Beneficiaries nationwide (The Beneficiaries in any part of India can avail Online Renewal Program based on Health Education).

Under This Scheme, Beneficiaries can get all dispensary related coverage including domiciliary care. It means that Beneficiaries have the privilege of being hospitalized each and every time when they fall ill.

You can also get free X-ray or Laboratory examination. You can also get Free Specialists consultation both on dispensary and hospital.

You can also visit www.cghs.gov.in for more details.

Employment State Insurance Scheme (ESIC)

The ESIC Scheme runs by Government protects all workers in India. It also provides the same privileges those who depend on workers protected under this scheme. The Insurance scheme started on the very first day when the workers or employees get insured. They are provided with full medical care facilities to them and their families.

The Employees or Workers (Mostly workers) are entitled for cash benefits who enrolled in this ESIC scheme. They take cash during Physical distress like sickness or if a person is permanent or temporary disabled.  If any woman who lose the capacity to earn or dependents of person injured during occupational accidents are entitled for monthly pension called dependent benefits.

ESIC schemes are covered for all permanently factories workers/employees (the factories must have at least 10 workers or more).  Recently, The Schemes is extended to various businesses like shops, restaurants, road and motor transports and newspaper entities who employs more than 20 employees.

 

Aam Admi Bima Yojana

There are more than 90% of the total workforce worked in an unorganized sector and they are poor and economically weaker sections of the society. Such people are liable to accident or illness and Lack of Health insurance causes their life more miserable. So, Government of India decided to Launch a Health Insurance Scheme in  2^nd October 2007 for the deprived and weaker section of the society. This Scheme covers accidental death, disability, natural death to the individuals from a specified occupational group.

Features

Some of the features of the Aam Admi Bima Yojana is as follows:

• This Scheme covers 48 Occupational group

Beedi Workers	Food Stuffs like Khandsari / Sugar	Carpenters	Manufacture of Wood Products
Cobblers	Manufacture of Paper Products	Fishermen	Manufacture of Leather Products
Hamals	Brick Kiln Workers	Textile	Printing
Handicraft Artisans	Rubber & Coal Products	Handloom Weavers	Lady Tailors
Chemical Products like candle manufacture	Handloom & Khadi Weavers	Mineral products like earthen toys manufacture	Agriculturists
Leather & Tannery Workers	Transport Drivers Association	Papad Workers attached to ‘SEWA’	Transport Karmacharis
Physically Handicapped Self-Employed Persons	Rural Poor	Primary Milk Producers	Construction Workers
Rickshaw Pullers / Auto Drivers	Fire Crackers’ Workers	Safai Karamacharis	Coconut Processors
Salt Growers	Anganwadi Teachers	Tendu Leaf Collectors	Kotwal
Scheme for the Urban Poor	Plantation Workers	Forest Workers	Women Associated with Self-Help Groups
Sericulture	Sheep Breeders	Toddy Tappers	Powerloom Workers
Hilly Area Women	Overseas Indian Workers	Unorganized workers covered under RSBY	Rural Landless Households

 

• This Scheme covers Permanent Partial Disability/Total Disability due to accident, Natural death and Accidental death

 Coverage Amount for the beneficiaries are as follow

  

Coverage/Sufferer	Benefit/Sum Assured
Natural death	Rs. 30,000
Accidental death	Rs. 75,000
Accident occurring Permanent Partial Disability	Rs. 37,500
Accident occurring Permanent Total Disability	Rs. 75,000
Scholarship Benefit	Rs. 100 per month per child

• Here the Premium varies from State to State and it is completely sponsored by the Government. Here 50% of the premium is sponsored/given/Subsidized by Social Security Fund of the government and remaining 50% premium is paid by State Government or Central Government, union territory or nodal agency.
• The enrollment process is very simple. You do not have to fill lengthy/complex document. The eligible person/beneficiaries have to just show their identification document/proof.
• This Policy is offered by LIC. So, if you require any assistance the you just have to call the nearest LIC Branch or send an email.
• At the time of settlement, you just have to show the AABY (Aam Admi Bima Yojana) card.

Disease or Disability not covered in this Scheme

Aam Admi Bima Yojana Scheme does not cover death or disability occurs from the following

• Participating in Adventurous and Dangerous Sports
• War or Related Perils
• Pregnancy or Child Birth
• Criminal Acts or Activities that break the law
• Chemical, Radioactive or Biological Weapons
• Self-imposed Injuries or Attempted Suicide
• Insanity or Mental Disorders

Eligibility Criteria for this Scheme

The person should meet any of the criteria to eligible in this Scheme

• The Age of the Applicant must be in between 18 and 59 years.
• The individual must be either Below Poverty Line or Marginal Above Poverty Line in the 48 Occupational group (mentioned above) OR  belonging to the rural landless household.
• Only one member per family is covered. It is either the Earning Family member or the Family head.
• The candidate should have to provide supporting documents such as age proof, identity proof, address proof and income certificate apart from application form.

 How a person claims in AABY scheme

The Claim process for this scheme is very easy in comparison to other health insurance product. It provides monetary help in an unfortunate death or disability of the policy holder.

Some of the details related to Aam Admi Bima Yojana claim process

Claim Process during Death

Here the Nominee have to Show Death certificate to claim. The AABY policy must be Active at the time of death of beneficiary. The claim should be filed to the designated “Nodal Agency officer” who will carry out the verification process like the Deceased person is from BPL or Marginal Above BPL family etc. He will also look their occupation etc.

Documents Required to file Claim

• Aam Admi Bima Yojana Death Claim form
• Original and Photocopy of Death certificate

Claim Process for Accidental Death

The claim process is same as above (Claim Process during Death). However, It requires some additional documents apart from the claim and death certificate form

Additional Document Required for Claiming

• Copy of FIR
• Final Report of Police
• Police Investigation Report
• Post-Mortem Report

 Claim Process for Disability

A person can claim Disability under this scheme when he/she is partial or total disability.

Documents required for Claiming

• Documentary evidence of the accident: It means that the beneficiary person should have to show Police FIR, video recording or photographs of the accident.
• Medical certificate: The certificate is issued by the Government Civil Surgeon or Qualified Government Orthopaedician stating the details of the accident like type of disability and loss of limbs of the member covered during scheme.

Claim Process for Scholarship

The AABY Scholarship Online Application form should be filled by the beneficiary (the form is filled half-yearly) and submitted to the Nodal Agency and he will select the eligible student. After identifying student, The Nodal Agency submit the list of identified students to the Pension & Group Scheme unit of LIC.

The List contains the details of the identified students

• Student name
• Name of the School which the Student study
• Class
• Name of the Policyholder/Insured Member
• Master policy number
• Membership number of the insured member
• NEFT details for paying the benefit directly to the bank account of the member