Health Insurance Government Scheme

Health Insurance Government Scheme



There is a lot of Health insurance Government scheme  in various parts of the world. In India, Government (State or Central) also carries out a lot of Health Insurance scheme for its own citizen.

Here, The Premium (basically paid annually by the citizen) is very less in comparison to the Private governed Health Insurer. The best part of the Government scheme Health Insurance is that it is followed in the immense rural area of the country and not limited to cities, big cities or metropolitan areas.

Health Insurance Scheme runs by Government (Central or State)  of India

Every Government around the world runs Health Insurance Scheme for their own citizen so that they can take care of your Health.  Government also runs several Healthcare Schemes for awareness of their people.

Government of India also runs Health Insurance Schemes for their own People. Health care Schemes are run by Central or State Government. It is designed to provide adequate health cover at a low price insurance cover.


Some of the Schemes are as follow
  • Ayushman Bharat Yojana
  • Universal Health Insurance Scheme
  • Pradhan Mantri Suraksha Bima Yojana
  • Central Government Health Scheme
  • Employment State Insurance Scheme
  • Aam Aadmi Bima Yojana
  • Janshree Bima Yojana
  • Chief Minister’s Comprehensive Insurance Scheme
  • West Bengal Health Scheme
  • Yeshasvini Health Insurance Scheme
  • Mahatma Jyotiba Phule JAn Arogya Yojana
  • Mukhyamantri Amrutam Yojana
  • Karunya Health Scheme
  • Telangana State Government Employees and Journalists Health Scheme
  • Dr YSR Aarogyasri Health Care Trust


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Ayushman Bharat Yojana

This is also called Pradhan Mantri Jan Arogya Yojana (PM JAY). It is a comprehensive health insurance scheme of the Government of India (Ministry of Health & Family Welfare). This Scheme is Introduced in aiming poor people to get medical facilities.

This Scheme is Introduced by Prime Minister Narendra Modi on Sept 23, 2018. It covers around 50 crores of Indian. Approximately 18000 hospitals in India have been Selected/empaneled in this Scheme.

The Beneficiaries of PM JAY (Pradhan Mantri Jan Arogya Yojana) receives an e-card which is used in any selected (empanel) hospital (public or private) in India. You can also get cashless treatment (in an empaneled hospital).

It covers 3 days Pre-hospitalization and 15 days Post-Hospitalization expenses and takes care of around 1400 procedures with all related costs like OT expenses etc. The PM JAY e-card facilitates covers Rs. 5 Lakh per family per annum.

Eligibility criteria for Ayushma Bharat Yojana (PM JAY) scheme



The Health care Scheme is available to

  • Ancient Tribal Communities.
  • Legally released Bonded Laborers.
  • Manual Hunter/Scavenger Families.
  • People living in Schedule Caste and Scheduled Tribes households
  • The Families with no male members (only Female or Kids) or any Individual aged between 16 and 59 years
  • Beggars and those who is surviving on Charity.
  • Families having at least one Physically Handicapped member and no healthy/able-bodied adult member
  • Families who is living in one room with no proper walls or roof.



The Health care Scheme is available to

  • Sanitation Workers, Gardeners, Sweepers
  • Cobblers, Hawkers and other Providing Services by working on Street or Pavements
  • Assistants, Peons in small establishment, delivery boys, Shopkeepers and waiters.
  • Domestic Help
  • Washer man/Chowkidar
  • Mechanics, Electricians, Repair Workers
  • Rag Pickers
  • Home based Artisans or Handicraft workers, tailors
  • Transport workers like driver, conductor, helper, cart or rickshaw puller


Coverage on Critical Illness

This Scheme covers Critical Illness like

  • Coronary Artery bypass grafting
  • Cartoid Angioplasty with Stent
  • Skull base Surgery
  • Prostate cancer
  • Tissue expander for disfigurement following burns
  • Anterior Spine Fixation
  • Laryngopharyngectomy with gastric pull up
  • Double Valve replacement
  • Pulmonary valve replacement

You can apply by going through and click on “Am I Eligible”


Universal Health Insurance Scheme (UHIS)

This Scheme was launched by Government of India in 2003 to cover the medical expenses for the poorest people among the country. The Scheme was introduced as part of Universal Health Assurance Mission for persons categorized under the Below Poverty Line (BPL) and After Poverty Line (APL).

This Scheme not only covers medical expenses but also provides benefits such as personal accident insurance cover to the primary income earner and compensation to the family incase of death of the breadwinner.



Some of the features of this scheme

  • This Scheme is available both to individual and group.
  • It will be in the name of Primary earning member of the family and it contains the name of the family members.
  • If it is a group policy then it will be the name of the group, association or the institution. It will consist the name of the member and family.
  • Members/Policy Holder cannot be a part of multiple group health schemes in a Group Policy

Benefits and Coverage of the Scheme

 Some of the Benefits under this Scheme

Hospital Benefits Criteria
Rooms and Boarding Cost per Day 0.5% of the Sum Insured
Room and Boarding Cost per Day (ICU) 1% of the Sum Insured
Cost of Surgeon, Medical Practitioners, Anaesthetist, Consultants, Nursing, Specialist 15% of the Sum Insured Per Injury or Illness
Cost of Oxygen, Blood, Medicines, X-Ray, Surgical Appliances, Anaesthesia, Chemotherapy etc 15% of the Sum Insured Per Injury or Illness
Maternity Rs.2500—Normal Delivery


One Child Only (12 Months Waiting Period)

Other Benefits for this Scheme

  • Hospitalization Benefits for Rs. 30000 per family per policy which includes the maternity benefit
  • Maximum expenses claim is restricted to Rs. 15,000 excluding maternity benefits.

Personal Accident cover

When the Insured person or the main income earner got accident due to mishappening and leads to death within 6 months of occurrence, then the insured person will receive Rs. 25,000/

Disability Compensation

If the primary policyholder or spouse is hospitalized because of an illness, disease or accident then after 3 days (waiting period), The insurer will pay Rs 50 per day from the fourth day of being hospitalized as compensation. However 15 days is the maximum per policy period.


 UHICS Premium Rate

The Premium Rate for BPL (Below Poverty Line) and APL (After Poverty Line) Families.

Below Poverty Line Families

Coverage Premium Rates (Rs)  Insured Share (Rs) Government Subsidy (Rs)
Individual 300 100 200
Up to 5 Family Members 450 150 300
Up to 7 Family Members 600 200 400

Above Poverty Line Families


Coverage  Premium Rates
Individual Rs. 365
Up to 5 Family Members Rs. 548
Up to 7 Family Members Rs. 730

Eligibility Criteria

Eligibility criteria among BPL and APL families are given below

Below Poverty Line (BPL) Families

  • Family Income must not be greater than Sum Insured amount
  • Proof (Certificate) is required from the Local Tehsildar or BDO of the Revenue Department confirming that the Family falls under the BPL category.
  • The Age must be in between 5 and 70 years
  • Children between 3 months and 5 years are covered if their parents are covered.

Above Poverty Lines (APL) Families

  • Family Income must not be greater than Sum Insured amount
  • The Age must be in between 5 and 65 years
  • Children between 3 months and 5 years are covered if their parents are covered.


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