National Health Insurance Schemes (NHIS): Benefits and Features

Medical costs have spiked across the globe to an extent where it is a big challenge to treat critical illnesses. If a person or a family member becomes severely ill or gets caught in an accident, the treatment cost can bring down the entire family’s finances. For such cases, health insurance becomes crucial.

However, not everyone can afford to have a health insurance plan that offers adequate coverage. Understanding the critical need for health coverage for people from every walk of life, the government of India introduced several health insurance plans. Collaboratively, these plans are known as NHIS, full form National Health Insurance Schemes.

Sadly, not many people are aware of the NHIS insurance coverage, which may deprive many of its benefits.
 

Therefore, we are penning this blog to inform our readers about some prominent NHIS scheme benefits and their features.

What is the National Health Insurance Scheme?

As we mentioned earlier, the National Health Insurance Scheme is an effort by the central government to provide adequate healthcare to the financially backward people of the society.

The central Government and the Ministry of Health & Family Welfare and National Knowledge Commission have created the National Health Portal to maintain the health insurance programmes. The portal is like a single-point access and offers consolidated healthcare information to Indian citizens.
 

Here, we will discuss multiple health insurance plans under this portal, their features and benefits.

Rashtriya Swasthya Bima Yojana (RSBY)

To extend the benefits of health insurance to people living below the poverty line, the Ministry of Labour & Employment launched the Rashtriya Swasthiya Bima Yojana or RSBY.

Features and Benefits of Rashtiya Swasthiya Bima Yojana:

 

• Hospitalisation cover limit up to ₹30,000.
• Fixed hospital package rates.
• Cover for pre-existing illnesses without any age limit criterion.
• Cover for up to 5 family members, including the insured, thier spouse, and their three dependents.  
• The registration fee is only ₹30 rupees.
• The government pays the NHIS premium to the insurance company.
• The coverage is spread across India.

Employment State Insurance Scheme (ESIS)

In an attempt to provide socio-economic protection to the working population and their dependents, the government of India designed Employment State Insurance. Under this scheme, the beneficiaries can avail of cash benefits if they face any medical emergency.

Features and Benefits of Employment State Insurance Scheme:

• Covers permanent or temporary disability that hinders earning capability.
• If the beneficiary loses his or her life due to an occupational hazard or in an accident occurring at the workplace, the dependents of the beneficiary will be entitled to a monthly pension.
• Apart from states like Sikkim, Mizoram, Manipur, Arunachal Pradesh, and the Union Territories, the ESIS is implemented based on the area.
• Any non-seasonal factory or small businesses like shops, movie theatres, restaurants, or manpower employers employing more than 20 employees can enlist for ESIS.

Aam Aadmi Bima Yojana (AABY)

To include the rural population (rural, landless households) in social security insurance, the central government introduced the Aam Admi Bima Yojana or AABY scheme on 2^nd October 2007. This NHIS insurance coverage is given to the breadwinner of a household between the age group of 10 & 59 years.
 

Features and Benefits of Aam Aadmi Bima Yojana:

• If the insured person dies of natural causes before 59 years of age, the dependent family members are entitled to a death benefit of ₹30,000.
• In case the insured dies in an accident, the dependents can get up to ₹75,000 as a death benefit. This benefit is also given in case of permanent disabilities (loss of both eyes or 2 limbs)
• In case of partial disabilities (losing one limb or an eye) as a result of an accident, a cash benefit of up to  ₹37,500 will be given to the insured person and his dependent family.

Central Government Health Scheme (CGHS)

The NHI scheme was started in 1954 and is exclusively available to central government employees and their dependent families. The benefits of the scheme are offered through hospitals and polyclinics under Allopathic, Yoga, Ayurveda, Unani, Siddha and Homoeopathy systems of medicine present in CGHS-covered cities.
 

Features and Benefits of Central Government Health Scheme:

• This NHI scheme offers comprehensive health insurance coverage.
• Hospitalisation coverage
• Medical tests (ECG, X-Ray)
• Laboratory tests
• Pharmaceutical coverage
• Domiciliary care
• Consultation with a specialist doctor.
• Cashless claims in case of surgery and other medical treatment

Universal Health Insurance Scheme (UHIS)

Unlike other NHI Schemes that are managed directly by government departments, the Universal Health Insurance Scheme was introduced and is now maintained by four public sector general insurance companies.

Features and Benefits of Universal Health Insurance Scheme:

• One can purchase UHIS at a subsidised premium. An individual can get the insurance at a government subsidy of ₹200 and can purchase it for ₹100.
• If he has 5 dependent family members, the subsidy for the plan will be ₹300, and the insured can purchase it for ₹150.
• The premium for a Universal Health Insurance Scheme bought for a family of 7 members will be  ₹200 after a subsidy of ₹400.
• It will offer hospitalisation cover up to ₹30,000 on a family floater basis.
• The UHIS plan offers an accidental death benefit of ₹25,000.
• It pays ₹50 per day to compensate for the insured's income loss.

Ayushman Bharat - National Health Protection Mission

Ayushman Bharat is a national health protection scheme that intends to cover more than 10 crore families living below the poverty line. Considering every family will have 5 members, the NHI scheme is expected to cover more than 50 crore people.

Features and Benefits of Ayushman Bharat:

• The Ayushman Bharat will provide hospitalisation coverage up to ₹5 lakhs per family per year.
• Free treatment at government hospitals as well as private hospitals in its network.
• It covers pre-existing illnesses from day one.
• Insured can claim health benefits across the country
• The Ayushman Bharat scheme offers pre-hospitalisation cover of 3 days and post-hospitalisation cover of up to 15 days.

Conclusion

These NHIS scheme benefits have far-reaching effects on people’s lives and also on our country's overall growth. Almost all developed nations offer medical insurance care to their citizens because the citizens have the fundamental right to health care against their taxes*. With the National Health Insurance Schemes, India moved a few steps ahead towards building a developed society.