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National Health Insurance Schemes (NHIS): Benefits and Features

National Health Insurance Schemes cover a large portion of the Indian population living below the poverty line. It gives them much-needed financial support in case of any medical emergency.

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 2nd 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.

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Tata AIA Life Insurance

A joint venture between Tata Sons Pvt. Ltd. and AIA Group Ltd. (AIA),  Tata AIA Life Insurance  is one of the leading life insurance providers in India. We post everything you need to know about life insurance, tax savings and a variety of lateral topics such as savings and investments in this space. You can access and read a host of different blogs, articles and pages at the Tata AIA Life Insurance Knowledge Center or get in touch with us with any queries or questions!

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Frequently Asked Questions (FAQs)

Who can get the Ayushman Bharat Health Card?

People belonging to a lower income category can get the Ayushman Bharat health card under the Ayushman Bharat Yojana. Also, people from the Scheduled Caste and Scheduled Tribe are eligible for Ayushman Registration and the health card.

What is Janashree Bima Yojana?

Janashree Bima Yojana was introduced on 10th August 2000 as a life insurance cover for members of 45 professional groups. However, it was later merged with the Aam Admi Bima Yojana.

Can I get a pan-India treatment facility under NHIS Coverage?

Yes. Under National Health Schemes like Ayushman Bharat and Rashtriya Swasthya Bima Yojana, you can get treatment anywhere in India and be entitled to all the benefits.

Disclaimers

  • Insurance cover is available under the product.
  • The products are underwritten by Tata AIA Life Insurance Company Ltd.
  • The plans are not a guaranteed issuance plan, and it will be subject to Company’s underwriting and acceptance.
  • For more details on risk factors, terms and conditions please read the sales brochure carefully before concluding a sale.
  • This blog is for information and illustrative purposes only and does not purport to any financial or investment services and do not offer or form part of any offer or recommendation. The information is not and should not be regarded as investment advice or as a recommendation regarding any particular security or course of action.
  • Please know the associated risks and the applicable charges, from your Insurance agent or the Intermediary or policy document issued by the insurance company.
  • Every effort is made to ensure that all information contained in this blog is accurate at the date of publication, however, the Tata AIA Life shall not have any liability for any damages of any kind (including but not limited to errors and omissions) whatsoever relating to this material.
  • Tax:*Income Tax benefits would be available as per the prevailing income tax laws, subject to fulfilment of conditions stipulated therein. Income Tax laws are subject to change from time to time. Tata AIA Life Insurance Company Ltd. does not assume responsibility on tax implications mentioned anywhere in this document. Please consult your own tax consultant to know the tax benefits available to you.