Top 5 Government Health Insurance Schemes in India
India’s diversity and large population make it challenging to provide quality and affordable healthcare to all. Many families struggle with high medical costs and limited access to quality healthcare services.
To solve this issue, the central and state governments of India have launched several health insurance programs. These programs are mainly designed for low-income families to help them pay for good healthcare. With these schemes in place, more people in India can now afford to see doctors and get treated without spending a fortune.
Let's take you through the different government health insurance plans in India. Read on!
Top Government-Run Health Insurance Schemes in India
Here we have curated a list of the government-run health insurance plans in India. Let's take a look:
Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
Launched: 2018
Established by: National Health Authority (NHA)
Overview: AB-PMJAY or Modicare is one of the largest government-funded health insurance programs in the world. It provides coverage of ₹5 lakh per family per year for secondary (referred from primary care) and tertiary (highly specialised) care hospitalisation. The scheme targets more than 12 crore low-income and vulnerable families, around 40% of the population of India.
Key Features
- No premium or enrollment fee.
- Includes coverage for all pre-existing conditions from the very first day.
- No restrictions on family size, gender, or age.
- Coverage for the entire family.
- Coverage for senior citizens aged 70 years and older.
- Offers cashless and paperless services at public and empanelled private hospitals.
Eligibility
Lower-income groups only
Employees’ State Insurance Scheme (ESIS)
Launched: 1952
Administered by: Employees’ State Insurance Corporation (ESIC), Ministry of Labour and Employment
Overview: The ESIS is a Social Security Scheme. It is designed for workers in the organised sector and their dependent family members. It offers comprehensive medical and cash benefits, including sickness pay, maternity and disability benefits, through contributions from employers and employees.
Key Features
- Comprehensive medical care for insured persons and their families.
- Cash compensation during sick leave and maternity leave.
- Free treatment in ESIC dispensaries and hospitals.
Eligibility
- Employees with a monthly salary of less than ₹21,000.
- It is mandatory for companies with 10 or more employees.
Central Government Health Scheme (CGHS)
Launched: 1954
Regulated by: Ministry of Health and Family Welfare
Overview: CGHS is intended to provide a wide range of healthcare services to central government employees, pensioners, and their dependents across select cities in India.
Key Features
- Outpatient care through CGHS wellness centres.
- Specialist consultations at government hospitals.
- Cashless hospitalisation at empanelled hospitals.
- Covers AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homoeopathy) treatments.
- Reimbursement of costs incurred for the purchase of prosthetic limbs, hearing aids (once permission is granted).
Eligibility
- Central government employees and pensioners.
- Members of Parliament, judges, and other eligible groups.
Also Read: What is Janani Suraksha Yojana?
Rashtriya Swasthya Bima Yojana (RSBY)
Launched: 2008 (Merged with AB-PMJAY in 2018)
Regulated by: Ministry of Health and Family Welfare, Government of India
Overview: RSBY is a pioneering government-run healthcare scheme designed to provide health insurance coverage to families below the Poverty Line (BPL). Although AB-PMJAY has subsumed RSBY now, it laid the foundation for wide-ranging public healthcare programs in India.
Key Features (when active)
- Annual coverage of ₹30,000 per family.
- Coverage for pre-existing illnesses.
- Transportation costs.
- Smart card-based cashless transactions.
- Coverage was extended to five members per family.
Eligibility
- Workers in the unorganised sector
- People listed under the BPL category
State-Level Health Insurance Schemes in India
Here’s a quick comparison of state-specific insurance schemes:
| State | Scheme Name | Eligibility |
| Tamil Nadu | Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS) | Low-income families |
| Andhra Pradesh | Dr YSR Aarogyasri Health Care Trust | BPL and low-income families |
| Telangana | Aarogyasri Health Care Scheme | BPL and low-income families |
| Karnataka | Arogya Karnataka | All residents of Karnataka |
| Maharashtra | Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) | Low-income families and farmers |
| West Bengal | Swasthya Sathi | All residents of West Bengal |
| Kerala | Karunya Health Scheme | Low-income families |
| Rajasthan | Mukhyamantri Chiranjeevi Swasthya Bima Yojana | All families in Rajasthan |
| Punjab | Sarbat Sehat Bima Yojana | All residents not covered by central schemes |
| Himachal Pradesh | Himcare | Residents not covered under PMJAY |
| Assam | Atal Amrit Abhiyan | BPL families with specific conditions |
| Odisha | Biju Swasthya Kalyan Yojana (BSKY) | All state residents |
| Delhi | Delhi Arogya Kosh | All Delhi residents |
| Chhattisgarh | Dr Khubchand Baghel Swasthya Sahayata Yojana | All residents of Chhattisgarh |
| Jammu & Kashmir | SEHAT Scheme | All residents of J&K |
Tip: Every scheme has its own set of benefits and coverage. Check the official website to understand what treatments are included. For example, the surgeries, tests, and hospital services covered under PMJAY may not be the same as those under a state scheme like CMCHIS. Therefore, it is advisable to visit the official website of the scheme you intend to use or consult with a health insurance advisor for better clarity. There, you can find a full list of what is covered and what is not.
Disclaimer* :- The information provided here is for general awareness only. It does not constitute professional advice. While care has been taken to ensure accuracy, readers are advised to consult a qualified professional before making any decisions.
FAQs
Who is eligible for the Ayushman Bharat - PMJAY scheme?
The eligibility for PMJAY depends on the Socio-Economic Caste Census (SECC) 2011 data. In rural areas, households are selected depending on aspects like poverty and occupation. In urban areas, eligibility is based on the type of work people do. There is no need to register separately. You can check if you are eligible by visiting the official PMJAY website.
How can I avail myself of cashless treatment under a government health insurance scheme?
To get cashless treatment, go to a hospital that is part of the scheme. If you are admitted, show your scheme-specific ID, for example, the Ayushman Bharat card, ESIC card, or State Health Card. The hospital will check your details, and you can get treatment without paying anything up front.
Can I be enrolled in more than one government health insurance scheme?
Yes, in some cases, a person may qualify for more than one scheme, like PMJAY and a state health scheme. However, usually only one scheme is used for a single treatment. Many states are working to link the schemes better to ensure there is no overlap and people get smoother access to benefits.
Are pre-existing conditions covered under government health insurance?
Yes, most major government schemes like PMJAY and CMCHIS offer coverage for pre-existing diseases from day one. There is no waiting period, making these schemes particularly useful for individuals with chronic illnesses.
What types of treatments are usually covered under these schemes?
Most schemes cover a wide range of secondary and tertiary care treatments, including: Cardiology and cardiac surgery Orthopedic surgery Cancer treatment (oncology) Dialysis and kidney transplant Maternity care and neonatal services
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