Top 5 Government Health Insurance Companies 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 a 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 more.
• 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 centers.
• Specialist consultations at government hospitals.
• Cashless hospitalization at empanelled hospitals.
• Covers AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) 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.

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:

FAQs on Government Insurance Company

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 upfront

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

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. There, you can find a full list of what is covered and what is not.