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National Health Insurance Scheme (NHIS) Benefits & Features

By Juhi Walia
30 September 2022, 2:10 PM

Health is one of the vital rights of all human beings. Hence, having the fundamental necessities to maintain good health and healthy living is vital. Concerning the country's growth, health is a crucial determinant affecting medical and financial infrastructure. Almost all countries invest massive capital in healthcare schemes and health insurance, ensuring the residents' effective healthcare practices. 

Today, the Indian government has also become quite severe and has made massive investments in healthcare plans and affordable schemes. These schemes enable the appropriate healthcare amenities reaching swiftly to the Indian citizens. In India, many people cannot afford private health insurance policies. Numerous national health programs and insurance schemes are already launched or in process. 

Important Healthcare Schemes of India

Today on the global platform, health has become a critical parameter to gauge the growth and development of any country. Thus, it has become necessary for any government to provide the best healthcare facilitation and comfortable accessibility to every citizen. 

Today the government builds up multiple healthcare schemes and health insurance plans to support the residents in any medical conditions. This trend has rapidly increased after the Covid-19 pandemic phase, which agitated the entire world with its impact. Below are some of the critical healthcare schemes of India benefitting Indian citizens to a great extent. Let us have a look: 

1. Rashtriya Swasthiya Bima Yojana (RSBY)

This cashless health insurance is launched by the Ministry of Labour & Employment, Government of India. This massive scheme helps families who live below the poverty line and cannot afford basic healthcare necessities. This plan economically supports the BPL families to avail of the necessary health insurance coverage.

Under the scheme of RSBY, it offers a fixed coverage limit of Rs. 30,000 for hospitalisation coverage under different package costs of hospitals. It also covers any pre-existing ailments without any age limit or specific criteria. It covers five members, including self, spouse and three dependents. Through this scheme, the government and individuals manage the premium payment to register with just 30 rupees.

Important features of Rashtriya Swasthiya Bima Yojana (RSBY)

Analysing the current health scenario Government of India is focusing on developing welfare and care schemes to guarantee the accessibility of healthcare accommodation to every citizen conveniently. These schemes are easily accessible and affordable for every Indian citizen. Below are some of the features of RSBY listed: 

  1. Insurers – Here, the government undertakes the complete authority for insurance premium payment to the health insurance company on behalf of every registered household.
  2. Beneficiary- When individuals buy health insurance from RSBY, they have the flexibility to choose the BPL domestic beneficiary for selecting the public and private hospitals.
  3. Hospitals- In the RSBY healthcare scheme, private and public hospitals receive additional incentives for providing essential treatment and care for registered RSBY members.

2. Employment State Insurance Scheme (ESIS)

This is the state-empowered online health insurance plan (ESIS (Employees' State Insurance Scheme). This state government controls this health insurance scheme and provides advanced socio-economic protection to registered employees with dependents. 

The ESIS provides additional cash benefits for specific medical emergencies with complete medical cover for registered self and dependents. The cover also supports the workers with any type of service injury, temporary and permanent infirmities, death because of employment vulnerability, etc. 

The health insurance plans are applicable only for factories with 10 or more employees. The Employment State Insurance Scheme is applicable in all States in compliance with specific areas. It is not applicable in the Union Territories and states like Arunachal Pradesh, Manipur, Sikkim, and Mizoram. 

3. Central Government Health Scheme (CGHS)

The Central Government Health Scheme (CGHS) is created to support medical, medical, and healthcare benefits for Central government employees. This healthcare scheme offers a wide range of healthcare services, including retirees with dependents living in different cities. 

The central government introduced this healthcare scheme in 1954. It offers healthcare facilities with numerous Wellness and fitness Centres such as Siddha, Yoga/Ayurveda, Unani, and Homeopathic Centres, Dispensaries/ Allopathic supported by CGHS. The Key feature of the CGHS Scheme is listed below: 

  • Specialist consultation at dispensary, polyclinic and hospital
  • Hospitalisation coverage
  • Clinical services
  • Medications requirements
  • Medical diagnosis and tests which involve X-Ray, ECG, and other laboratory examination
  • Healthcare and well-being education
  • Domiciliary treatment and care

4. Aam Aadmi Bima Yojana

These health insurance plans were introduced for landless and rural families. The Indian government introduced AABY or Aam Admi Bima Yojana on the 2nd of October 2007. This scheme operates under National Health Insurance Scheme with coverage for earning members and dependents aged between 10 and 59 years. This insurance scheme provides distinct types of compensation under particular regulations. These are listed as follows –

  • Rs 30,000 compensation for any natural death
  • Rs. 75,000 compensations for permanent and partial disabilities such as loss of eyes and limbs. It also compensates for accidental death.
  • Rs. 37,500 compensations for permanent- partial permanent infirmities from accidents damaging one eye or limb.

5. Ayushman Bharat - National Health Protection Mission

It is the most popular National Health Protection Scheme, which is Ayushman Bharat Yojana. This one of the massive scale online health insurances supports poor and susceptible citizens with Rs. 5 Lakh for tertiary and secondary hospitalisation and medical care every year. 

It subsumed the progressive healthcare schemes sponsored by RSYB (Rashtriya Swasthya Bima Yojana) and SCHIS (Senior Citizen Health Insurance Scheme) active under Central Government. The significant notion of the Ayushman Bharat Scheme is to offer cooperative federalism and flexibility to the Indian states. For implementing this scheme, the State Health Agency (SHA) registration is necessary for the states.

6. Universal Health Insurance Scheme (UHIS)

Universal Health Insurance Scheme (UHIS) is a collective approach for public sector insurance agencies offering healthcare insurance coverage to impoverished families. In this healthcare scheme, the family floater health insurance basis covers hospitalisation and medical care with a specific coverage limit of Rs. 30,000. 

Conclusion

India's higher medical inflation rate specifies the significance of the National Health Insurance Scheme. These schemes are framed to solve the infrastructural concerns which improve the healthcare amenities' accessibility and affordability, contributing to the growth and development of India. It is why all the listed healthcare schemes are dedicated to welfare and health insurance and for the citizens supporting their part in national and state level improvement.  

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FAQs

1. What does the National Health Insurance Scheme prominently focus upon?

The prime focus of these schemes is to provide basic and essential health insurance benefits to the susceptible, side-lined and financially weak segments of the Indian community by the (NHIS) National Health Insurance Scheme.

2. What is the coverage limit of the Ayushman Bharat Yojana?

It benefits with Rs 5lakh for medical care support for family and dependents for tertiary and secondary hospitalisation. 

3. Which type of organisation does the Employment State Insurance Scheme (ESIS) cover?

The Scheme covers cinemas, retail shops, hotels, newspaper firms, restaurants, and road transport businesses with 20 or more employees.

4. What are the promising features of Rashtriya Swasthiya Bima Yojana (RSBY)?

The pan-India coverage, advanced IT support, vast hospital network, cashless and paperless transactions, and secured investment are some promising features of this scheme. 

5. What is the compensation offered under Universal Health Insurance Scheme?

The UHIS scheme provides daily compensation of Rs 50 in case of income loss. The nominee of the policyholder receives an amount of 25,000 rupees. 

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