Team AckoNov 17, 2023
Medical care, especially highly specialised treatments, are often too expensive for low-income people. As a result, people Below the Poverty Line (BPL) are left with the burden of expensive hospital bills, making it worse for the poor in India. To meet the need for medical care for the poor, the government has launched several health insurance policies to cater to the financial needs of the poor. Let’s review these health plans for low-income people and their benefits.
For the poor, health insurance was not considered an option in the past until the end of 2007. They had to save and pay a premium to afford health insurance. Hence, the government assumed the responsibility of meeting the medical care needs of the poor.
To provide health insurance coverage for low-income people and those Below the Poverty Line, the government has launched the flagship National Health Protection Scheme. It shall cover more than 10 crore poor and economically vulnerable families. The scheme provides coverage of Rs. 5 lakhs per family per annum.
But, how do regular health insurance plans differ from health insurance plans for people Below the Poverty Line? In the following section, we have compared the two types for your understanding.
|Parameters||Health insurance for BPL families||Regular health insurance|
|Premium||As low as Rs. 30 per annum as per the terms and conditions||More than the health plans for low-income families|
|Payment||Government pay the total or partial premium||Primary policyholders are responsible for paying the premium|
|Sum insured||Up to Rs. 5 lakhs||Up to Rs. 1 crore|
|Types of hospitals||Public and private||Public and private|
|Cashless facility||At network hospitals||At network hospitals|
Here is the list of government health insurance schemes in India.
Ayushman Bharat: Based on the recommendations made by the National Health Policy, the government launched the Ayushman Bharat Yojana keeping in mind the objective of the Universal Health Coverage (UHC) initiative. The health plan, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), aims to cater to society's poor and vulnerable sections. The plan offers coverage of up to Rs. 5 lakhs per family in a year for a premium of Rs. 30 per annum. And all pre-existing conditions are covered from day one.
Rashtriya Swasthya Bima Yojana (RSBY): The RSBY health insurance scheme is primarily aimed at the people Below the Poverty Line, especially those in the unorganised sector. The scheme covers the workers and their families with coverage of up to Rs. 30,000 per family per annum. The policy's beneficiaries shall avail cashless hospitalisation, and pre-existing diseases are covered from day one. The government shall contribute 75% of the annual premium rate, and the beneficiary shall pay Rs. 30 per annual as renewal or registration fee. The cost of the smart card and expenses related to administering the scheme shall be borne by the respective State Governments.
Aam Admi Bima Yojana (AABY): This type of health insurance plan is a personal accident cover and covers rural households that don’t own land. It caters to 45 occupational groups covered under the plan. The government pays the total premium, and the coverage is limited to one family member only (head of the family or an earning member). The payout under this plan is Rs. 30,000 for natural death and Rs. 75,000 in case of accidental death or permanent disability. In the case of partial permanent disability, the compensation is Rs. 37,500.
Employment State Insurance Scheme (ESIS): The scheme covers workers employed in non-seasonal factories with an employee strength of at least 10. The plan provides coverage for self and dependents towards hospitalisation costs and cash benefits in case of disablement or sickness. If those workers die in an accident during their employment, the benefit is paid to the dependent, and a regular pension is paid.
Awaz Health Insurance Scheme: The Government of Kerala has launched a specific health scheme for migrant workers working in the State. It provides hospitalisation coverage against accidental death and disablement. Those between 18 and 60 years are eligible for this scheme. The coverage is up to Rs. 15,000 for hospitalisation expenses, Rs. 1 lakh for accidental permanent disablement and Rs. 2 lakhs for accidental death.
Universal Health Insurance Scheme (UHIS): The government launched the UHIS to cater to the lower-income sections of the society who fall Below and Above the Poverty Line. Beneficiaries can claim up to a maximum of Rs. 15,000 for a single illness and added benefits such as maternity cover of Rs. 2,500 for normal delivery and Rs. 5,000 for cesarean delivery. The scheme also provides accidental cover for the main earning member of the family and offers coverage of Rs. 25,000. The premium for the scheme starts from Rs. 100 per annum.
Central Government Health Scheme (CGHS): The scheme caters to the Central Government employees, including present and retired employees. The health care facility is provided in 71 cities across India. The beneficiaries of the scheme have access to Wellness Centres, allopathy, Ayurveda, Unani, Homeopathy, Siddha and Yoga. The premium is based on the pay grade of an employee.
Apart from the above health insurance for low-income people, there are several other State Government specific health insurance plans. These plans are designed to cater to BPL families and the poor.
Also, check: Ayushman Bharat Health Account (ABHA Card)
India has been on the economic surge, and the livelihood of many have evolved over the years, offering access to quality health care. However, a major portion of the population still lives in poverty, having no access to quality healthcare. To overcome this hurdle, the Central Government has launched several schemes over the years targeting the low-income and poor people of the country. All these schemes have different benefits, features and criteria. So, choose the plan that caters to your medical needs.
Here are some common queries about health insurance for the poor.
Not all Government health insurance schemes are free of cost. However, most are affordable for the poor. The Government may bear a portion of the premium, while the policyholder may have to bear a portion of it.
The motive behind the Government’s initiative to launch health insurance schemes is to lower the burden of financial cost on the poor. It also ensures people Below the Poverty Line have access to healthcare and encourages low-income people to invest in health insurance.
Typically, an ID proof is required to avail coverage under the Government health insurance schemes. However, it is better to check with the respective authorities to understand if there are specific documents required.
|Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.|
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