Health Insurance in India varies from state to state. Ours is a very populated country. Still the lack of resources and management issues, the mass population depends on the private sector rather than the government policies. Insurance Regulatory and Development Authority of India and The General Corporation of India conduct campaigns throughout the nation. In 2018, for underprivileged citizens, Prime Minister Narendra Modi announced the launch of new health insurance called Modicare and the government claims that the new system will try to reach more than 500 million people.
The two types of plans that work in India are:
The indemnity plan: This is for basic medical coverage like maternity and other basic admissions in hospitals for both individual and family members.
The fixed plan: This covers all the critical illnesses like accident coverage, cancer expenses, heart-based operations, etc.
The expenses that are covered in these kinds of insurance are mainly bed charges, doctor’s and nurses’ fees, etc. based on the type of insurance they choose.
Let me explain How health insurance works?
Health insurance companies always pay directly to the hospitals where your family members have been hospitalized. Simply, it’s cashless. The amount paid is the total sum of the amount that you have insured. For example, if you have insured yourself and your family members for a sum of 2 lakhs rupees. Then you will be directly paid by your insurance company to the hospital that your family is being admitted or hospitalized.
Whenever someone fills up the insurance form they have to mention whether it’s a family floater or for an individual. The difference between the family floater and individual is nothing but the former has beneficial values throughout the family while the later benefits only the single person.
How good is health insurance by government?
According to Nitish Singh, Vice president in the General Insurance sector policy, “Health insurance is used as a tax-saving instrument rather than a risk coverage option”.
In a growing republic country like India, the saturation of Health insurance is low. Many points have to be taken care of when it comes to health insurance. Health issues are like guests. They come without proper notice and anytime they are not welcome. But when it comes it leaves us with no choice. Accidents, sudden ailments, Newer diseases are unpredictable. In India, the health industry is one of the major business realms. It creates a lot of employment opportunities, along with a huge turnover.
National health insurance in India
This is also known as the Ayushman Bharat scheme. This scheme mainly targets the below poverty line people. This is a family floater type and so numbers that to be added as the family has no limits. Cashless hospitalization to all the included family members up to 5 Lakhs INR is provided under this scheme.
This scheme is currently offered by LIC. We can call this as micro-level insurance because only one individual in a family is added. He/She should be the head of the family or the breadwinner. And he/she should not own a house and they should work under 45 occupational groups that are valid under this policy. The age limit for this policy is 18 to59 years. As said before this is also a government-paid free policy.
This is also for poor economical background people. Yojna covers up to INR 30,000 in case of hospitalization and pre-existing illness from day 1. This is a family floater policy that covers up to 5 members. One has to pay Rs.30 as entry fee and government pays the rest of the premium.
As the heading says this for the employer that covers their family members too. In case of death, government pays the dependent beneficiary along with a lifetime pension.
This is for all the central government employees for both working and retired. This covers all the medical expenses along with non-allopathy medicine too.
This is also for the below poverty line people. Only four health sectors are offering this scheme. Premiums are low starting from Rs.200 for individuals and for additional family members Rs.300 to Rs.400.
Kerala government launches this scheme for migrant workers working in Kerala. The age limit is 18 to 60. It offers 1lakh for permanent disability and 2lakhs for accidental death. The scheme also covers Hospitalization up to INR 15,000.
Rajasthan based health insurance scheme to enroll only Rajasthan citizen. The Yojna covers hospital coverage of Rs. 30,000 along with critical disease illness of Rs. 3 lakhs.
Tamilnadu state-specific health insurance where one has to prove as Tamilnadu
Citizens to get this policy beneficial. This is a family floater scheme where along with spouse, children, and prosperous parents. This scheme covers below poverty line people whose yearly income should be less than Rs. 72,000.
Refugees, orphans, and migrant workers can also enjoy this plan.
Kerala state-sponsored health insurance scheme was both above and below the poverty line people can benefit from this plan. Yearly income of 3Lakhs or less than that people can avail of this policy. This policy covers Kidney related ailments up to 3 Lakhs and other diseases up to 2 Lakhs.
Maharashtra governmnet launches this health insurance previously known as Rajiv Gandhi Jeevandhayee Arogya Yojana policy. This scheme covers 971 procedures or therapies or surgeries under 30 specified categories. Hospital coverage of 1.5Lakhs on a family floater basis.
The government of Gujarat offers this scheme for people who are below the poverty line. This scheme covers mainly critical illness.
This is a nationwide scheme that is available to all citizens whose age limit is 18 to 60. The policy covers death and loss of certain body organs. 1 Lakh coverage for partial disability and 2Lakhs for permanent disability is provided.
Andhra Pradesh government launches this scheme for people below the poverty line for free. The sceme covers up to 2 Lakhs for hospitalization and other treatments on a family floating basis.
Officially known as Yeshasvini cooperative farmer’s health care scheme launch by the Karnataka government in 2002. Farmers of rural society members of Karnataka are under this scheme. A premium of Rs.250 for rural farmers and Rs. 710 for urban farmers is there under the scheme.
West Bengal Government launched a Health insurance scheme that provides beneficiary for Pensioners of the government of West Bengal. IAS, IFS, IPS, and retired AIS officers can also avail these health benefits. Cashless and reimbursement offers are available both inside of West Bengal and also in selected hospitals outside of West Bengal too. This scheme is rename as West Bengal Health of all employees and pensioners cashless medical treatment scheme 2014 in the year 2014.
All the details are available on mera.pmjdy.gov.in. One can just follow the process by giving the mobile number and other mandatory details.
Disclaimer:This article is for educational purpose only and should not be took as professional advice.
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