21st November, 2018

Government of India Health Schemes

Health Schemes

The Government of India has brought out several Health schemes that are run for the health benefits of the common man. A few notable ones among them are:

  1. Rashtriya Swasthiya Bima Yojana (RSBY)
  2. Central Government Health Scheme (CGHS)
  3. Employment State Insurance Scheme (ESIS)
  4. Aam Aadmi Bima Yojana (AABY) and Janashree Bima Yojana (JBY)

 

1. Rashtiya Swasthiya Bima Yojana (RSBY) | Overview :

The Indian Government is committed to providing the health insurance facilities for all its citizens. It is seen that the unorganized sector is the group which is the most deprived and does not have much social security benefits. An Act was made in 2008 for ensuring the Social security of this unorganized category in India. This scheme was launched in 2008. In the beginning, this scheme was made mainly for the people under the BPL category. Now it has not been kept restricted to the under BPL category. Many other workers in the unorganized sector have been brought under this scheme.

Aim

The premium that has to be paid for this health scheme is jointly borne by the Union and the State Governments. It is envisioned as a very strong health scheme that will cover the majority of the unorganized sector in India. This Scheme is under the overall control of the Ministry of Health & Family Welfare. The major 2 objectives of this scheme is to provide financial assistance to high costs in health protection and enhance the accessibility of standard health care features for the members of the BPL category of people. The beneficiaries are the people who are under the BPL category.

Features :

 The following are the salient features of the RSBY Health Scheme :

  • Independence of the beneficiary: The beneficiary is free to choose among the government and the private hospitals for availing the treatment. The hospitals can also be gainers by treating these patients. There are good amounts of earning that these people can fetch the hospitals.
  • Win-win situation for all the stakeholders: This scheme is been framed in such a manner that it is beneficial to all the stakeholders who are involved with this scheme. It is a well-devise scheme that can be run for a long time as all the parties concerned can benefit from it.
  • Insurance Company: The Company gets its income from the premium of the insured. The more number people covered will ensure a larger income for the company. It is also in turn a benefit to the insured as their risks are getting covered.
  • Hospitals/Medical Centers: With the greater number of patients being treated at their premises, the revenue of the hospitals is also found to rise. The hospital is always inclined to attract the most number of patients.
  • Intermediary organizations: The organizations which have an intermediary role such as the NGOs are responsible for enrolling the BPLs and extending the scheme related services to them. The more they can do, the greater are their income generations.
  • Government: The Government is responsible for meeting the needs of the country’s citizens. It becomes a big challenge for meeting this need to such a huge population spread over so big a land. The Government pays the premium for the people under the BPL category and is able to render the required medical services.
  • Digitally enabled: This scheme is enabled digitally. All the member families are handed over a card that is digitally enabled. It contains all the relevant data of the family members including the photos and the fingerprints. It enables a smooth process of operation. The digital method makes the system entirely safe. No one is able to tamper with the card. No middleman can take any benefit in between. The entire process remains clear and transparent. The duplication of the card is not possible. The storage of the patient data becomes authentic and foolproof.
  • Can be availed anywhere in India: The RSBY scheme is not restricted only to the region of the beneficiary’s residence. A person can just present his card to a listed hospital throughout India to avail the desired services. It is useful to the workers if they have to shift to a new place of work.
  • No monetary transactions required: If the cards are used at an empanelled hospitals, the beneficiary can avail the cashless services. It is easier for the patients to avail the services.
  • Error-free tracking: The reports regarding the availing of the scheme can be fetched at any moment easily. The entire data is stored on the server and a real-time data can be retrieved. 

Documents Required :

The person should be a holder of the BPL card to avail this scheme. Workers in the unorganized sector also can avail the scheme. A Government specified list of 11 categories of unorganized sector is defined. These people have to show the proof of their occupation. 

Benefits :

The persons who are covered under this scheme can avail a benefit of Rs. 30,000/- in case of hospitalization. The scheme follows a floater option as the money may be utilized for any member of the beneficiary family. There are certain declared diseases under this scheme for which the financial assistance will be available. One of the biggest advantages in this scheme is that a person of any age can avail the benefits. Even a pre-existing disease is covered under this scheme. 5 persons in a single family can be covered. Though the scheme is a Central Government one, nodal agencies have been set up in each state to oversee the functioning of this scheme. 

2. Central Government Health Scheme (CGHS) | Overview : 

The CGHS Scheme is devised for the employees under Central Government services. It has a wide range of benefits for the employees. The benefits can be enjoyed by the current working people and also the ones who have retired from the Central Government Services.  Their dependents are also eligible to enjoy the similar benefits.  The facilities that are available under this scheme are available in all the state capitals along with the major cities and towns of India. Full-fledged health services are admissible under this Health Scheme.

Documents Required :

The patient must have the authentic document to prove that he is a Central Government employee (working or retired).

Benefits :

The major areas of the benefits that can be enjoyed under this scheme are the dispensary serves inclusive of the domiciliary state, consultation with the specialist physicians; all types of pathological and radiological investigations, hospitalization charges, arrangement of the medicines and health education for the patients.

3. Employment State Insurance Scheme (ESIS) | Overview : 

It is a social security scheme that takes care of the worker class.  There is a huge worker category of persons who are engaged in different establishments such as factories etc. who are always under the threat of health hazards and injury. These people get their coverage benefit along with that of their dependents. If the workers in a factory are more than 9, ESI becomes applicable for the workers. Apart from the factories, the workers in other establishments such as shops, hotels, cinema halls, transport sector employees are all covered under ESI. The workers in these establishments have to be 20 persons minimum for the coverage to be binding. Staffs working in the educational institutes are also covered by ESI. All areas in the country are not yet covered by ESI. Gradually, the areas are being increased. 

Documents Required :

The person should possess the ESI card to avail the facility.

Benefits :

If a person becomes sick, they are eligible to get cash benefits by availing the treatment at the notified ESI hospitals. If a person undergoes temporary or permanent disability, he will get the benefit from it. If a person becomes incapacitated, he will get a pension monthly to run his household expenses. The same will be given to the family members, if the person dies due to any kind of injury during the course of employment. 

4. Aam Aadmi Bima Yojana (AABY) and Janashree Bima Yojana (JBY) | Overview :

 The beneficiary of the AABY scheme has to belong to landless persons in the rural areas. A single member of the family gets the benefit of this health scheme. The wage earner of the family is the person who gets the benefit of this scheme. The person has to be with the age of 18 to 59 to qualify. The premium is paid by the Centre and the State equally. The coverage is for people under the BPL category or slightly above the limits for the JBY Scheme. Both these schemes have now been combined.

Documents Required :

  • For AABY scheme, should prove that the person belongs to the rural area and does not possess any land
  • For JBY scheme, should prove the income figures as being below or slightly above BPL category 

Benefits :

There are benefits available on the natural as well as the accidental death of the person covered. Partial or permanent disability is also covered in this scheme. Meritorious students of these families are eligible to get scholarships from this scheme. Similar benefits are permissible to people from 45 specified types of occupation under the JBY Scheme. The benefits are similar to the AABY Scheme. The age eligibility is also the same.