Types of Government Health Insurance Scheme overall are focused on giving top notch medical services to their residents. They carry out different measures to guarantee the government assistance of individuals, including bringing issues to light about clinical issues, guaranteeing adequate framework, and advancing health care coverage administrations. The Indian government likewise finds a way these ways to focus on the strength of its residents. There are various government health insurance schemes that exist to provide coverage to citizens. These schemes can differ in terms of their eligibility criteria, benefits offered, and the target population.
Government Health Insurance Scheme- Ayushman Bharat Yojana:-
Ayushman Bharat is a Types of Government Health Insurance Scheme universal health insurance scheme launched by the Ministry of Health and Family Welfare, Government of India. Also known as PMJAY, this initiative aims to provide free healthcare services to over 40% of the population. The scheme provides a health cover of up to Rs 5 Lakh, including coverage for medicines, diagnostic expenses, medical treatment, and pre-hospitalization costs. The most underprivileged families in India can benefit from this comprehensive healthcare program.
https://www.india.gov.in/spotlight/ayushman-bharat-national-health-protection-mission.
| Key Features of PM-JAY | Benefit Cover Under PM-JAY |
| It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empaneled hospitals in India. | Medical examination, treatment and consultation |
| PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital. | Pre-hospitalization |
| It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines. | Medicine and medical consumables |
| There is no restriction on the family size, age or gender. | Non-intensive and intensive care services |
| All pre–existing conditions are covered from day one. | Diagnostic and laboratory investigations Post-hospitalization follow-up care up to 15 days |
| Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empaneled public or private hospital in India to avail cashless treatment. | Medical implantation services (where necessary) Complications arising during treatment |
Under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme, there are two types of beneficiaries:–
02 Types of Families Government Health Insurance Scheme
Deprived Rural Families:-
This category includes families that live in rural areas and have been identified as socio-economically deprived based on the Socio-Economic Caste Census (SECC) 2011 data. The SECC is a survey conducted by the Government of India to identify households that are living in poverty and are in need of social welfare schemes.
Under PM-JAY, all families living in rural areas who meet at least one of the six deprivation criteria (D1 to D5 and D7) are eligible for coverage.
- D1- Only one room with kucha walls and kucha roof
- D2- No adult member between ages 16 to 59
- D3- Households with no adult male member between ages 16 to 59
- D4- Disabled member and no able-bodied adult member
- D5- SC/ST households
- D7- Landless households deriving a major part of their income from manual casual labour
Occupational Categories of Urban Workers:-
The second category of beneficiaries includes families that are classified as being part of certain occupational categories within urban areas. These categories are defined by the Ministry of Labour and Employment
For urban areas, the following 11 occupational categories of workers are eligible for the scheme:-
- Ragpicker
- Beggar
- Domestic worker
- Street vendor/ Cobbler/hawker / other service provider working on streets
- Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and other head-load worker
- Sweeper/ Sanitation worker/ Mali
- Home-based worker/ Artisan/ Handicrafts worker/ Tailor
- Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller
- Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter
- Electrician/ Mechanic/ Assembler/ Repair worker
- Washer-man/ Chowkidar
Overall, 02 Types of Government Health Insurance Scheme the PMJAY scheme aims to provide financial protection to around 50 crore people, making it the largest government-sponsored health insurance scheme in the world. The objective of the scheme is to ensure that no family has to bear the burden of high healthcare costs and to promote the overall health and wellbeing of the population.
