Government Health Insurance Schemes You Should Know About

At a Glance

1. Introduction
    
2. Understanding Govt Health Insurance Schemes
    
3. Top Govt Health Insurance Schemes in India
    
4. Benefits of Govt Health Insurance Schemes
    
5. Eligibility Criteria for Govt Health Insurance
    
6. State Govt Health Insurance Schemes in India
    
7. Final Thoughts

Introduction

Medical costs are increasing at a fast pace, and health insurance has become a necessity, not a luxury. The govt health insurance scheme plans offered in India ensure financial protection to people, particularly those belonging to economically weaker sections. These plans help to provide quality medical treatment without the weight of heavy medical expenses. In this blog, we discuss some of the best government health insurance schemes that you must know about in 2025.

Understanding Govt Health Insurance Schemes

A govt health insurance scheme is an organized scheme launched by the government to offer financial and medical benefits to citizens, making healthcare more affordable. The schemes generally entitle hospitalization bills, surgeries, serious diseases, maternity benefit, and other benefits. As compared to private health insurance, these government-supported policies do not involve much premium payments or are completely free.

Two goals for government health insurance schemes are: 

• Low-income support: People in the poorer sections cannot afford private insurance; therefore, they are provided financial help by the government.
• Universal Health Coverage: Through these programs, the citizens of India are arranged into various categories: as government employees, other workers, and pensioners.

Top Govt Health Insurance Schemes in India

The Government of India launched a variety of health insurance schemes for providing financial assistance and medical benefits to different strata of society. The overarching objective of these schemes is to facilitate access to health care for the economically weaker sections of society, the government employees, and those working in the organized sector. Hereunder are some of the major government health insurance schemes in India, along with their benefits and coverage details.

1. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) or simply Ayushman Bharat is the largest government-sponsored health insurance program in India. It offers cashless hospitalization of up to INR 5 lakh for each family in a year free of cost to mainly poor households. The program includes coverage for hospitalization in case of critical illnesses and provision of cashless care at panelled public and private hospitals.

Key Features:

• Protection of up to five lakhs INR to a family annually. 
• No upper limit on the age, gender, or number of persons in a family. 
• Treatment at networked hospitals is cashless and paperless. 
• Day one coverage for pre-existing diseases. 
• Health services are free for poor underprivileged citizens.

2. Central Government Health Scheme (CGHS)

The Central Government Health Scheme (CGHS) is catered exclusively to members of the central government, retired government employees, and their families. Comprehensive medical care is extended by a wide network of government and private hospitals across India. CGHS provides vast OPD and inpatient care which covers diagnostic tests, surgeries, and even chronic illnesses.

Key Features:

• Cashless hospitalization for the central government employee.
• Networks of dedicated CGHS dispensaries across cities.
• Wide range of OPD services including consultation and medicines.
• All health care services- tests, surgery, and critical illnesses which are covered.

3. Employees’ State Insurance Scheme (ESIS)

The Employees' State Insurance Scheme (ESIS) is an insurance-based scheme run by the government for the workforce in the organized sector. It offers a variety of services, which includes medical, cash, and disability benefits, to employees and their dependents. This scheme financially protects the insured person against any sickness, maternity, or injuries due to an accident at work.

Key Features:

• Coverage for the employee and their dependents.
• Hospitalization, medicines, and surgical benefits are provided.
• Maternity and disability benefits are included.
• Monetary help in short-term and long-term disability.

4. Rashtriya Swasthya Bima Yojana (RSBY)

The Rashtriya Swasthya Bima Yojana (RSBY) is a health insurance scheme launched to provide care for poor families with financial assistance during their hospitalization and thereby reduce their out-of-pocket expenditures for medical care. This scheme serves significance for the below-poverty-line (BPL) families, who are offered cashless hospitalization in the empaneled hospitals. 

Key Features:

• Annual cumulative coverage of INR 30,000 per family.
• Cashless hospitalization in empaneled hospitals. 
• Pre-existing diseases are covered by health security in totality.
• Accidental deaths & maternity benefits are also covered.

5. Aam Aadmi Bima Yojana (AABY)

The program of Aam Aadmi Bima Yojana (AABY), introduced for rural landless households, is a social security scheme because it provides health coverage and accidental death benefits, ensuring provision of financial security for economically vulnerable families. In addition, the scheme provides scholarship schemes to the children of the insured individuals. 

Key Features:

• Its coverage is for both natural and accidental death.
• Children of the insured are provided with scholarships.
• Affordable by way of government-subsidized premiums.

6. Pradhan Mantri Suraksha Bima Yojana (PMSBY)

The PMSBY is an accident insurance scheme meant for very low-income groups of people and grants financial compensation in the case of accidental death or disability. This scheme is open to all individuals with a bank account and helps at a very minimal annual premium, thus ensuring cheap accident insurance coverage for all.

Key Features:

• Very cheap insurance scheme with an annual premium of INR 12.
• An accidental death cover of INR 2 lakhs.
• Partial disability cover of INR 1 lakh.

7. Yeshasvini Health Insurance Scheme

The scheme referred to as Yeshasvini Health Insurance is a novel program initiated for those attached to rural cooperative societies in Karnataka. The facility is for financial backing for major surgeries that have become quite affordable through an annual premium. This holds relevance in a country without a correlation to quality healthcare facilities for rural citizens. 

Key Features:

• Covers more than 800 surgical procedures.
• For cooperative society members in Karnataka.
• Also, the annual premium is very cheap and can be taken up even by rural populations.

Also Read: Central government schemes for girl child

Benefits of Govt Health Insurance Schemes

The Government of India has several health insurance schemes to ensure financial security and provide healthcare to various sections of society. This scheme offers multiple benefits that ensure quality medical care is received by all groups without the weight of financial obligations.

1. Financial Protection

The cost of government-dependent health insurance will pay for much of the out-of-pocket expense, while covering hospitalization fees, treatment, surgery, and medical exams. This ensures free, easy access to affordable healthcare services for economically weaker sections including small-scale industries or workers in the organized sector without being loaded with financial burden.

2. Affordable Premiums

Most health schemes by the government have very low premiums, or are absolutely free and offered to low-income groups. For example, Pradhan Mantri Suraksha Bima Yojana (PMSBY), for a mere INR 12 a year, and PM-JAY, which provides free cover to eligible beneficiaries.

3. Cashless Treatment

These schemes envisage cashless hospitalization for treatment in empaneled government hospitals and privatized institutes. There is no prior payment by the beneficiaries, as expenses for hospitalization and treatment are taken care of by the insurance scheme. This way, healthcare is made convenient and hassle-free.

4. Extensive Coverage

Most public health insurance schemes provide complete coverage for pre-existing conditions, surgeries, maternity benefits, emergency treatment, and disability assistance. Some of these schemes, such as Ayushman Bharat (PM-JAY) and ESIS, cover critical illnesses, thus guaranteeing proper medical coverage for the insured. 

5. Wider Accessibility

Government insurance schemes provide insurance coverage to many people: low-income families; central and state government employees; organized sector workers; and members of rural cooperative societies. This ensures equitable access to healthcare for various income groups and categories of employment for the benefit of public health.

Eligibility Criteria for Govt Health Insurance

The eligibility for the different government insurance schemes in India varies according to income, employment, age, and residence. Some of the common key eligibility factors are:

1. Income Level

Many such schemes like Ayushman Bharat (PM-JAY) and RSBY target below poverty line (BPL) families and economically weaker sections. Eligibility is popularly based on the Socio Economic Caste Census (SECC) data to ascertain that financial assistance goes to the truly needy.

2. Employment Status

Some schemes like the Employees' State Insurance Scheme and the Central Government Health Scheme are purely limited to organized sector employees and government servants. These provide all hospital-related services along with maternity care and disability benefits.

3. Age Restrictions

A few of the government health insurance such as Pradhan Mantri Suraksha Bima Yojana have an age restriction on participants, while some don't follow the same. For PMSBY members would be those ranging from 18-70 years, but some other schemes have different age eligibility requirement criteria.

4. Residency Status

There are some health insurance schemes specific to the states, like the Yeshasvini Health Insurance Scheme in Karnataka; some are national like PM-JAY. Other beneficiary specifications serve to ensure that they receive health services based in their state or region.

Also Read: Public vs. Private Health Insurance: Pros and Cons

State Govt Health Insurance Schemes in India

India’s state governments have introduced various health insurance schemes to provide affordable and accessible healthcare, particularly for economically weaker sections. These schemes aim to reduce out-of-pocket medical expenses and ensure quality healthcare. Here are some key state government health insurance schemes:

1. Swasthya Sathi Scheme – West Bengal

• A fully state-funded health insurance scheme launched by the Government of West Bengal.
• Provides cashless medical treatment up to ₹5 lakh per family per year.
• Covers all pre-existing diseases and includes secondary and tertiary care.
• Smart cards are issued to beneficiaries for hassle-free treatment at empaneled hospitals.

2. Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) – Maharashtra

• Provides free healthcare services to economically weaker families.
• Covers hospitalization, surgeries, and critical illnesses.
• Offers cashless treatment at empaneled hospitals, reducing financial burden.

3. Rajiv Aarogyasri Scheme – Andhra Pradesh & Telangana

• Designed for families below the poverty line, offering financial aid for major medical treatments.
• Covers serious ailments like cancer, kidney failure, and heart disease.
• Includes tertiary care services at government and private hospitals.

4. Arogya Karnataka – Karnataka

• Aims for universal health coverage, with a focus on the economically weaker sections.
• Covers essential healthcare services, diagnostics, and hospitalization at subsidized rates.
• Provides financial support for critical disease treatments.

5. Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) – Tamil Nadu

• Offers coverage for low-income families for surgeries, maternity care, and critical illnesses.
• Provides cashless treatment at network hospitals across the state.
• Covers medical expenses up to ₹5 lakh per family per year.

These state-run health insurance schemes play a crucial role in making quality healthcare accessible and affordable for millions of Indians, reducing the financial strain of medical expenses.

Final Thoughts

Ensuring your family is financially and physically secure is ensured through the government health insurance scheme. Many government insurance plans are available to get quality healthcare without the financial weight if the right one is chosen. Compare varied plans and buy the best government health insurance today. 

Protect your family with the best health insurance plans. Visit OneAssure to explore comprehensive health insurance options that fit your needs. Start charting your destiny in healthcare today!