5 Comprehensive National Insurance Schemes That Can Help You In Medical Emergencies

In times of medical emergency, it is difficult to manage the financial aspect of treatment. Thankfully, the Indian Government has a number of schemes in place to provide assistance to those in need.

Published on: 15 February, 2023

In times of medical emergencies, it is not uncommon to feel overwhelmed and helpless. Not only do you have to worry about the health of your loved one, but you also have to grapple with the financial implications of such a crisis.

Fortunately, the Indian Government has put in place a number of schemes and initiatives to help those in need. Through these government programs, individuals and families can access financial assistance for medical care and other related costs.

Here are 5 national schemes that provide insurance coverage to patients in times of medical need, regardless of their age or location:

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

PMJAY is a national public insurance fund that aims to provide free access to health insurance for low-income earners in the country, in both public and enlisted private healthcare facilities.

Benefit cover of INR 5 lakhs is provided per family, per year
Patients can avail free secondary health care for specialist treatment and tertiary health care for hospitalisation
Caters to poor families in both rural and urban areas
Facilitates cashless healthcare services
Patient can be recompensed for the transportation cost incurred pre and post-hospitalization period
The scheme also covers medical examination and diagnostic expenditure, pre and post-hospitalisation costs, follow-up treatment expenses, medicine and consumables costs, accommodation fees, and even food services
To apply, the applicant will be required to get themselves identified at the nearest PM-JAY enlisted hospital or Community Service Centre (CSC) and produce their Aadhaar Card/PAN Card, contact details, caste certificate and income certificate
To check if your name is on the beneficiary list or that you are eligible for Ayushman Bharat, click here.
A patient is not eligible for financial assistance under PM-JAY, if
- - They own a vehicle
  - They are a government employee
  - Their monthly income exceeds INR 10,000
  - They live in a well-constructed house
  - They hold a Kisan card
  - They own agricultural land of more than 5 acres and farming machinery
  - They own a refrigerator and landline connection in their house

Read more about PMJAY, here.

2. Central Government Health Scheme (CGHS)

CGHS provides comprehensive healthcare facilities to government officials and pensioners, residing across 71 cities where this scheme is currently in operation.

The scheme requires beneficiaries covered to be residing in India
Benefits of the scheme can be availed on family-floater basis
Covers treatments under allopathy, homoeopathy, and the Indian system of medicine
Patients can avail cashless facilities at empanelled hospitals / authorised wellness centres through the CGHS card received after registration
The scheme provides reimbursement on expenses incurred on emergency treatments at government or private hospitals
It also covers OPD treatment, medication charges and consultation costs at government hospitals or polyclinics and indoor treatment at government or CGHS enlisted hospitals
To apply:
- A currently serving employee will be required to produce proof of residency, disablement certificate from a valid authority in case a dependent is differently-abled, proof of residency and age of the dependent

- A pensioner will be required to produce proof of residency, disablement certificate from a valid authority in case a dependent is differently-abled, proof of residency and age of the dependent, attested copies of PPO/provisional PPO/last pay certificate, Surrender Certificate (if CGHS card was issued during service) and demand draft

Read more, here.

3. Employees’ State Insurance Scheme (ESI)

ESI is an integrated social security plan tailored to provide workers in factories and other establishments like road transport, hotels, restaurants, newspapers, shops etc., medical care at enlisted hospitals during certain health-related eventualities. It is the legal responsibility of the employer to register for the ESI scheme and enroll all their employees, under the ESI Act.

Medical expenses are covered from day one of employment
The insured person must draw monthly wages of less than INR 21,000 and be employed in a non-seasonal factory with over 10 employees to avail the scheme’s benefits
The worker is eligible for cash benefits in the case of sickness, disability, maternity, physical rehabilitation, etc.
The scheme provides maternity benefit of 100% of wages for 12 weeks
In the event of an employee becoming temporarily or permanently disabled, they are supplied a monthly wage of 90%
The insured can receive 70% of cash benefits during medical leave for a maximum of 91 days.
To apply, the employer will be required to produce a registration certificate or licence under the Shops and Establishment Act or Factory Act, partnership deed for partnership firms and Certificate of Registration for Private Limited Companies, list of all workers with their monthly compensation details, address proof and PAN card of all employees as well as the business entity, list of shareholders, partners, and directors of the establishment and employee attendance registers

Read more, here.

4. Universal Health Insurance Scheme

The UHIS is an insurance plan offering coverage for all medical expenses for persons falling below poverty line and above poverty line.

Insurance coverage is on family-floater basis
Insurance companies will help with enrolling in this scheme
The income must be lesser than the sum insured amount for BPL families and more than the sum insured amount for APL families
The insured members are reimbursed for medical expenses incurred during hospitalisation for any illness, disease, or injury sustained by them
Each family is liable to receive INR 30,000 as hospitalisation benefit, which includes maternity benefit
Minimum claim expenses are limited to INR 15,000 (excluding maternity benefits)
The insured member or their spouse may receive INR 50 for a maximum of 15 days, in case they are hospitalised due to illness or an accident. This is provided from the 4th day of hospitalisation.
People aged between 5 and 70 years can avail the benefits of the scheme
Children aged between 3 months and 5 years old are covered with their parents under the scheme.
The premium is calculated at INR 365 annually
- Families with 5 members or less have to pay an annual premium of INR 548
- Families with more than 5 but less than 7 members have to pay an annual premium of INR 73
To apply, a BPL applicant is required to produce certificate providing proof of BPL status from Tehsildar or Block Development Officer of the State Revenue Department

Read more, here.

5. Janani Shishu Suraksha Karyakram (JSSK)

SSK enables expecting mothers and sick newborns to access better facilities and institutional care at government hospitals.

The scheme provides free and cashless delivery, c-section, treatment, drugs and consumables, diagnostics and diet, provision of blood, transport from home to health institutions, transport between facilities in case of referral, drop back from institutions to home and exemption from all kinds of user charges
The benefits are extended to all antenatal & postnatal complications of pregnancy
To apply, an applicant will be required to register at any government health centre and produce an Aadhar card, caste certificate, and Ration card (BPL)

Read more, here.

Here are 5 national schemes that provide insurance coverage to patients in times of medical need, regardless of their age or location:

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

Benefit cover of INR 5 lakhs is provided per family, per year
Patients can avail free secondary health care for specialist treatment and tertiary health care for hospitalisation
Caters to poor families in both rural and urban areas
Facilitates cashless healthcare services
Patient can be recompensed for the transportation cost incurred pre and post-hospitalization period
The scheme also covers medical examination and diagnostic expenditure, pre and post-hospitalisation costs, follow-up treatment expenses, medicine and consumables costs, accommodation fees, and even food services
To apply, the applicant will be required to get themselves identified at the nearest PM-JAY enlisted hospital or Community Service Centre (CSC) and produce their Aadhaar Card/PAN Card, contact details, caste certificate and income certificate
To check if your name is on the beneficiary list or that you are eligible for Ayushman Bharat, click here.
A patient is not eligible for financial assistance under PM-JAY, if
- - They own a vehicle
  - They are a government employee
  - Their monthly income exceeds INR 10,000
  - They live in a well-constructed house
  - They hold a Kisan card
  - They own agricultural land of more than 5 acres and farming machinery
  - They own a refrigerator and landline connection in their house

Read more about PMJAY, here.

2. Central Government Health Scheme (CGHS)

CGHS provides comprehensive healthcare facilities to government officials and pensioners, residing across 71 cities where this scheme is currently in operation.

The scheme requires beneficiaries covered to be residing in India
Benefits of the scheme can be availed on family-floater basis
Covers treatments under allopathy, homoeopathy, and the Indian system of medicine
Patients can avail cashless facilities at empanelled hospitals / authorised wellness centres through the CGHS card received after registration
The scheme provides reimbursement on expenses incurred on emergency treatments at government or private hospitals
It also covers OPD treatment, medication charges and consultation costs at government hospitals or polyclinics and indoor treatment at government or CGHS enlisted hospitals
To apply:
- A currently serving employee will be required to produce proof of residency, disablement certificate from a valid authority in case a dependent is differently-abled, proof of residency and age of the dependent

- A pensioner will be required to produce proof of residency, disablement certificate from a valid authority in case a dependent is differently-abled, proof of residency and age of the dependent, attested copies of PPO/provisional PPO/last pay certificate, Surrender Certificate (if CGHS card was issued during service) and demand draft

Read more, here.

3. Employees’ State Insurance Scheme (ESI)

Medical expenses are covered from day one of employment
The insured person must draw monthly wages of less than INR 21,000 and be employed in a non-seasonal factory with over 10 employees to avail the scheme’s benefits
The worker is eligible for cash benefits in the case of sickness, disability, maternity, physical rehabilitation, etc.
The scheme provides maternity benefit of 100% of wages for 12 weeks
In the event of an employee becoming temporarily or permanently disabled, they are supplied a monthly wage of 90%
The insured can receive 70% of cash benefits during medical leave for a maximum of 91 days.
To apply, the employer will be required to produce a registration certificate or licence under the Shops and Establishment Act or Factory Act, partnership deed for partnership firms and Certificate of Registration for Private Limited Companies, list of all workers with their monthly compensation details, address proof and PAN card of all employees as well as the business entity, list of shareholders, partners, and directors of the establishment and employee attendance registers

Read more, here.

4. Universal Health Insurance Scheme

The UHIS is an insurance plan offering coverage for all medical expenses for persons falling below poverty line and above poverty line.

Insurance coverage is on family-floater basis
Insurance companies will help with enrolling in this scheme
The income must be lesser than the sum insured amount for BPL families and more than the sum insured amount for APL families
The insured members are reimbursed for medical expenses incurred during hospitalisation for any illness, disease, or injury sustained by them
Each family is liable to receive INR 30,000 as hospitalisation benefit, which includes maternity benefit
Minimum claim expenses are limited to INR 15,000 (excluding maternity benefits)
The insured member or their spouse may receive INR 50 for a maximum of 15 days, in case they are hospitalised due to illness or an accident. This is provided from the 4th day of hospitalisation.
People aged between 5 and 70 years can avail the benefits of the scheme
Children aged between 3 months and 5 years old are covered with their parents under the scheme.
The premium is calculated at INR 365 annually
- Families with 5 members or less have to pay an annual premium of INR 548
- Families with more than 5 but less than 7 members have to pay an annual premium of INR 73
To apply, a BPL applicant is required to produce certificate providing proof of BPL status from Tehsildar or Block Development Officer of the State Revenue Department

Read more, here.

5. Janani Shishu Suraksha Karyakram (JSSK)

SSK enables expecting mothers and sick newborns to access better facilities and institutional care at government hospitals.

The scheme provides free and cashless delivery, c-section, treatment, drugs and consumables, diagnostics and diet, provision of blood, transport from home to health institutions, transport between facilities in case of referral, drop back from institutions to home and exemption from all kinds of user charges
The benefits are extended to all antenatal & postnatal complications of pregnancy
To apply, an applicant will be required to register at any government health centre and produce an Aadhar card, caste certificate, and Ration card (BPL)

Read more, here.

If you find that you are not eligible to benefit from any of the above mentioned schemes, medical crowdfunding is also an option that is available to you. In times of need, support means everything, and with Milaap, you need not look any further. Milaap enables you to set up a fundraiser for any medical emergency within minutes, and you can easily raise funds for treatment expenses.

Do you know someone who could benefit from fundraising? Simply refer them to us and we’ll be happy to lend a hand.

Visit www.milaap.org or call us on +91 9916174848 to get started now.

For more information, write to us at cx@milaap.org.

Do you know someone who could benefit from fundraising? Simply refer them to us and we’ll be happy to lend a hand.

Visit www.milaap.org or call us on +91 9916174848 to get started now.

For more information, write to us at cx@milaap.org.