Home / Health Insurance / Articles / Individual Health Insurance / How to qualify for government health insurance subsidies

How to qualify for government health insurance subsidies

TeamAckoNov 7, 2024

Governments are actively working to improve public health by promoting awareness, building better infrastructure, and pushing for health insurance. The Indian government also takes these steps on a regular basis.

A government health insurance scheme is a comprehensive program run by the central or state government to make health care more available and affordable for people from all walks of life. These plans are different from regular health insurance plans offered by private companies because they are made with the goal of including everyone and providing for the many different medical needs of the people in the country.

Government health insurance programs aim to protect individuals and families financially from high medical bills in case of emergencies. They typically provide coverage for a broad range of medical services, including hospitalization, surgeries, and expenses before and after hospital stays. These schemes act as a safety net for those who may not have access to private health insurance or the means to afford it, ensuring that they can still receive essential medical care.

Unlike regular policies, the government provides health insurance subsidies to make medical services more affordable for its citizens. If you're wondering, "How to qualify for government health insurance subsidies in India?" you've come to the right place. This comprehensive guide will walk you through the eligibility criteria, application process, and everything you need to know to access these subsidies.

Contents

What is meant by subsidies?
Qualifying for government health insurance subsidies in India
What are some government-sponsored health insurance schemes?
Difference between regular and government-sponsored health insurance plans
Wrapping up
Frequently Asked Questions (FAQs)

What is meant by subsidies?

Subsidies are like financial help from the government or others to make things cheaper for you. It's kind of like getting a discount to make things more affordable or to encourage certain things to happen. For example, government-sponsored schemes for health insurance. The premium of such schemes is considerably low for the comprehensive coverage offered.

Qualifying for government health insurance subsidies in India

To qualify for government health insurance subsidies in India, you need to meet certain criteria. The primary factors that determine your eligibility include.

1. Income Criteria

Your annual household income plays a crucial role in determining whether you are eligible for health insurance subsidies. The government sets income thresholds, and if your household income falls within these limits, you could qualify for subsidies. These income limits are designed to ensure that those who need assistance the most receive it.

2. Age Criteria

Age is another significant factor that affects eligibility for health insurance subsidies. Certain age groups, such as the elderly and children, might have higher chances of qualifying for subsidies to ensure their healthcare needs are met effectively

3.Employment Status

Your employment status also matters. Some government health insurance subsidy programs are designed to assist low-income individuals who might not have access to employer-sponsored healthcare plans.

4.Family Size

The size of your family and the number of dependents you have can influence your eligibility. Larger families might have different income thresholds compared to smaller families.

5.Socioeconomic Factors

Certain socioeconomic factors, such as whether you belong to marginalised communities or economically disadvantaged groups, can also impact your eligibility for health insurance subsidies.

6.State of Residence

Health insurance subsidy programs can vary from state to state in India. Your eligibility might be influenced by the state you reside in and the specific subsidy schemes it offers.

7.Application Process

Applying for government health insurance subsidies involves several steps:

Documentation: Gather necessary documents, including proof of income, age, residence, and other relevant certificates.
Online Registration: Visit the official website of the relevant government authority or agency responsible for health insurance subsidies. Create an account and fill out the application form with accurate details.
Document Submission: Upload scanned copies of the required documents as per the guidelines provided.
Verification: Your submitted documents will be reviewed and verified. Ensure all information is accurate to prevent any delays in the process.
Approval and Subsidy Allocation: Once your application is approved, you will receive notification. The subsidy amount will be determined based on your eligibility and other factors.
Enrollment in Health Insurance Scheme: Depending on the subsidy program, you might need to choose from a list of approved health insurance schemes and enrol in the one that suits your needs.

Remember, the process can vary depending on the specific subsidy program and the government authority overseeing it. It's essential to stay informed about the latest updates and requirements.

What are some government-sponsored health insurance schemes?

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY): This is a centrally sponsored health insurance scheme that offers a cover of up to Rs. 5 lakh/family per year for secondary and tertiary care hospitalisation. It is available to all Indian citizens living below the poverty line (BPL) and to those above the poverty line who are willing to pay a premium of Rs. 300 per year.
Rajiv Gandhi Universal Health Insurance Scheme (RGUHS): This is a state-level health insurance scheme that is available to all residents of Andhra Pradesh. The sum insured is Rs. 5 lakh/family per year. The premium for the scheme is Rs. 100 per year for individuals and Rs. 200 per year for families.
Tamil Nadu Health Insurance Scheme (TNHIS): This is a state-level health insurance scheme that is available to all residents of Tamil Nadu. The sum insured of this scheme is Rs. 1 lakh/family per year. The premium for the scheme is Rs. 120 per year for individuals and Rs. 240 per year for families.
Mahatma Gandhi Rural Health Insurance Scheme (MGRHIS): This is a state-level health insurance scheme that is available to all rural residents of Kerala. It provides a cover of up to Rs. 30,000 rupees per family per year for secondary and tertiary care hospitalisation. The premium for the scheme is Rs. 100 per year for individuals and Rs. 200 per year for families.
Pradhan Mantri Suraksha Bima Yojana (PMSBY): PMSBY is a government-run micro-insurance scheme that provides life insurance cover of Rs. 2 lakh to all insured persons in the age group of 18 to 70 years. The policyholder must pay a premium of Rs. 12 per year to avail the benefits.
Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY): It is a government-run micro-insurance scheme that provides life insurance cover of Rs. 3 lakh to all insured persons in the age group of 18 to 50 years. The premium for the scheme is Rs. 330 per year.
Awaz Health Insurance Scheme: This particular plan by the Kerala government is for migrant workers. The policy offers a death benefit of Rs 2 lakh. Moreover, it offers health insurance coverage of up to Rs 15000 for labourers between 18 to 60 years.
Bhamashah Swasthya Bima Yojana: This cashless scheme is for the rural people in Rajasthan. It covers expenses related to general as well as critical illnesses. No age restrictions exist for this particular health insurance policy.
Central Government Health Scheme: This particular scheme is available for central government employees. Available in 71 cities, this scheme has been active for six decades. It covers homeopathy and allopathy treatment expenses.
Karunya Health Scheme: The Kerala government introduced this particular initiative in 2012. It covers different critical illnesses, including heart diseases, cancer, and kidney ailments. To be eligible for this scheme, you must provide an income certificate and an Aadhaar card.

Also read: Ayushman Bharat Health Account

Difference between regular and government-sponsored health insurance plans

Criteria	Regular Health Insurance	Government-Sponsored Health Insurance
Maximum coverage	Rs 1 crore	Rs 5 lakh
Minimum premium	Rs 200 per month	Rs 100 per month or fully paid by the government
Policy purchase process	You can buy a policy instantly.	It takes time to purchase a policy because there are stringent eligibility criteria to follow.
Network hospitals	Private hospitals	Public and private hospitals
Ambulance charges	Available in most plans	Available with some plans
Maternity benefits	Depends on the plan	Available (limited to a single child in most cases)
Domiciliary hospitalisation	Available	Not available
No-claim bonus	Available	Not available
Online renewal	Available in most plans	Might not be available
Tax benefits	Available	Not available

Wrapping up

Accessing government health insurance subsidies in India can significantly ease the financial burden of healthcare expenses. By understanding the eligibility criteria and following the application process, you can secure affordable healthcare coverage for yourself and your family. Remember to stay informed about the latest updates from the government authorities and choose the health insurance scheme that best meets your needs.

Frequently Asked Questions (FAQs)

Here are some common questions on How to qualify for government health insurance subsidies

Can I apply for health insurance subsidies if I'm self-employed?

Yes, self-employed individuals can qualify for health insurance subsidies if they meet the income and other eligibility criteria.

What types of health insurance coverage are available under these subsidies?

The available coverage options can include hospitalisation, medical treatments, surgeries, and preventive care, depending on the chosen health insurance scheme.

Is there an age limit to receive these subsidies?

The age limit can vary depending on the specific subsidy program and the target demographic. Some schemes might focus on specific age groups, while others might be more inclusive.

How often do I need to renew my health insurance coverage?

The renewal frequency can vary based on the chosen health insurance scheme. Some might require annual renewals, while others could have longer renewal periods.

Are these subsidies applicable only to Indian citizens?

While many subsidy programs are designed for Indian citizens, some might also extend to specific categories of residents, such as permanent residents or certain visa holders.

Can I apply for subsidies on behalf of my family members?

Yes, in most cases, you can apply for subsidies on behalf of your eligible family members, provided you have the necessary documentation.

What is the insured amount for government-sponsored health insurance schemes?

The insured amount for government-sponsored schemes differs according to the plan. Usually, the sum insured is lower than the policies offered by private insurers.

Do I need an Aadhaar card to be eligible for government-sponsored health insurance schemes?

Usually, an Aadhaar card is an important identity proof to become eligible for government-sponsored health insurance schemes. However, it is important to check the specific documentation requirements of each policy to fulfil the eligibility criteria.

What is the purpose behind government-sponsored health insurance schemes?

Government-based health insurance schemes aim to make medical treatment affordable for all. These schemes are mainly for covering the healthcare expenses of people below the poverty line.

What are the limitations of government-sponsored health insurance plans?

Usually, government-sponsored health insurance plans don’t cover cosmetic procedures. However, the exceptions will differ from one policy to another. You will have to read the terms of each scheme to become aware of the limitations.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.