Health insurance cover offered by different states

In 2018, the government of India launched ‘Ayushman Bharat Yojana’ (ABY) programme to provide cashless medical insurance facility to the common people of India. With that launch, residents of several states can have the benefits of more than one insurance cover – one of the state government and the other of the Centre.

A few state governments such as West Bengal, Tamil Nadu and Rajasthan have not implemented ABY since they have their own health insurance schemes.

Opposition-ruled states

Opposition ruled states like West Bengal, Maharashtra, Delhi, Rajasthan or Tamil Nadu all have separate health policy almost free of cost. And these policies generally provide medical insurance up to Rs 5 lakh per family per year free of cost – the same as AYB.

West Bengal: In West Bengal, the Left Front state government launched ‘Swasthya Sathi’ in 2008. At that time it was only for the government employees.

But from 2019 the state government decided to extend the catchment area and this facility is available for the common people of the state free of cost.

Up to Rs 5 lakh floater cashless medical insurance is provided under the scheme. Till March 2021 the total number of Swasthya Sathi beneficiaries stood at almost 9 crore.

Delhi: Like Bengal, Delhi government also has a 360 degree medical insurance cover up to Rs 30 lakh. The Ayushman Bharat scheme is also available for the residents of Delhi.

The chief minister of Delhi said that while under Ayushman Bharat beneficiaries could get treatment of up to Rs 5 lakh but under the AAP dispensation’s scheme, there was no such limit and hence, the government bears all expenses, even if these amounted to Rs 30 lakh.

Maharashtra: In Maharashtra only residents of select district can apply for the state’s insurance policy. Policyholders can claim financial benefit for the diseases from the first day of coverage. The maximum coverage amount is up to Rs.1.5 lakh which was extended to Rs 3 lakh in 2020. This insurance is named after Jyotirao Phule as Mahatma Jyotirao Phule Jan Arogya Yojana.

Rajasthan: In Rajasthan, the state government offers a health insurance named Bhamashah Swasthya Bima Yojana. This is a specific initiative to offer healthcare coverage to the residents of Rajasthan. Individuals who are eligible to claim benefits from the Rashtriya Swasthya Bima Yojana and the National Food Security Act (NFSA) are also eligible to opt for this scheme.

This scheme of the Rajasthan government offers the people to take advantage of cashless medical facility up to Rs 5 lakh. Another important aspect is that this scheme has no upper limit when it comes to a policyholder’s age.

Tamil Nadu: In Tamil Nadu, Chief Minister’s Comprehensive Insurance Scheme is there for the people of the state. In association with the United India Insurance Company, the state government offers this family floater medical insurance to the needy public in the state. Individuals earning less than Rs 6,500 monthly are eligible for this scheme.

If you avail of this offer, you can claim up to Rs 5 lakh as hospitalisation expenses at select government and private medical facilities.

Multiple policies
As per the latest information, states such as Kerala, Assam, Karnataka and Gujarat have multiple health insurance policies for its citizens.

Kerala: In Kerala ‘Ayushman Bharat’ is not as popular as Awaz Health Insurance Scheme is. This scheme was launched by the Kerala government in 2017. This insurance policy targets the migrant labourers in Kerala. Besides financial assistance during medical emergencies, this scheme also offers a death benefit feature to the policyholder’s family members.

One can claim medical coverage of up to Rs 15,000 from such a plan. The death benefit feature provides a pay out of Rs 2 lakh to surviving family members after the policyholder’s death.

Besides this, Karunya Health Scheme is another popular initiative by the Kerala government, the Karunya medical insurance plan offers critical illness coverage to individuals from the economically weaker sections of society. From cancer to cardiac conditions, all of these health problems are categorised as chronic illnesses. To opt for this scheme, one would need to submit the income certificate, along with a photocopy of the Aadhaar card.

However, this facility is only available to the people aged between 18 and 60 years. Therefore, senior citizens do not qualify for such coverage.

Gujarat: Gujarat and Assam have implemented ‘Ayushman Bharat’ scheme of free health insurance of Rs 5 lakh per family. Gujarat also has Mukhyamantri Amrutum Yojana launched by the Narendra Modi when he was the chief minister.

This scheme was launched in 2012 as part of a Gujarat government initiative. It aims to assist the state’s citizens belonging to the lower and middle-income group and those below the poverty line. A sum insured of Rs 5 lakh is available to beneficiaries as part of a family floater policy.

One can seek treatment at a variety of medical facilities, including trust-based hospitals, public and private hospitals throughout the state as well out of the state.

Assam: On the other hand, in Assam the people have Atal Amrit Abhiyan. Citizen from lower middle class and middle-class families get these facilities, when critical illnesses occur, access to quality treatment is limited mainly due to the often prohibitive cost of treatment.

The scheme will be open for all BPL and APL families in the state having annual family income up to Rs 5 lakh. Families of government employees are not eligible under the scheme.

The scheme will provide inpatient treatment facility at the empanelled hospitals, both private and public up to a maximum limit of Rs 3 lakh per individual member per annum within and outside the state of Assam.

Karnataka: Besides ‘Ayushman Bharat’ Karnataka offers ‘Arogya Karnataka Scheme’ for its citizens. Financial assistance up to Rs 5 lakh per annum will be provided for specified healthcare services. Under this scheme, people can acquire medical coverage against more than 800 procedures across various medical fields.

However, beneficiaries need to visit network medical facilities only to seek the necessary financial assistance during treatment. This is just an extension of central government scheme.

Some other states
Apart from all these states there are some more states which have a dedicated health insurance apart from ‘Ayushman Bharat’.

Andhra Pradesh: The Andhra Pradesh government offers Dr YSR Aarogyasri Health Care Trust. Rather than being one scheme, this is an umbrella plan that includes four different kinds of policies for Andhra Pradesh residents.

One benefits the poor, while another is targeted at individuals above the poverty line. The third variety covers journalists, offering cashless treatment. Lastly, another part of this umbrella scheme caters to state employees only.

The sum assured varies between Rs 5 lakh to Rs 20 lakh depending on the scheme concerned.

Madhya Pradesh, Bihar, Goa: On the other hand, states such as Madhya Pradesh, Bihar, Tripura and Goa has ‘Ayushman Bharat’ health insurance scheme. Previously the states had some health schemes for different classes of people, but not for the masses.

After ‘Ayushman Bharat’ came into the picture these states have changed the name of the scheme accordingly and run this central health insurance scheme throughout the state.