Government Health Insurance for Senior Citizens

All about Senior Citizens Government Health Insurance Schemes

The modern world is engaging fast with day-to-day activities, and people are unable to take care of their health. Meanwhile, the medical costs are increasing fast in India, making it challenging for senior citizens to get quality health care. To overcome this, the Indian government has come up with many healthcare insurance schemes that offer reasonable and comprehensive health insurance coverage to senior citizens. These schemes help reduce out-of-pocket expenses and ensure health care or medical treatments for senior citizens without any financial strain. There are some health insurance plans that help senior citizens, and they could be considered government health insurance for senior citizens in India.

Why is Medical Insurance needed for Senior Citizens?

Health insurance for senior citizens is needed because it secures their money savings and finances from high health care costs. Here are the reasons why health insurance for senior citizens is required.  

• Financial Safety: Health insurance for Senior Citizens helps secure the savings from health care bills and treatments.
• Financial Freedom: Senior Citizens Health insurance helps the elderly people get quality medical care without have to worry about health care costs.  
• Early diagnosis: Healthcare check-ups on a regular basis could help diagnose diseases early, which could protect lives.  
• Pre-existing conditions: Health insurance plans offer Coverage for the costs of treating pre-existing conditions.
• Chronic illnesses: Health insurance plans offer Coverage for the costs of treating chronic illnesses.  
• Unexpected emergencies: Health insurance for aged people cover the costs of unexpected medical emergencies.  
• Stops dependency on others: Health Insurance for the Senior citizens help them to reduce their dependency on others for a few of their medical treatment requirements. However kindly note that, not all the health care needs will be included under the senior citizen medical insurance plans.    

Let’s have a look at the various government health insurance for senior citizens.  

Types of Government Health Insurance for Senior Citizens 

Let's discuss the list of different types of government health insurance schemes that provide mediclaim Coverage to senior citizens during their life period:

1. Central Government Health Scheme (CGHS)

The Central Government Health Scheme (CGHS)  offer comprehensive health care to central government employees, pensioners, and their dependents. This scheme provides treatment at CGHS wellness centres, government and empanelled private hospitals.

Advantages

• At polyclinics and empanelled hospitals, free consultation with specialists.
• For the cost of hearing aids and other medical appliances, reimbursement is available.
• Tests such as X-rays and lab investigations are given free of cost.

2. Pradhan Mantri Jan Arogya Yojana (PMJAY)

Pradhan Mantri Jan Arogya Yojana (PMJAY) introduced offers coverage for secondary and tertiary care hospitalisation for up to 12 crore vulnerable families in India. This scheme, also called Ayushman Bharat Yojana, supports economically weaker families in the country.

Advantages  

• Sum Insured - ₹5 lakh per family yearly
• Covers pre-existing diseases from day 1
• No restrictions on family size, age, or gender
• Coverage for 1,929 healthcare procedures 
• Offers coverages till 3 days of pre-hospitalisation and 15 days of post-hospitalisation costs

3. Pradhan Mantri Suraksha Bima Yojana (PMSBY)

Pradhan Mantri Suraksha Bima Yojana is a  personal accident insurance policy available to people aged 18 to 70 years who have a savings account in a participating bank or post office. This scheme launched on June 1, 2015, offers financial protection during the accidental death, total disability, or partial disability.

Advantages

• In case of accidental death or total disability, Coverage up to ₹2 lakh is available.
• A Health Coverage up to ₹1 lakh for partial disability is available.
• An annual premium of ₹20 is deducted from the account of the policyholder.

4. Universal Health Insurance Scheme (UHIS)

Universal Health Insurance Scheme (UHIS) introduced by the Ministry of Health and Family Welfare is available to both the Below Poverty Line (BPL) & Above Poverty Line (APL) families. This scheme provides financial protection during medical emergencies, accidents or death of the primary breadwinner of the family.

Advantages

• Health coverage till ₹30,000 for medical expenses is available.
• It provides Coverage for the hospitalisation expenses without any waiting period.
• Till ₹25,000,  an Accident death coverage for the head of the family or spouse.
• Disability compensation of ₹50 per day for up to 15 days is available.  

5. Employees' State Insurance Scheme (ESIC)

The Employees' State Insurance (ESI) scheme helps support employees in the organised sector. This is a government-backed health insurance and social security program, that offers Coverage to the employees of the permanent factories/businesses. In a few states, it offer coverages to the shops, restaurants, transport companies, and newspapers employees.

Advantages

• Ensures financial safety for workers and their families during healthcare emergencies. 
• It also provides expenses for sickness benefits, funeral expenses, maternity insurance, and confinement.   
• This compensates for wage loss due to temporary or permanent disablement.

6. Rashtriya Swasthya Bima Yojana (RSBY)

The Rashtriya Swasthya Bima Yojana introduced in 2008 helps protect the BPL families from financial burdens because of the hospitalisation expenses.  

Advantages

• Offers coverage for treatments for all PEDs.
• Provides reimbursement to the actual travel costs, to ₹100 per visit, with a yearly limit of ₹1,000.
• No restriction on the age or number of family members.
• Payment of ₹30 yearly for registration or renewal.

7. Mukhyamantri Amrutum (MA) Yojana

The Mukhyamantri Amrutum Yojana offers quality medicare services to lower-income families and those living below the poverty line. This scheme by the Gujarat State Government ensures cashless healthcare and surgical treatment for catastrophic illnesses associated with cardiovascular diseases, neurological diseases, etc. 

Advantages

• Premium is fully paid by the government
• Sum Insured- ₹5 lakh 
• Offers coverages for many illnesses like heart disease, cancer, kidney diseases, etc.
• For per hospital visit for treatment, ₹300 is provided.
• Till ₹5 lakh, kidney, liver, and kidney-pancreas transplants are also covered.

8. West Bengal Health Scheme (WBHS)

The West Bengal Health Scheme (WBHS) offers better healthcare facilities to state government employees, pensioners, and their dependents. This scheme named West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme 2014 covers IAS, IPS, and IFS officers in the State.  

Advantages 

• Offers reimbursements for indoor treatment in-network and non-network hospitals.
• Provides Coverage of OPD treatment for up to 18 specified diseases.
• Offers cashless health insurance facilities to ₹2 crore per indoor treatment.

9. Yeshasvini Health Insurance Scheme

Yeshasvini Health Insurance Scheme offers quality healthcare at minimal costs, providing better access to medical facilities. This scheme was launched by the Government of Karnataka for members of cooperative societies, self-help groups and farmers.

Advantages

• Sum Insured - ₹5 lakh
• Offers coverages for medical procedures, like heart diseases and orthopaedics.
• Beneficiary can only get treatment in the general ward.    
• At the network hospitals, OPD consultation is capped at ₹200 for three months.

10. Karunya Arogya Suraksha Padhathi (KASP)

The Karunya Arogya Suraksha Padhathi (KASP) of Kerala merges different government health schemes to offer better healthcare access for economically vulnerable families.

Advantages

• Offers coverages to pre-existing diseases from day 1
• Sum Insured- ₹5 lakh
• No restriction on the size of the family or the age of beneficiaries
• Coverage for 1,573 health care procedures
• Offers coverages to the 3 days pre-hospitalisation and 15 days post-hospitalisation expenses

11. Telangana State Government - Employees and Journalists Health Scheme

Telangana State Government - Employees and Journalists Health Scheme aims to offer cashless treatment to employees, journalists, pensioners and their dependent family members.  

Advantages

• No coverage limit for procedures listed below the scheme.
• Offers in-patient treatment for listed therapies for identified diseases.
• Offers coverages for the medication for 10 days and complications for 30 days post-discharge.
• Coverage for follow-up services for specified treatments for one year.
• OPD Care for predefined long-term chronic illnesses in listed hospitals.  

Government Health Insurance vs Personal Health Insurance Plans for Senior Citizens - Know the Difference

Many may be interested in understanding the difference between government health insurance for senior citizens and private health insurance for senior citizens. Let’s discuss the difference between government health insurance and private health insurance here.