Government Health Insurance Schemes in India
Health insurance in India is no longer just for the privileged few. In the last decade, government-backed health schemes have helped millions of families across the country get access to basic healthcare services. These schemes are especially important in a country where medical expenses can quickly become overwhelming
for low-income households.
As of 2023–2024, around 514 million people (roughly 37% of India’s population) were covered under health insurance, and a large part of this was through government schemes. One of the biggest initiatives is Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PM-JAY), which alone aims to cover the bottom 40% of India’s population, reaching nearly 12.37 crore families and that’s about
550 million beneficiaries.
What’s also worth noting is that government spending on healthcare has doubled in the past decade going from a mere 20% to 48% of total health expenditure. And in FY23, India’s healthcare spending reached 2.1% of GDP, up from 1.6% in FY21.
However, access is still uneven. While states like Rajasthan, Andhra Pradesh, and Goa have more than 70% family coverage, others like Bihar and Maharashtra lag
behind, with less than 25%.
In this blog, we’ll walk through the major government health insurance schemes in India, explaining who they’re meant for, what they offer, and how they’re making a
difference in people’s lives.
Top Government Health Insurance Schemes in India
| Scheme | Who Can Claim | Sum Insured | Pre/Post Hospitalisation | Cashless | In-patient | Accidental Death | Disability | OPD Treatment |
|---|---|---|---|---|---|---|---|---|
| PM-JAY | SECC-identified poorer families | ₹5 Lakh per family/year | 3 days pre, 15 days post | Yes | Yes | - | - | - |
| CGHS | Central govt employees/pensioners | No cap (service-based) | - | Yes | Yes | - | Yes | Yes |
| RSBY | Families Below Poverty Line (BPL) | ₹30,000 per family/year | - | Yes | Yes | - | - | - |
| ESIS | Workers earning ≤ ₹21,000 + dependents | Wage-based medical cover | - | Yes | Yes | - | - | - |
| PMSBY | Citizens aged 18-70 with savings account | ₹2 Lakh (accidental death cover) | - | No | No | Yes | - | - |
| AABY | Unorganised sector laborers | ₹30K (natural), ₹75K (accidental) | - | No | No | Yes | - | - |
| UHIS | Social sector employees, families | ₹15K-₹1 Lakh (varies by category) | - | Yes | Yes | Yes | Yes | Yes |
| Aarogyasri (AP) | Andhra Pradesh BPL families | ₹5 Lakh per family/year | - | Yes | Yes | - | - | - |
| MJPJAY (MH) | Maharashtra BPL families | ₹5 Lakh per family/year | - | Yes | Yes | - | - | - |
| Amrutum (GJ) | Gujarat BPL families | ₹5 Lakh per family/year | - | Yes | Yes | - | - | - |
| Yeshasvini (KA) | Karnataka farmers/cooperative members | Approx ₹2 Lakh | - | Yes | Yes | - | - | - |
| CMCHIS (TN) | Tamil Nadu low-income families | ₹5 Lakh per family/year | - | Yes | Yes | - | - | - |
| KASP (KL) | Kerala low-income families (PM-JAY linked) | ₹5 Lakh per family/year | - | Yes | Yes | - | - | - |
| WBHS (WB) | WB state govt employees & pensioners | ₹1.5-2 Lakh | - | Yes | Yes | - | - | - |
| Telangana EJHS | State employees & registered journalists | ₹2 Lakh | - | Yes | Yes | - | - | - |
| Awaz (KL) | Kerala migrant laborers | ₹15K (hospital), ₹2 Lakh (death) | - | Yes | Yes | Yes | - | - |
| BSBY (RJ) | Rajasthan NFSA cardholders & RSBY families | ₹30K (general), ₹3 Lakh (critical) | 7 days pre, 15 days post | Yes | Yes | - | - | - |
* Please read the disclaimer at the end of this page before purchasing this policy.
Govt Health Insurance Schemes in India
Here's a closer look at some of the government health insurance schemes in India:
Central Government Schemes
There are 2 situations where you might go for a cashless claim: planned hospitalisation and emergency hospitalisation.
This is one of the largest government-backed health insurance schemes in the world. It provides free treatment up to ₹5 lakh per family, every year, for secondary and tertiary hospital care. The scheme is targeted at poor and vulnerable families. You don’t have to pay any premium, and the coverage includes over 1,500 procedures. If you qualify, you can walk into any enrolled hospital and get treatment without worrying about the bill.
This is one of the largest government-backed health insurance schemes in the world. It provides free treatment up to ₹5 lakh per family, every year, for secondary and tertiary hospital care. The scheme is targeted at poor and vulnerable families. You don’t have to pay any premium, and the coverage includes over 1,500 procedures. If you qualify, you can walk into any enrolled hospital and get treatment without worrying about the bill.
This scheme was started for people working in the unorganised sector. If you fall under the Below Poverty Line (BPL) category, RSBY offers coverage for hospital expenses up to ₹30,000 per family per year. It also provides smart cards that make the entire process easier and paperless. This scheme helps daily wage workers and labourers afford treatment that would otherwise be out of reach.
This scheme is specially designed for workers earning ₹21,000 or less per month in the formal sector. If you're employed in a company that contributes to the ESI fund, you get access to a wide range of benefits including hospital care, disability benefits, maternity leave, and even unemployment allowance. It's a complete social security net for workers and their families.
Accidents can hit without warning. This scheme provides accident insurance coverage of ₹2 lakh for death or permanent disability, and ₹1 lakh for partial disability. The best part is that it costs just ₹12 a year. Anyone with a savings bank account and aged between 18 and 70 can join. It's simple, low-cost, and gives some peace of mind.
This scheme supports landless households by giving insurance coverage for the earning member of the family. It provides ₹30,000 in case of natural death, and more in the event of accidental death or disability. It also covers 48 types of occupations, like fishing, farming, or handloom weaving. The premium is partly subsidised, making it easier for families to stay protected.
UHIS is meant for the underprivileged. It offers health cover for hospitalisation and personal accident benefits at a very low premium. Families get ₹30,000 cover for medical expenses, ₹25,000 for accidental death of the earning member, and ₹50 per day as hospital cash benefit for up to 15 days. It’s a safety net for families that don’t have any other health insurance support.
State Government Health Insurance Schemes You
Should Know
Every state in India has its own way of making healthcare more affordable for its people. These health schemes are aimed at helping families who cannot always afford expensive hospital bills. Here’s a closer look at of some of the major state-level health insurance schemes that are currently active:
If you're living in Andhra Pradesh and have a low income, the Dr YSR Aarogyasri Scheme could be a lifesaver. It offers cashless treatment for serious illnesses at both government and select private hospitals. The best part is that you don’t need to worry about huge surgery bills. From heart conditions to cancer treatments, the scheme covers over 2,000 medical procedures for families below the poverty line.
This is Maharashtra’s flagship health insurance plan for economically weaker sections. Families can get up to ₹1.5 lakh per year for hospitalisation and treatment, and in some critical cases, the limit goes up to ₹2.5 lakh. It covers major surgeries, therapies, and maternity care in over 500 hospitals. If you’re a farmer, labourer, or from a low-income group, this scheme could reduce a lot of financial stress in medical emergencies.
This scheme is designed especially for BPL (Below Poverty Line) families in Gujarat. It provides cashless medical and surgical coverage up to ₹5 lakh per family per year. It includes major surgeries like cardiac, neurological, kidney, and burns. The scheme also covers diagnostics, follow-ups, and even transportation. A smart card makes it easy to access treatment at any enrolled hospital.
If you’re a farmer or part of a rural cooperative in Karnataka, this scheme is worth knowing about. The Yeshasvini Scheme provides low-cost health insurance for surgeries and hospitalisation. Despite its modest premium, it covers over 800 surgical procedures and is accepted in hundreds of network hospitals. It’s a simple and affordable safety net for rural families.
This scheme helps low-income families in Tamil Nadu access free medical treatment worth up to ₹5 lakh every year. It covers treatments ranging from heart surgeries to cancer therapies and emergency care. One standout feature is that it supports both government and private hospitals, giving people more options for treatment without spending from their own pocket.
Also known as Kerala’s version of Ayushman Bharat, this scheme gives ₹5 lakh health coverage per family per year for secondary and tertiary care. It’s meant for families under the socio-economic caste census (SECC) list. With a wide range of empaneled hospitals and paperless processing, it's aimed at making quality healthcare accessible to all in the state.
This scheme supports state government employees, pensioners, and their families with health coverage. Beneficiaries can claim cashless treatment in listed hospitals, including some private ones. From OPD to surgeries, the plan helps with medical expenses without requiring any upfront payment. It’s an important welfare step for public sector workers in the state.
This one is designed for government employees, pensioners, and accredited journalists in Telangana. It offers completely cashless treatment for a wide range of diseases at select hospitals. The scheme covers inpatient services, diagnostics, follow-ups, and post-surgery care. If you're a working or retired state employee or part of the press, this scheme ensures you and your family get medical support without financial pressure.
Kerala launched this unique scheme for migrant workers. It covers health insurance up to ₹15,000 annually for hospitalisation, plus an accident cover of ₹2 lakh. What makes it special is that it focuses on non-Keralite workers who often don’t get access to welfare schemes. It’s a thoughtful step toward inclusivity and worker protection.
This is a cashless health insurance scheme that benefits low-income families across Rajasthan. It covers up to ₹30,000 for general illnesses and ₹3 lakh for serious conditions, per family per year. Treatments are available at both government and private hospitals, and the scheme even includes transportation costs and pre- and post-hospitalisation care.
Read More: Explore what health insurance is
What is a Government Health Insurance Scheme in India?
A Government Health Insurance Scheme in India is a public health initiative designed to make healthcare affordable and accessible for every citizen, especially those from low-income and vulnerable groups. These schemes are either fully or partially funded by the government and cover a wide range of medical services, including hospitalisation, surgeries, and sometimes even OPD care. They aim to reduce the financial burden on families during health emergencies and ensure that no one has to delay or avoid treatment due to lack of money. Popular schemes include Ayushman Bharat (PM-JAY), CGHS, ESI, and various state-level programs.
These schemes are especially helpful for families who cannot afford private health insurance. With simple eligibility rules and a wide hospital network, they act as a safety net for millions across the country. Whether you're in a metro city or a rural village, these schemes are designed to give you access to basic healthcare without the stress of huge medical bills.
Features and Benefits of Government Health Insurance Schemes
Financial Protection
These schemes are built to support families during medical emergencies. They cover treatment costs that would otherwise burn a hole in your pocket, offering peace of mind and real savings.
Hospital Coverage
Most government health insurance plans cover a wide network of public and empanelled private hospitals. This gives you access to medical care across the country without worrying about hospital restrictions.
Maximum Coverage
From minor illnesses to major surgeries, most schemes offer extensive coverage. Some even include expenses like pre- and post-hospitalisation, medicines, diagnostics, and transportation.
Nationally Applicable
Many of these schemes, like Ayushman Bharat, can be used across India. Even if you move to another state, you’re still covered under the same policy, which makes it ideal for migrant workers or families on the move.
Affordable Premiums
Most of these health schemes come with either very low premiums or are completely free for eligible individuals. The goal is to ensure that even the poorest households can access quality healthcare without financial stress.
Cashless Treatment
You don’t have to pay upfront and claim later. Government schemes offer cashless treatment at enrolled hospitals, so you can focus on getting better while the system handles the payments.
Who Can Apply for Government Health Insurance Schemes?
Government health insurance schemes in India are designed to support specific groups of people. Your eligibility depends on a few important factors like:
1
Location
Some government health schemes are only meant for people living in a particular state or region. For example, the Yeshasvini Health Insurance Scheme is only available for residents of Karnataka. On the other hand, national-level schemes like Ayushman Bharat (PM-JAY) are available across India. So, where you live plays a big role in deciding which schemes you're eligible for. Always check if the scheme applies to your state or city before applying.
2
Income
Your income level is one of the most common filters used to decide if you qualify for a government scheme. Many health insurance schemes focus on helping those who belong to below poverty line (BPL) families or are part of economically weaker sections. Authorities often use Socio Economic Caste Census (SECC) data to verify income and make sure the support reaches those who actually need it. If your family falls under that category, you’re likely to be eligible for schemes like PM-JAY or RSBY.
3
Who You Work For
Your job also plays a part in determining eligibility. Some schemes are specially designed for government employees or people working in the organised sector. For instance, the Central Government Health Scheme (CGHS) is meant for central government employees and pensioners, while the Employees' State Insurance Scheme (ESIS) is for workers in certain industries. These schemes cover a wide range of medical needs, including maternity care and disability support.
4
Your Age Bracket
Age restrictions can also apply depending on the scheme. Some policies have specific age limits for who can join. Take the Pradhan Mantri Suraksha Bima Yojana (PMSBY), for example. It only covers people between the ages of 18 and 70. However, not all schemes follow the same rule. It’s important to read the age criteria before signing up so you know if you fall within the required range.
Documents Required for a Government Health Insurance Scheme
Before you start the application process, make sure you have the following documents ready. These will help confirm your identity, address, and eligibility:
Key Takeaways
Disclaimers & Important Conditions
