Health insurance goes beyond hospitalization—it covers OPD visits, medicines, ambulance charges, preventive checkups, and even alternative treatments, giving you all-around financial security.
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Government Health Insurance Schemes in India Full List
In summary
Public health insurance schemes form the backbone of India’s universal healthcare mission, while private health insurance ensures premium comfort, private rooms, and zero queue delays.
- Ayushman Bharat PM-JAY: World's largest government-funded healthcare scheme, offering Rs. 5 lakh annual cashless hospitalisation cover per family to over 55 crore vulnerable citizens.
- Universal senior citizen expansion: Expanded to cover all senior citizens aged 70 and above with a dedicated Rs. 5 lakh annual cover, regardless of economic status.
- Comprehensive institutional schemes: Central Government Health Scheme (CGHS) for civil servants and Employees’ State Insurance (ESI) for formal private sector wage earners.
- Private health insurance synergy: Private health plans complement public schemes by providing access to luxury private rooms, overseas emergency coverage, and advanced robotic surgeries.
Ensure your family enjoys world-class clinical care: view plans on Bajaj Finance to compare partner health insurance policies with direct cashless access across premier private hospitals.
Pro tip
What is a government health insurance scheme?
A government health insurance scheme is a publicly funded or subsidized social welfare initiative designed to provide accessible and affordable healthcare services to citizens. Financed through central or state government budgetary revenues or mandatory statutory contributions, these schemes aim to eliminate catastrophic out-of-pocket medical expenditures that push millions of Indian households into poverty each year.
Public schemes establish empaneled networks of government district hospitals, medical colleges, and selected private healthcare providers to deliver cashless secondary and tertiary medical treatments based on pre-defined clinical packages. Complementary health insurance and retail insurance plans bridge medical treatment needs.
Did You Know? (Ayushman Bharat senior citizen expansion)
Under a historic Union Cabinet decision, Ayushman Bharat PM-JAY was expanded to provide free health insurance coverage of up to Rs. 5 lakh per family per year to all senior citizens aged 70 and above, regardless of their socioeconomic or income background, under a distinct Ayushman Vay Vandana card.
Quick Fact: 100% paperless cashless treatment
Hospitalisation under Ayushman Bharat PM-JAY is completely cashless and paperless. The scheme covers up to 3 days of pre-hospitalisation diagnostic evaluations and 15 days of post-hospitalisation medications and follow-up consultations.
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Difference between regular health insurance plans and government health insurance schemes
Understanding the structural distinctions between public schemes and commercial private health insurance helps families make balanced healthcare decisions:
| Evaluation Factor | Government Health Insurance Schemes | Private Retail Health Insurance Plans |
| Primary target audience | Socio-economically vulnerable, BPL families, senior citizens (70+), civil servants | Open to all individuals, families, and corporates across India |
| Premium funding | Fully funded or heavily subsidized by Central/State governments | Funded 100% by the policyholder through annual or multi-year premiums |
| Sum insured limit | Typically capped at Rs. 5 lakh per family per year | Highly flexible; sums insured range from Rs. 5 lakh up to Rs. 1 crore+ |
| Hospital room category | Shared general ward or multi-occupancy beds | Choice of single private rooms, deluxe suites, with zero room caps |
| Hospital network reach | Government hospitals and selected empaneled private facilities | Expansive nationwide private hospital networks (10,000+ to 20,000+ hospitals) |
| Tax deduction benefit | No direct tax deduction for fully subsidized schemes | Full gross premium deductible under Section 126 / Section 80D up to Rs. 1 lakh |
List of popular government health insurance schemes in India
India features several prominent central and state government healthcare programs:
1. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
Administered by the National Health Authority (NHA), PM-JAY is the world's largest public health assurance scheme. It provides an annual health cover of Rs. 5 lakh per family for secondary and tertiary care hospitalisation across more than 29,000 empaneled public and private hospitals nationwide. Covered procedures encompass over 1,949 clinical packages, including oncology, neurosurgery, cardiac stenting, and joint replacements.
2. Central Government Health Scheme (CGHS)
Established in 1954 under the Ministry of Health and Family Welfare, CGHS provides comprehensive outpatient and inpatient medical care to central government employees, sitting and former Members of Parliament, Supreme Court judges, and central pensioners. Beneficiaries access healthcare through dedicated CGHS wellness centers and premier empaneled private superspeciality hospitals.
3. Employees’ State Insurance Scheme (ESIS)
Operated under the ESI Act, 1948 by the Ministry of Labour and Employment, ESIC provides comprehensive social security and medical care to formal private sector workers earning monthly gross wages up to Rs. 21,000. It provides uncapped clinical treatments through over 160 ESI hospitals and cash sickness/maternity compensation.
4. Pradhan Mantri Suraksha Bima Yojana (PMSBY)
An affordable government-backed personal accident insurance scheme offering Rs. 2 lakh compensation for accidental death or permanent total disability for an annual premium of just Rs. 20, auto-debited from participating bank accounts.
5. State government health insurance schemes
Various state governments operate specialized health schemes offering free healthcare to regional populations:
- Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY - Maharashtra): Offers up to Rs. 5 lakh coverage per family per year across 1,356 medical procedures.
- Dr. YSR Aarogyasri Scheme (Andhra Pradesh): Covers catastrophic treatment expenses for low- and middle-income families across public and private hospitals.
- Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS - Tamil Nadu): Provides up to Rs. 5 lakh cashless cover for hospitalization across state and private hospitals.
Did You Know? (Portability across states in PM-JAY)
Ayushman Bharat PM-JAY features nationwide portability. A beneficiary registered in Bihar, Uttar Pradesh, or Odisha can walk into an empaneled superspeciality hospital in Mumbai, Delhi, or Hyderabad and receive 100% cashless treatment by presenting their Ayushman card, with zero inter-state bureaucracy.
Quick Fact: Tax deduction under Section 126 for private plans
While public welfare health schemes involve no tax deductions, investing in a supplementary private health insurance plan unlocks up to Rs. 1 lakh in direct tax deductions under Section 126 of the Income-tax Act, 2025 (formerly Section 80D) under the Old Tax Regime.
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Arjun Mehta
13 Jul 2025
I opted for the Health Infinity plan for my parents. The digital onboarding was incredibly fast with no medical tests required since they are under 50. We had a minor daycare procedure last month, and the cashless approval came through in less than 2 hours. Very impressed with the efficiency.
Priya Sharma
28 Feb 2025
The Bajaj Finance Health app is a lifesaver. I use it for my regular OPD consultations and medicine orders. The 10% discount on pharmacy bills and the easy reimbursement for doctor visits make it much more than just a 'hospitalization' policy. It’s daily health support.
Sneha Kapoor
15 Mar 2025
Switched my family floater to Bajaj General this year. The network of hospitals in my city (Pune) is excellent. The only downside was a slight delay in getting my physical card, but the digital copy on the app works everywhere. The 'Wellness Rewards' for hitting step goals is a cool touch!
Advantages and limitations of public health schemes
Public health schemes deliver immense social benefits but carry practical operational limitations:
- Major advantages: Zero or nominal premium outlays, elimination of medical debt for low-income households, pre-existing disease coverage from Day 1, and nationwide portability.
- Critical limitations: High patient loads leading to long waiting times for elective surgeries, restriction to general shared wards, limited empanelment of top-tier private corporate hospitals, and fixed clinical package caps that may not cover cutting-edge experimental therapies.
Why private health insurance is essential alongside public schemes?
Middle-class households, business owners, and salaried professionals increasingly complement public coverage with private retail health insurance:
- Guaranteed private room accommodation: Private plans eliminate shared ward overcrowding by granting access to single private air-conditioned rooms without sub-limits.
- Direct access to top-tier hospitals: Private policies allow immediate cashless hospitalisation at leading corporate hospital chains without referral bottlenecks.
- Higher financial coverage: Upgrading to sums insured of Rs. 25 lakh, Rs. 50 lakh, or Rs. 1 crore protects family wealth against modern medical inflation.
- Global treatment options and advanced care: Covers advanced robotic surgeries, modern cancer immunotherapies, and overseas hospitalisation options available across individual health insurance or family health insurance plans.
Explore high-sum insured retail plans: explore plans on Bajaj Finance to secure comprehensive healthcare coverage for your family.
Brief example scenario: public scheme coverage vs private comprehensive plan
Consider Santosh Deshmukh (age 46), whose 68-year-old mother requires complex bilateral knee replacement surgery. Santosh compares undergoing surgery under a state government health scheme vs using a private comprehensive health insurance policy with a Rs. 15 lakh sum insured:
| Treatment Factor | State Government Health Scheme Option | Private Comprehensive Health Policy Option |
| Hospital type | Empaneled public district hospital or basic private nursing home | Top-tier private orthopedic superspeciality hospital |
| Room category | Shared general ward (6 to 10 patients per room) | Single private room with attendant accommodation |
| Surgical waiting time | 4 to 6 months waiting queue for non-emergency joint surgery | Scheduled within 48 hours at patient's preferred time |
| Surgical implant technology | Standard government package implants | High-durability titanium implants and robotic-assisted surgery |
| Total hospital bill | Rs. 2,50,000 (Covered under scheme package) | Rs. 6,20,000 (Admissible bill settled cashlessly) |
| Net out-of-pocket cost | Rs. 15,000 (Uncovered consumables) | Rs. 20,000 (Non-admissible consumables only) |
| Post-hospitalisation physiotherapy | Basic government dispensary physiotherapy | Specialized private clinic physiotherapy covered for 90 days |
Key financial insight: While the public scheme provided free basic surgery, the private health insurance policy allowed Santosh's mother to receive immediate robotic surgery in a single private room with zero waiting queue delays.
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Do’s and don’ts for government health schemes
| Do | Why it matters | Don’t | Risk to avoid |
| Check family eligibility on the official mera.pmjay.gov.in portal. | Confirms whether your family holds active coverage under PM-JAY. | Do not pay unauthorized agents or intermediaries for Ayushman cards. | Ayushman cards are issued free of cost at government centers. |
| Create your Ayushman Bharat Health Account (ABHA) digital ID. | Enables secure digital storage of health records across hospitals. | Do not assume government schemes cover luxury private rooms. | Public schemes cover general ward beds exclusively. |
| Verify whether your local private hospital is actively empaneled under the scheme. | Ensures cashless admission before scheduling elective treatments. | Do not delay purchasing private health insurance if your income exceeds limits. | Ineligible families face complete out-of-pocket financial ruin. |
| Secure a private family health insurance floater on Bajaj Finance. | Guarantees access to premier corporate hospitals and private rooms. | Do not let your private health insurance policy lapse past grace periods. | Policy lapse permanently resets all accumulated waiting periods. |
| Claim income tax deductions on private health insurance premiums under Section 126. | Lowers your net taxable income under the Old Tax Regime. | Do not ignore pre-existing disease waiting periods in private policies. | Disclose past medical history transparently to prevent claim disputes. |
Step-by-step roadmap to assess public schemes and secure private health cover
- Step 1: Check public scheme eligibility. Verify your ration card and SECC data on pmjay.gov.in or state health portals to confirm whether your family is eligible for public health assurance.
- Step 2: Generate ABHA and Ayushman cards. Download your ABHA digital health ID and Ayushman cards for eligible senior family members aged 70+.
- Step 3: Complement with private health insurance on Bajaj Finance. Benchmark partner private health insurers to purchase a comprehensive family floater with zero room rent sub-limits and instant cashless access. You can get quote online to review options.
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Glossary of public health and insurance terms
| Term | Definition |
| Ayushman Bharat PM-JAY | The national public health insurance scheme providing Rs. 5 lakh annual cashless hospital cover to vulnerable families and seniors (70+). |
| ABHA (Ayushman Bharat Health Account) | A 14-digit unique digital health identity card enabling secure electronic sharing of medical records across India. |
| Central Government Health Scheme (CGHS) | A comprehensive healthcare scheme providing outpatient and inpatient medical care to central government employees and pensioners. |
| Employees’ State Insurance (ESI) | A statutory social security scheme for formal sector workers earning up to Rs. 21,000 monthly, providing medical and cash benefits. |
| Empaneled Health Care Provider (EHCP) | A public or private hospital officially accredited to deliver cashless treatments under government health schemes. |
| Standard Treatment Guidelines (STGs) | Pre-defined clinical protocols established by the National Health Authority governing procedures under PM-JAY. |
| Customer Information Sheet (CIS) | An IRDAI-mandated summary sheet detailing coverage terms, waiting periods, sub-limits, exclusions, and claim workflows. |
| Room rent sub-limit | A commercial policy clause capping daily room expenses; choosing a room above this cap triggers proportionate billing deductions. |
| Section 126 (Income-tax Act, 2025) | The direct tax provision replacing Section 80D, allowing deductions for private medical insurance premiums under the Old Tax Regime. |
| Third Party Administrator (TPA) | An IRDAI-licensed entity facilitating network hospital empanelment, cashless pre-authorization, and document verification. |
Sources and references
| Regulatory Authority / Publication | Document Identifier / Citation | Statutory Subject / Verified Parameter | Official Source Link |
| National Health Authority (NHA), Ministry of Health & Family Welfare | Ayushman Bharat PM-JAY Operational Guidelines & Benefit Packages | Rs. 5 Lakh Family Coverage Ceiling, Senior Citizen (70+) Expansion, and Portability Norms | NHA Official Portal (https://nha.gov.in) |
| Ministry of Health and Family Welfare, Government of India | Central Government Health Scheme (CGHS) Rulebook & Rates | Eligibility Norms for Central Employees, Pensioner Coverage, and Empaneled Hospital Rates | CGHS Portal (https://cghs.nic.in) |
| Ministry of Labour and Employment, Government of India | Employees’ State Insurance Act, 1948 & ESIC Operational Manual | Social Security Provisions, Wage Ceilings (Rs. 21,000), and Contributory Benefit Schedules | ESIC Official Portal (https://esic.gov.in) |
| Insurance Regulatory and Development Authority of India (IRDAI) | Master Circular on Operations and Allied Matters of Health Insurance Business (Ref: IRDAI/HLT/CIR/PRO/84/5/2024) | Private Health Insurance Standards, Cashless Turnaround SLAs, and CIS Disclosures | IRDAI Official Portal (https://irdai.gov.in) |
Conclusion
Government health insurance schemes in India represent a transformative milestone in social welfare, providing an indispensable safety net that shields over 55 crore citizens from the catastrophic threat of medical debt. Through programs like Ayushman Bharat PM-JAY, CGHS, and ESI, millions of families gain access to life-saving surgical and secondary treatments that were once financially unattainable.
However, public health schemes are designed as minimum baseline protections. To secure immediate access to top-tier private corporate hospitals, eliminate long surgical waiting queues, and enjoy the comfort of single private rooms, prudent families combine public safety nets with private comprehensive health insurance. Explore partner health plans: apply now on Bajaj Finance today to compare top private insurers, evaluate transparent feature matrices, and secure complete, uninterrupted healthcare security for your household.
Frequently Asked Questions
Scheme eligibility, benefits, and Ayushman Bharat
Public vs private health insurance and tax rules
What is the purpose of launching government health insurance schemes in India?
Government health insurance schemes are designed to provide accessible, affordable, and quality healthcare to vulnerable and low-income populations, preventing medical poverty and improving health outcomes.
Who is eligible for Ayushman Bharat PM-JAY?
Families identified in the Socio-Economic Caste Census (SECC) 2011 database, eligible occupational categories, and all senior citizens aged 70 and above (regardless of income) are eligible for PM-JAY.
What is the maximum coverage under Ayushman Bharat PM-JAY?
PM-JAY provides an annual health insurance cover of up to Rs. 5 lakh per family per year for secondary and tertiary care hospitalisation on a completely cashless and paperless basis.
Are government health schemes valid across all hospitals in India?
No. Government schemes are valid only at public district hospitals, government medical colleges, and specifically empaneled private hospitals that have agreed to government package rates.
Can senior citizens aged 70 and above get free government health insurance?
Yes. The Government of India has expanded Ayushman Bharat PM-JAY to cover all senior citizens aged 70 and above with a dedicated Rs. 5 lakh annual cover under the Ayushman Vay Vandana card.
What are the limitations of relying solely on government health insurance schemes?
Limitations include crowded general wards, long waiting lists for non-emergency elective surgeries, restricted private hospital empanelment, and fixed package caps that exclude luxury amenities.
Why should someone buy private health insurance if they are covered under a government scheme?
Private health insurance provides immediate cashless admission to premier corporate hospitals, single private room comfort, zero surgical waiting queues, and higher sums insured (up to Rs. 1 crore).
Can you hold both a government health scheme and private health insurance?
Yes. You can hold an Ayushman Bharat or CGHS card alongside a private retail health policy. You can choose which policy to utilize based on the hospital, treatment type, and room category desired.
Are premiums paid for private health insurance tax-deductible?
Yes. Premiums paid for private health insurance qualify for direct tax deductions under Section 126 of the Income-tax Act, 2025 (formerly Section 80D) up to Rs. 1 lakh under the Old Tax Regime.
How can you find empaneled hospitals under Ayushman Bharat PM-JAY?
You can search for empaneled public and private hospitals by state, district, and medical specialty on the official National Health Authority portal at pmjay.gov.in.
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