“Top 5 Health Schemes in India: ESI Act, RGSKY, CGHS, RSBY, and AABY Explained”

Discover the top 5 health schemes in India. These include ESI Act, RGSKY, CGHS, RSBY, and AABY. They offer comprehensive coverage for workers and the underprivileged. Learn about benefits, eligibility, and financial protection under these essential programs.

“Top 5 Health Schemes in India like ESI Act, RGSKY, CGHS, RSBY, and AABY offer crucial support to employees. They also support rural landless families and those below the poverty line. These schemes are designed to offer medical and financial protection, ensuring better healthcare access for millions.”

1. ESI Act (Employees’ State Insurance Act, 1948)

The ESI Act provides social security and health insurance to industrial employees. It offers various benefits, including sickness, maternity, and employment injury coverage.

• Year Passed: 1948
• Amendments: 1975, 1984, 1989, 2010
• Purpose: Social security and health insurance for employees.
• Benefits: Cash and medical benefits for sickness, maternity, and employment injury.

Scope of the ESI Act:

• Geographical Coverage: Whole of India.
• Applies to: Factories using power with 10+ employees.
• 1975 Amendment: Extended to cover small factories (10+ employees), regardless of power usage.
• Other Establishments Covered:
• Shops
• Hotels & Restaurants
• Cinemas & Theaters
• Road-motor transport establishments
• Newspaper establishments
• Private medical and educational institutions employing 20+ employees.

2010 Amendment:

• Covers all employees (manual, clerical, supervisory, technical) earning ≤ ₹15,000 per month.

Administration of ESI Corporation:

• Chairman: Union Minister for Labor
• Deputy Chairman: Secretary to Govt. of India
• Director General: Chief Executive Officer
• Supporting Roles: Insurance Commissioner, Medical Commissioner, Financial Commissioner, etc.
• Medical Advantage Council assists with medical-related aspects.

Beneficiaries Under the ESI Scheme:

• Coverage: 185 lakh family units (165 lakh employees).
• Medical Facilities:
• 1,427 ESI dispensaries
• 2,100 panel clinics
• 307 diagnostic centers
• 151 ESI hospitals
• 27,000 beds

Finance of ESI Scheme:

• Employer Contribution: 4.75% of total wage bill.
• Employee Contribution: 1.75% of wages.
• State Government Share: 1/8th of medical care cost.
• ESI Corporation Share: 7/8th of medical care cost.

Benefits to Employees:

1. Medical Advantage:

• Full medical care for sickness, maternity, or employment injury.

1. Maternity Advantage:

• 12 weeks for confinement, 6 weeks for miscarriage, 30 days for sickness from confinement.
• Rate: Full wages, ₹5,000 per confinement.

1. Disablement Advantage:

• Cash & free medical for temporary or permanent disablement due to employment injury.
• 90% wages paid during temporary disablement.
• Life pension for permanent disablement.

1. Dependent’s Advantage:

• 90% of wages as a pension to dependents in case of death due to employment injury.
• Pension shared among dependents, valid for son/daughter up to age 18.

1. Funeral Expenses:

• ₹5,000 (from 01-04-2011) for funeral of insured person.

Extended Sickness Aid (ESB):

• Eligibility: Insured persons with long-term illnesses (e.g., TB, AIDS, heart disease).
• Duration: Top 2 years.
• Protection from Dismissal: Insured persons can’t be dismissed during sickness.

Benefits to Employers:

• Exemption From:
• Workmen’s Compensation Act, 1923
• Maternity Advantage Act, 1961
• Medical allowance for employees and their dependents.
• Income Tax Rebate: Contributions deposited into ESI account.
• Result: Healthy workforce benefits employers in long term.

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2. RGSKY (Rajiv Gandhi Shramik Kalyan Yojana)

This scheme, launched in 2005, provides unemployment allowance for workers who have been retrenched or whose factories have closed.

Rajiv Gandhi Shramik Kalyan Yojna

• Launch Date: 1st April, 2005
• Target Group: Employees under the Employees’ State Insurance (ESI) Scheme.

Key Features:

• Purpose:
• Provides unemployment allowance to employees who are involuntarily unemployed due to reasons like retrenchment or factory closure.
• Eligibility Criteria:
• The employee must have contributed for a least of 5 years under the ESI establishment.
• Benefits:
• Unemployment Allowance:
  • Eligible employees can claim unemployment allowance for 6 months or for their entire service period (whichever applies).
• Medical Care:
  • The employee and their dependents are also entitled to medical care under this scheme.

This scheme ensures financial and healthcare support during times of unemployment, providing a safety net for ESI-covered employees.

3. CGHS (Central Government Health Scheme)

Introduced in 1954, CGHS offers comprehensive medical care to central government employees and pensioners. It covers a wide range of outpatient, domiciliary, and emergency services.

Central Government Health Scheme (CGHS)

• Introduction:
• Initially introduced as the Contributory Health Service Scheme in 1954 at New Delhi.
• Aimed at providing comprehensive healthcare services to Central Government employees.

Growth and Expansion:

• Beginning:
• Started with 16 allopathic dispensaries covering 2.3 lakh beneficiaries.
• Current Status:
• Now serves 42.76 lakh beneficiaries through 320 dispensaries and hospitals.
• Provides services through different systems of medicine:
  • Allopathic
  • Homeopathic
  • Indian Systems of Medicine (Ayurveda, Unani, Yoga, and Siddha).

Beneficiaries of CGHS:

• Central Government Employees paid from Civil Estimates (excluding railway services and Delhi administration).
• Pensioners drawing from Civil Estimates and their family members.
• Members and Ex-Members of Parliament.
• Judges of the Supreme Court of India.
• Ex-Governors, Ex-Vice Presidents, and Former Prime Ministers.
• Former Judges of Supreme Court and High Courts, and freedom fighters.
• Employees and pensioners of autonomous bodies under CGHS.

Services Provided:

• Outpatient Services
• Domiciliary Care
• Family Welfare and MCH Services
• Supply of Necessary Drugs
• Specialist Consultations at dispensary, polyclinic, and hospitals.
• Diagnostic Facilities: X-ray, ECG, laboratory tests.
• Hospitalization in recognized government and private hospitals.
• Emergency Treatment
• Supply of Optical and Dental Aids at reasonable costs.
• Health Education

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4. RSBY (Rashtriya Swasthya Bima Yojana)

RSBY, launched in 2008, aims to provide health insurance coverage to Below Poverty Line (BPL) families. It helps them deal with hospitalization expenses.

Rashtriya Swasthya Bima Yojana (RSBY)

• Launch Date: 1st April 2008
• Implemented by: Ministry of Labor, Government of India
• Primary Aim:
• To give health insurance coverage to families Below Poverty Line (BPL).

Goal:

• To help families overcome financial difficulties related to hospitalization costs.

Beneficiaries:

• The scheme covers five members of a family:
• Head of the family
• Spouse
• Up to three dependents
• It is particularly helpful for migrant families.
• Registration Fee: ₹30.

Salient Features of RSBY:

• Beneficiaries can choose either government or private hospitals.
• The insurer is paid the premium for each household enrolled in the scheme.
• Participating hospitals get incentives for serving beneficiaries.
• Beneficiaries are issued biometric-enabled smart cards, which allow for cashless and paperless transactions.
• The smart card can be used in any empanelled hospital under RSBY.
• IT-enabled health facilities guarantee smooth and easy transactions.
• The highest charge per family for coverage is ₹750 per year.

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5. AABY (Aam Aadmi Bima Yojana)

This social security scheme, launched in 2007, provides insurance to rural landless families, covering death and disability due to accidents.

Aam Aadmi Bima Yojana (AABY)

• Launch Date: 2nd October 2007
• Goal:
• A social security scheme specifically designed for rural landless families.

Beneficiaries:

• Eligibility Criteria:
• The head of the family or any earning member of the family.
• Age range: 18 to 59 years.
• The premium for the scheme is ₹200 per person per year.
• Premium Payment:
• Equally shared between the State Government and Central Government.

Benefits:

• Scholarship is provided to the children of the insured family.
• Compensation on Death:
• In case of natural death, ₹30,000/- is paid to the family.
• In case of death due to accident or permanent disability, ₹75,000/- is paid.
• In case of partial permanent disability due to accident, ₹37,500/- is given.

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Read more: “Top 5 Health Schemes in India: ESI Act, RGSKY, CGHS, RSBY, and AABY Explained”

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