Beneficiary Level

  1. Government provides health insurance cover of up to Rs. 5,00,000 per family per year.
  2. More than 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) covered across the country.
  3. All families listed in the SECC database as per defined criteria will be covered. No cap on family size and age of members.
  4. Priority to girl child, women and and senior citizens.
  5. Free treatment available at all public and empaneled private hospitals in times of need.
  6. Covers secondary and tertiary care hospitalization.
  7. 1,350 medical packages covering surgery, medical and day care treatments, cost of medicines and diagnostics.
  8. All pre-existing diseases covered. Hospitals cannot deny treatment.
  9. Cashless and paperless access to quality health care services.
  10. Hospitals will not be allowed to charge any additional money from beneficiaries for the treatment.
  11. Eligible beneificiares can avail services across India, offering benefit of national portability. Can reach out for information, assistance, complaints and grievances to a 24X7 helpline number - 14555

Health System

  1. Help India progressively achieve Universal Health Coverage (UHC) and Sustainable Development Goals (SDG).
  2. Ensure improved access and affordability, of quality secondary and tertiary care services through a combination of public hospitals and well measured strategic purchasing of services in health care deficit areas, from private care providers, especially the not-for profit providers.
  3. Significantly reduce out of pocket expenditure for hospitalization. Mitigate financial risk arising out of catastrophic health episodes and consequent impoverishment for poor and vulnerable families.
  4. Acting as a steward, align the growth of private sector with public health goals
  5. Enhanced used to of evidence based health care and cost control for improved health outcomes.
  6. Strengthen public health care systems through infusion of insurance revenues.
  7. Enable creation of new health infrastructure in rural, remote and under-served areas.
  8. Increase health expenditure by Government as a percentage of GDP.
  9. Enhanced patient satisfaction.
  10. Improved health outcomes.
  11. Improvement in population-level productivity and efficiency
  12. Improved quality of life for the population