HEALTH SCHEME

List of government schemes in India

The ministries of Government of India had came up with various schemes time to time.

These schemes could be either Central, State specific or joint collaboration between the

Centre and the States.

Cont…Aam Aadmi Bima Yojana

death and disability insurance for rural landless households

Central Government Health SchemeMoHFW

1954comprehensive medical care facilities to Central

Government employees and their family members

Cont…Deendayal Disabled Rehabilitation Scheme

MoSJE2003

Create an enabling environment to ensure equal opportunities, equity, social justice and empowerment of persons with

disabilities.Gramin Bhandaran Yojna

MoAMarch 31, 2007

Creation of scientific storage capacity with allied facilities in rural areas to meet the requirements of farmers for storing

farm produce, processed farm produce and agricultural inputs. Improve their marketability through promotion of grading, standardization and quality control of agricultural produce.

Cont…Indira Awaas Yojana

MoRD1985

Housing for the rural poorIndira Gandhi Matritva Sahyog Yojana

MoWCD2010

A cash incentive of Rs. 4000 to women (19 years and above) for the first two live births

Cont…Integrated Rural Development Program

MoRD1978

self-employment program to raise the income-generation capacity of target groups among the poor

Janani Suraksha YojanaMoHFW

2005One-time cash incentive to pregnant women for

institutional/home births through skilled assistance

Cont…Kasturba Gandhi Balika Vidyalaya

MoHRDJuly 2004

Educational facilities (residential schools) for girls belonging to SC, ST, OBC, minority communities and families below

the poverty line in Educationally Backward BlocksKishore Vaigyanik Protsahan Yojana

MoST1999

Scholarship program to encourage students to take up research careers in the areas of basic sciences, engineering

and medicine

Cont…Mahatma Gandhi National Rural Employment Guarantee Act

MoRDAugust 25, 2005

Rs. 40,000 crore in 2010–11Legal guarantee for one hundred days of employment in every financial year to adult members of any rural household willing to do public work-related unskilled manual work at the statutory minimum wage of Rs.

120 per day in 2009 prices.

Cont…Members of Parliament Local Area Development Scheme

MoSPIDecember 23, 1993

Each MP has the choice to suggest to the District Collector for, works to the tune of Rs.5 Crores per annum to be

taken up in his/her constituency. The Rajya Sabha Member of Parliament can recommend works in one or more

districts in the State from where he/she has been elected.Midday Meal Scheme

MoHRDAugust 15, 1995

Lunch (free of cost) to school-children on all working days

Cont…National Pension Scheme

January 1, 2004Contribution based pension system

Pradhan Mantri Adarsh Gram YojanaMoRD

July 23, 2010Integrated development of Schedule Caste majority villages

in four statesPradhan Mantri Gram Sadak Yojana

MoRDDecember 25, 2000

Good all-weather road connectivity to unconnected villages

Cont…Rashtriya Krishi Vikas Yojana

MoAAugust 1, 2007

Achieve 4% annual growth in agriculture through development of Agriculture and its allied sectors during the

XI Plan periodRashtriya Swasthya Bima Yojana

MoLEApril 1, 2008

Health insurance to poor (BPL), Domestic workers, MGNERGA workers, Rikshawpullers, Building and other

construction workers, and many other categories as may be identified by the respective states

Cont…RNTCP

MoHFW1997

Tuberculosis control initiativeSabla or Rajiv Gandhi Scheme for Empowerment of

Adolescent GirlsMWCD

March 8, 2011Empowering adolescent girls (AGs) of 11–18 years with focus on out-of-school girls by improvement in their nutritional and health status and upgrading various skills like home skills, life skills and vocational skills. Merged Nutrition Programme for

Adolescent Girls (NPAG) and Kishori Shakti Yojana (KSY).

Cont…Sampoorna Grameen Rozgar Yojana

MoRDSeptember 25, 2001

Providing additional wage employment and food security, alongside creation of durable community assets in rural areas.

Swarnajayanti Gram Swarozgar YojanaMoRD

April 1, 1999Bring the assisted poor families above the poverty line by organising them into Self Help Groups (SHGs) through the process of social mobilisation, their training and capacity

building and provision of income generating assets through a mix of bank credit and government subsidy.

Cont…Swavalamban

MoFSeptember 26, 2010

pension scheme to the workers in unorganised sector. Any citizen who is not part of any statutory pension scheme of the Government and

contributes between Rs. 1000 and Rs. 12000/- per annum, could join the scheme. The Central Government shall contribute Rs. 1000 per annum

to such subscribers.Udisha

MoWCDnationwide training component of the World Bank (External website

that opens in a new window) assisted Women and Child Development Project (External website that opens in a new window). Udisha has been

cleared with an outlay of about Rs.600 crores for five years. UNICEF is also a technical collaborator in the Project. The programmes aims to

train child care workers across the country.

Cont…National Rural Livelihood Mission (NRLM)

Ministry of Rural Development (MoRD)June 2011

$ 5.1 BillionThis scheme will organize rural poor into SHG groups

and make them capable for self employment. The idea is to developing better livelihood options for the

poor.

CENTRAL GOVERNMENT HEALTH SCHEME

The Central Government Health Scheme (CGHS) was started under the Indian Ministry of Health and Family

Welfare in 1954 with the objective of providing comprehensive medical care facilities to

Central Government employees, pensioners and their dependents residing in CGHS covered cities.

The scheme was initially started in Delhi in 1954. Subsequently CGHS Services were extended to the following 17 cities: Allahabad, Ahmedabad, Bangalore, Mumbai, Kolkata, Hyderabad, Jaipur, Jabalpur, Lucknow, Chennai, west bengal, Nagpur, Patna, Pune, Kanpur, Thiruvananthapuram and Guwahati.

The Central Govt. Health Scheme is applicable to the following categories of people residing in CGHS covered cities:

All Central Govt. Servants paid from Civil Estimates (other than those employed in Railway Services and those employed under Delhi Administration except members of Delhi Police Force).Pensioners drawing pension from Civil Estimates and their family members (Pensioner residing in non- CGHS areas also may obtain CGHS Card from nearest CGHS covered City)Members and Ex-members of Parliament

Judges of the Supreme Court and High Court (sitting and retired)Freedom FightersCentral Government Pensioners, Employees of Semi-Autonomous bodies/Semi Government OrganisationsAccredited JournalistsEx-Governors and Ex-Vice-Presidents of India

The medical facilities are provided through Wellness Centres(previously referred to as CGHS Dispensaries) /polyclinics under Allopathic, Ayurveda, Yoga, Unani, Sidha and Homeopathic systems of medicines. 254 allopathic dispensaries, 19 polyclinics.78 Ayush dispensary/ units 3 Yoga Centres 65 Laboratories 17 Dental Units

Main components of the Scheme The dispensary services including domiciliary care.F. W. & M.C.H. Services Specialists consultation facilities both at dispensary, polyclinic and hospital level including X-Ray, ECG and Laboratory Examinations. Hospitalization. Organization for the purchase, storage, distribution and supply of medicines and other requirements. Health Education to beneficiaries.

THE EMPLOYEE’S STATE INSURANCE ACT – 1948

Pioneering measure in social insurance in india.

•Health insurance first discussed in 1927 by indian legislature.

•Scheme entrusted to prof. B.P. Adarkar in march 43 and submitted by him in Dec 44.

•Originally called “workmen’s state insurance bill” 1946.

•Came into force on 19th april 1948.

•Provides for cash benefits and medical facilities to employees in sickness, maternity and employment

injury.

APPLICABILITYAct applies to factories using power not using AND Employing 20 or more persons. Gradually extended to the following:Smaller power-using factories with 10-19 personsNon-power factories with 20 or more personsShopsHotels and restaurants

Cinemas including preview theatersNewspaper establishmentsRoad motor transport undertakings employing 20 or more personsState govt may cover other establishments in consultation with the ESI corporation and with approval of the central govt.

DEFINITIONSEmployee Employee refers to any person employed on wages in connection with the work of a factory or establishment to which this act applies.

Includes technical, manual, clerical and supervisory functions

Persons with remuneration upto Rs.6500 are covered under the act.

Cont…No distinction between casual and temporary employees or technical and non-technical, or time-rate or piece-rateCovers admin staff and those in purchaseDoes not include naval, military or air force personnel.

Cont…Wages: means all remuneration paid in cash, including payment in period of leave, lockout or strike which is not illegal. Does not include:Contribution paid to the provident fund or pension fundTravelling allowanceSum paid to defray special expensesGratuity payable on discharge

CONTRIBUTIONSMain sources of finance are contributions from employers and employees, and 1/8th share of expenses by state governments.

Employee’s contribution 1.75% of wages

Employer’s contribution 4.75% of total wages

Total amount to be deposited in the state bank of india or other authorised bank by 21st of the month followng the month when the wages became due.

An employer who fails to pay within the specified period is liable for fines and damages for late payment

Employees with daily wages below Rs 40 are exempt; however employer’s contribution applicable.

REGISTRATION

Registration of a factory/establishment with the employees state insurance corporation (ESIC) is a statutory responsibility of the employer under section 2-A and 10-B.Declaration of registration in form to be furnished to the appropriate regional office within 15 days of the act becoming applicable.Employer should get the declaration form filled in by every employee covered under the scheme.

MAINTENANCE OF REGISTERS

The statutory registers to be maintained up to date are:

A) Register of employees

B) Accident book in which every accident to employees during the course of employment is recorded

C) Inspection book (to be produced before an inspector or authorised officer.)

ADMINISTRATIONThe scheme is administered by the esic (employee’s state insurance corporation)Chairman: Union minister for labourComprises groups like employers, employees, parliament, state and central govt. And the medical profession.A standing committee drawn from this broad based body is responsible for policy, planning and decision making.

The chief executive officer of the corporation isDirector general of esicEx officio member of the corporationMember of the standing committeeResponsible forFormulation of policyOverall supervisionCo-ordination and liaison with central and state governments.

Esic has set up regional offices all over India. Each office is under the charge of the regional director who maintains records and administers local offices.

BENEFITS1. Sickness and extended sickness benefit

2. Maternity benefit

3. Disablement benefit

4. Dependants’ benefit

5. Medical benefit

6. Funeral benefit

7. Rehabilitation benefit

SICKNESS AND EXTENDED SICKNESS BENEFITRepresents periodical payments made to an insured person for the period of certified sickness after completing 9 months in insurable employment.To qualify, contributions should be for minimum 78 days in the relevant period.Maximum duration for benefit is 91 days.

Cont…Rates of payment vary from Rs.14-125 per day, i.e. Average of 50% of daily wages.Insured persons suffering from TB, leprosy, mental and malignant diseases or other specified long term diseases are entitled to extended benefits at higher rates, provided he has been continually employed for at least two years.

MATERNITY BENEFITImplies cash payment to an insured woman in case of confinement or miscarriage or sickness arising out of pregnancy or premature birth.Woman should have contributed for minimum 70 days in the preceding two consecutive contribution periods.

Cont…Daily rate of benefits double the standard sickness benefit rate, i.e. Full wages.Normally payable for max 12 weeks for confinement and 6 weeks for miscarriage or medical termination of pregnancy.Payable even in the event of the death of the woman.

DISABLEMENT BENEFITIn case of temporary disability arising out of employment injury, this benefit is admissable for the entire period certified by an insurance medical officer/practitioner for which the insured person does not work for wages.

Rate payable not less than 70% of daily wages; minimum 3 days of incapacity required.In case injury results in permanent, partial or total loss of earning capacity, periodical payments to be made for life. One-time lumpsum is permissible in certain cases.

DEPENDANT’S BENEFITPeriodical pension paid to dependants of deceased where death occurs out of employment injury or disease.Widows: 3/5th of benefit rate for life or until remarriageChildren: 2/5th of benefit rate until 18Total amount distributed not to exceed ceiling of disablement benefit.

Cont…Benefit not paid to married daughters.In case there is no widow or child, benefit can be paid to other dependants including parents.Amount paid is reviewed and increases granted from time to time to compensate for erosion in real value and cost of living.

MEDICAL BENEFIT Insured persons and their families entitled to free, full

and comprehensive medical care. Extended upto two years for chronic and long-term

diseases. Treatment continues even if person goes out of coverage,

till sickness ends. Package covers all aspects of health care from primary to

super-specialist facilities, such as:1. Out-patient treatment2. Domiciliary treatment3. Specialist consultation and diagnostic facilities

Cont…1. In-patient treatment2. Free supply of drugs and dressing3. X-ray and laboratory investigations4. Vaccination and preventive innoculations5. Ante-natal, confinement, post-natal care6. Ambulance service or conveyance charges7. Free diet during admission in hospitals

Cont…8. Free supply of artificial limbs, aids and appliances for

physical rehabilitation9. Family welfare services and other national health

programme services10. Medical certification11. Special provisions including super-speciality treatment.

FUNERAL BENEFITFuneral expenses are in the nature of a lump sum payment upto a maximum of rs.2500 made to defray the expenditure of the funeral of deceased insured person.The amount is paid either to the eldest surviving member of the family or, in his absence, to the person who actually incurs the expenditure on the funeral.

REHABILITATION BENEFITThe corporation grants rehabilitation allowance to the insured persons for each day on which they remain admitted in an artificial limb centre, on the rates, which generally conform to double the standard sickness benefit rate.

All benefits under the esi scheme are paid in cash except medical benefit, which is given in kind.

RESTRICTIONSA person entitled to esi benefits shall not be entitled to any

other benefit. Further an insured person will not be entitled to receive for the same period:

1. Both sickness and maternity benefit, or2. Both sickness and maternity benefit for temporary

disablement, or3. Both maternity and disablement benefit for temporary

disablement.

Where a person is entitled to more than one of the benefits, he has an option to select any one of them.

PROTECTIONAn employer cannot dismiss or punish an employee under treatment for sickness of in receipt of any benefit or absent from work due to illness. Any notice of dismissal, discharge or reduction is invalid. However, the employer can discharge or punish the employee if:He has received temporary disablement benefit and remained absent for 6 months or moreIs under treatment for sickness other than tb or arising out of pregnancy and remained absent for 6 months or moreIs under medical treatment for tb or a malignant disease and has remained absent continuously for 18 months or more.

PENALTIES AND DAMAGESIf a person commits an offence after being convicted by a court, every subsequent offence attracts imprisonment upto 1 year or fine upto rs.2000 or both.If the subsequent offence is for failure to pay contribution, punishment will be upto 1 year and not less than 3 months, and fine upto rs.4000.Contribution can be recovered through the district collector as arrears of land revenue.Employer is liable for 6% interest p.A. For each day of default or delay in payment of contribution.Power to levy damages is discretionary and in the nature of a quasi-legal provision. Reasonable opportunity to the employer to be given before levying damages.

MISCELLANEOUSCash benefits payable under the esi act are not liable to attachment or sale in execution of any court decree or order.Right to receive benefit is not transferable.Disputes under the provisions of the act to be decided by the employees’ insurance court (eic) and not by a civil court. Appeals to the high court only by an order of the eic on a question of law.Period of limitation for appeal is 60 days.

OBLIGATIONS OF EMPLOYERS1. Get his factory registered within 15 days of the act

becoming applicable, by supplying information in prescribed form. Obtain code number.

2. Arrange allotment of insurance number to all employees covered by the act by completing their declaration forms and submitting them to the regional office.

3. Assist employees in obtaining their identity certificates, and pending this issue certificates of employment to enable employees to avail of cash and medical benefits meanwhile.

4. He should not dismiss or punish any employee during period of medical treatment or if absent from work as a result of illness.

5. Maintain up to date registers and records of the establishment and afford facilities for easy inspection.

6. Reimbursement to the corporation excess expenditure incurred due to insanitary working and living conditions in the establishment or housing colony of its employees.

OBLIGATIONS OF EMPLOYEES1. Assist employer in obtaining registration, insurance

number and id cards from the esi authorities.2. Obtain necessary sickness/other certificates from the

medical authorities for claiming cash benefits.3. Give proper notice to employer of accident causing

employment injury and submit for medical examination as an when necessary to claim benefits.

4. Repay to the esic any benefit to which he was not entitled.

5. Submit claims within prescribed time along with prescribed documents.

HEALTH INSURANCEHealth insurance is insurance against the risk of incurring

medical expenses among individuals. Insurance

1. Voluntary health insurance schemes or private-for-profit

schemes.

2. Employer-based schemes.

3. Insurance offered by NGOs / community based health

insurance,

4. Mandatory health insurance schemes or government run

schemes (namely ESIS, CGHS).

Existing infrastructure under ESIS in India

No. of Centers 632No. of Insured Persons/Family Units 84,45,000ESI Hospitals 125Number of ESI Hospital Beds 23,334ESI Dispensaries 1,443Insurance Medical Officers 6,220Insurance Medical Practitioners 2,900

ESIS HOSPITAL

NagpurE.S.I.S. Hospital, Manewada Road, Somwari Peth,

Nagpur-9.

0712-744 767

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