Private and government health insurance policies vary in coverage, costs, and terms and conditions for hospitalisation, treatments, surgeries, medicine, preventative care, etc. Government health insurance plans are primarily focused on economically vulnerable sections of society. As a result, they are heavily subsidised or free. These policies may cover consultations and diagnostics besides other usual medical expenses. Government schemes also have criteria for income, work, demographic, etc., to be eligible.

Also Read: RBI Annual Report: Banking Frauds Increased Almost Three Times Y-O-Y In 2023-24

Here are some differences between the two:

Eligibility: Health insurance policies from private insurers are open to all individuals. Anyone can enrol, provided they match the insurer’s eligibility requirements. Government health insurance plans have established eligibility requirements based primarily on income, job status, age, and other considerations. They mainly focus on economically disadvantaged groups.

Premiums and Costs: Private insurers decide premiums based on age, region, total insured, and other risk variables, which can lead to hefty out-of-pocket expenses for policyholders. Government policies are substantially subsidised to keep premiums reasonable for designated groups, reducing out-of-pocket expenses.

Coverage: Regular health plans provide customers with tailored coverage, although the premiums could be higher. Government policies have a uniform basic coverage package centred on critical healthcare. Customisation of the policy may not be available.

Choice: Regular health insurance policies allow customers to get treatment from their preferred hospitals and healthcare providers. Government plans have established provider networks as outlined in the scheme. There may be a limited selection of hospitals.

Pre-Existing Conditions: Regular health plans may exclude pre-existing medical issues from coverage for the first 2-4 years, depending on policy terms and circumstances. Pre-existing health issues are also covered via government policies, with no extensive waiting periods.

Also Read: Is Real Estate Investing A Safe Option For Senior Citizens?

Government health insurance policies are important in increasing healthcare access and financial security for India’s poor population. Though the coverage is not as broad as private insurance plans, government schemes have helped crores of people by providing cheap coverage for hospitalisation and medical care.

As India takes steps toward universal health coverage, government-sponsored insurance schemes are vital for providing quality healthcare to the poor and vulnerable. They have helped improve people’s lives and promote healthcare in India.