Page 15 - Ebook health insurance IC27

Sashi Publications

Employees' State Insurance Scheme

 Formal systems for Health Insurance in India began with the inception of the
Employees' State Insurance Scheme, introduced vide the ESI Act, 1948.

 Established in 1948, the Employees State Insurance Scheme (ESIS) provides for
both cash and medical benefits.

 It was introduced as a social security blanket for workers employed in the formal
sector, in organizations which meet certain criteria for enrolment, and these criteria
have been revised from time to time.

 ESIS provides for comprehensive health services through a network of its
own dispensaries and hospitals, supplemented by Authorized Medical
Attendants and private hospitals to serve needs which cannot be met by its
own network.

 The coverage includes OPD and IPD services, and a large variety of cash benefits
to compensate for loss of pay and other eventualities.

 Theschemeis largely financed through acontribution from employers and employees,
which is supplemented by the Central and State governments.

 The ESIS covered about 33 million beneficiaries in 2005-06.

Central Government Health Scheme (CGHS)

 The ESIS was soon followed by a scheme for Central Government Employees,
the Central Government Health Scheme (CGHS), which was introduced in 1954
as a contributory health scheme to provide comprehensive medical care to the
central government employees and their families.

 The list of beneficiaries includes all categories of current as well as former central
government employees, members of parliament, supreme court and high court judges,
and certain other categories of beneficiaries.

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