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Should a government employee buy personal health insurance?

Let's see what health benefits government employees get and when they should go for an additional cover

Should a government employee buy personal health insurance?

I am a government employee. Should I buy health insurance too? - Amit Solanki

Government employees are generally covered by certain specified health schemes. For example, central government employees are covered by the Central Government Health Scheme (CGHS). This scheme provides healthcare facilities to working or retired central government employees, including their family members. Likewise, some state governments also provide certain health insurance policies such as the West Bengal Health Scheme, and Telangana State Government Employees and Journalists Health Scheme, to name a few.

  • CGHS provides services at the government and empanelled hospitals for medical treatments including diagnostic tests, the issue of medicines, specialist consultation and more.
  • It also covers health care under different systems of medicine, ranging from allopathy, homoeopathy to Ayurveda, Unani, Siddha, and Yoga.
  • It has a cashless facility available for treatment.
  • You can also reimburse your expenses for emergency treatments and purchase of hearing aids, artificial limbs, etc., at government or private hospitals.

But do note that CGHS coverage or any other government-provided benefit is generally available only at certain specified hospitals and centres. They are not necessarily available at all places and are generally concentrated in major metropolitan cities. Even then, only a few empanelled hospitals provide the facility in metro cities. So do check if the empanelled hospitals are located near you and depending on which part of the country you live in. It is better to check what kind of facility you get near you and evaluate whether it works for you.

In case of emergencies
If the government-provided facility is not easily accessible during an emergency, then it is better to have a small additional cover from a private insurer to battle such situations. For someone in the early 60s, you can get Rs 5 lakh health coverage in the range of Rs 20,000 to 25,000 a year. While buying a cover at this age, do ensure to go through the co-pay clause, which is generally applicable to senior citizens.

What is co-pay?
A co-pay, also referred to as coinsurance in health insurance, is the percentage of the admissible claim amount that you need to bear during claim settlement.

Suppose your hospital expenditure was Rs 10 lakh, and your policy has a co-pay clause of 10 per cent. Then the insurance company will pay only Rs 9 lakh and Rs 1 lakh (10 per cent of the total cost) will have to be borne by you. Do check for it to understand how much you need to contribute during claim settlement and avoid unpleasant surprises.

Suggested watch: Why should one have a health insurance policy independent of the employer?

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