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 ND
COMMUNITY HEALTH NURSING-2
A Lesson Plan
on
HEALTH SCHEMES
SUBMITTED TO SUBMITTED ON SUBMITTED BY
Mr. KIRAN KUMAR D. JUNE 11,2024 TRAPTI VERMA
HOD OF COMMUNITY BSC NURSING 4TH YEAR
FLORENCE NIGHTINGALE FLORENCE NIGHTINGALE
COLLEGE OF NURSING COLLEGE OF
SHAHJHANPUR NURSINGSHAHJHANPUR
 SELF INTRODUCTION
My name is Trapti Verma, student of BSC nursing 4th year at Florence nightingale College of Nursing. I got
the topic named as"HEALTH SCHEMES” for my community health nursing presentation.
 IDENTIFICATION DATA
Name:Trapti Verma
Batch:4th year
Course: BSc nursing
Topic:Health Schemes
Subject:Community health nursing
Time education: 45 minutes
Group size: 40 students
Methods of AV aids: White board, Pamphlet, Chart,Bulletin board
Method of teaching: Lecture cumm discussion
Supervised by: Mr. Kiran Kumar D.
 OBJECTIVES
GENERAL OBJECTIVE- At the end of the session the student gain knowledge about health schemes of
the country and apply that in the field of community health nursing,
SPECIFIC OBJECTIVE-At the end of the session the student will be able to:
 define health schemes in India.
 list down the types of health schemes in India
 explain ESIC.
 elaborate CGHS.
 discuss other Health schemes.
 illustrate the health insurance.
 elucidate employers’ health scheme and some other schemes.
TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION
OBJECTIVE ACTIVITY ACTIVITY AIDS
4 min define Health HEALTH SCHEME The Teacher The student Pamph Do you know
schemes in India
Public health is a state ; hence teach the will listen let about the
health schemes is referred to the health attentively Health schemes
responsibility of providing medical schemes to to the in India?
assistance to patient of all income the student teacher.
group is of respective state /union in the class.
territory government.
TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION
OBJECTIVE ACTIVITY ACTIVITY AIDS
4 min list down the TYPES OF HEALTH SCHEME IN The Teacher The student Pamphlet What are the
types of Health INDIA teach the types will listen classification of
schemes in IT IS MAINLY CLASSIED INTO FOUR: of health health scheme?
attentively to
India. Mandatory Health Insurance schemes schemes to the
student in the the teacher
The two mandatory government run schemes
includes: class.
 Central Government Health Schemes
(CGHS)
 Employee's state insurance scheme
(ESIS)
Employer based scheme
The railways, defense and security forces
providesmedical benefits to the employees
Voluntary Health Insurance Schemes Or
Private ForProfit Scheme
TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION
OBJECTIVE ACTIVITY ACTIVITY AIDS
10 min explain ESIC. MANDATORY HEALTH The Teacher The student Pamphlet How will you define
INSURANCE SCHEME teaches the will listen the Employees state
health schemes- Insurance scheme?
attentively to
Employees state
EMPLOYEES STATEINSURANCE insurance the teacher
SCHEME scheme to the
 Started in the year 1948 student in the
 Programmed provides health care to class.
industriallabors and their families
 Money is contributed by the
management aswell as the employees.
 It extends the whole India.

Employee- Employee refers to any person

employed on wages inconnection with the work
of a factory or establishment to which
this act applies.
o Includes technical, manual, clerical and
supervisory functions.
o Persons with remuneration up to
Rs.6500 are covered under theact.
o No distinction between casual and
temporary employees ortechnical and
non-technical, or time rate or piece-rate
o Covers admin staff and those in
purchase
o Does not include naval, military or air
force personnel.
 Wages: means all remuneration paid in cash,
including payment in period of leave, lockout
or strike which is not illegal. Does not include:
o Contribution paid to the provident fund
or pension fund
o Travelling allowance
o Sum paid to defray special expenses.
o Gratuity payable on discharge.

TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION

OBJECTIVE ACTIVITY ACTIVITY AIDS
BENEFICIARIES
o Non -power using factories employing
ten ormore persons.
o Power using factories employing ten or
more persons.
o Road transport establishments.
o Cinemas and theaters and Hotels and
restaurants.
PENALTIES AND DAMAGES
 If a person commits an offence after
being convicted by a court, every
subsequent offence attracts
imprisonment up to 1 year or fine up
tors.2000 or both.
 If the subsequent offence is for failure
to pay contribution, punishment will be
up to l year and not less than 3 months,
and fine up to 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
damage.
TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION
OBJECTIVE ACTIVITY ACTIVITY AIDS
LIMITATIONS
 Less than half the enrollees use the
ESISfacilities because of the low
quality of care.
 Many of the staff are not aware of the
benefits.
 The employers also do not disseminate
theinformation to their staff.
 There is duality of control, with both
the ESIC and the State governments
trying to establish superiority.
 Poorpenetration in rural area
 Act does not include employees of
Indian navy, military or air force; or
whose wagesexceed Rs. 15000 or as
prescribed by the Central Government
 To avail of the sickness benefit, the
employeehas to have worked for 78
days prior to thesickness.Similarly, to
avail of the maternitybenefit., the
woman has to have worked for 70
days prior to the sickness
TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION
OBJECTIVE ACTIVITY ACTIVITY AIDS
15 min Elaborate CENTRAL The Teacher The student Chart Can you tell about
Central GOVERNMENTHEALTH SCHEME teaches the will listen Central Government
Government health schemes- Health Scheme
Started under the Indian ministry attentively to
Health scheme. Central (CGHS)?
of health and family welfare Government the teacher
in 1954. Health Scheme
The scheme was started in Delhi to the student in
in 1954. the class.
The scheme was extended to the17 cities
all over the India(Allahabad,
Ahmedabad, Bangalore, Mumbai,
Kolkata, Hyderabad,Jaipur, Jabalpur,
Lucknow, Chennai,West Bengal,
Nagpur, Patna, Pune,Kanpur,Guwahati,
Thiruvananthapuram).

op
TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION
OBJECTIVE ACTIVITY ACTIVITY AIDS
OBJECTIVES
 To give extensive medical facilities to
central government employes and
theirfamilies.
 To save the Government from heavy
expenses on medical fund.
TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION
OBJECTIVE ACTIVITY ACTIVITY AIDS
BENEFECIARIES
 Central government employees and
their family members
 Members of parliament
 Judge of supreme court and high court
 Freedom fighters
 Pensioners of central government semi
government organizations
 Governors and ex- Vice president
 Workers and Pensioners of selected
autonomous organizations
in the Delhi state.
 Journalists qualified with PIB (In Delhi
Only).
 Police Personnel (In Delhi Only).
 Workers of Railway Board.
TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION
OBJECTIVE ACTIVITY ACTIVITY AIDS
Components of the Central
Government Health Scheme (CGHS)
 The dispensary services including
domiciliary care.
 F. W. &Maternal and Child health
Services.
 Specialists' consultation facilities both
at dispensary. Polyclinicand hospital.
 Level including X-Ray, ECG and
Laboratory Examinations.
 Hospitalization.
 Organization for the purchase, storage,
distribution and supplyof medicines and
other requirements.
TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION
OBJECTIVE ACTIVITY ACTIVITY AIDS
LIMITATIONS
 Less than half the enrollees use the
ESIS facilities because of the low
quality of care.
 Many of the staff are not aware of the
benefits.
 The employers also do not disseminate
the information to their staff.
 There is duality of control, with both
the ESIC and the State governments
trying to establish superiority.
TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION
OBJECTIVE ACTIVITY ACTIVITY AIDS
Facilities Offered Under Central
Government Health Scheme (CGHS)
o OPD Treatment including issue of
medicines.
o Specialist Consultation at
Polyclinic/Govt. Hospitals.
o Indoor Treatment at Government and
Empaneled Hospitals.
o Investigations at Government and
Empaneled Diagnostic centers.
o Cashless facility available for treatment
in empaneled hospitals and diagnostic
centers for Pensioners and other
identifiedbeneficiaries
o Reimbursement of expenses for
treatment availed in Govt. /Private
Hospitals under emergency.
o Reimbursement of expenses hearing
incurred for purchase of aids, artificial
limbs, appliances etc. as specified.
°Family Welfare, Maternity and Child
Health Services. °Medical consultation
and dispensing of medicines in
Ayurveda, Homeopathy, Unaniand
Siddha system of medicines (AYUSH).
TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION
OBJECTIVE ACTIVITY ACTIVITY AIDS
Cost of Central Government Health
Scheme (CGHS)Facilities
For Pensioner
In case a pensioner wants to avail the
facilities of CGHS they willalso have to
make a contribution according to the
grade pay theywere entitled at the time
of their service. The contribution can
bedone as yearly contribution and one
time contribution:
Yearly Contribution: Every year
acertain amount of money (as pergrade
pay) is to be contributed towardsCGHS.
One Time Contribution: A pensioner
pays onetime contributionamount
towards CGHS for 10years. It will be
considered as alifetime contribution.
For Serving Government Employees
A central government employee, who is
currently serving in CGHS covered
area, is bound to take the CGHS card. A
deduction ismade from the salary by
their department every month,
whichdepends upon the grade pay of the
serving employees.
Required time to get CGHS Card
A printed index card of CGHSisissued
on the day of applicationfor CGHS.
Later, the plastic cards are issuedand
 sent to theconcerned card holders
within 3 weeks. The cards are sent to
theresidence of the government
employees.

TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION

OBJECTIVE ACTIVITY ACTIVITY AIDS
8 min illustrate the HEALTH INSURANCE The Teacher The student Bulleti What is Health
Health Health insurance programme, people teaches the will listen n board Insurance?
Insurance. health schemes-
who havethe risk of a certain event attentively to
Health Insurance
contribute a smallamount (premium) to the student in the teacher
towards a health insurancefund. This the class.
fund is then used to treat patients
who experience that particular event
(e.g.hospitalization).
Definition- "Health insurance, like other
forms ofinsurance, is a form of
collectivism by means of which people
collectively pool their risk, in this case
the risk of incurring medical expenses.”

TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION

OBJECTIVE ACTIVITY ACTIVITY AIDS
 OBJECTIVES
Health insurance programme have two main
objectives:
• To increase the access to health care
• To protect the employees from high medical
expenses at the time of illness.

TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION

OBJECTIVE ACTIVITY ACTIVITY AIDS
 PRINCIPLES OF INSURANCE
 Utmost good faith.
 Insurable interest
 Principles of indemnity
 Principle of Subrogation
 Principle of loss minimization

CHARACTERISTICS OF HEALTH
INSURANCE
•It is contract between an insurance
company and an individual or his
sponsor (e.g. an employer).
•The contract can be renewable
annually or monthly.
• The type and amount of health care
costs that will be covered by the health
insurance Company are specified
in advance, in the member contract or
"Evidence ofCoverage" booklet.

TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION

OBJECTIVE ACTIVITY ACTIVITY AIDS
 Health Insurance in India is very
limited covering about 13% of the
total population. The existingschemes
can be categorized as:
1. Voluntary health insurance schemes or
private for-profit schemes
2. Mandatory health insurance schemes
or government runscheme.
3. Employer-based schemes.
4. Insurance offered by NGOs/
community-based health insurance.

TIME SPECIFIC CONTENT TEACHER’S STUDENT’S AV EVALUATION

OBJECTIVE ACTIVITY ACTIVITY AIDS
4 min elucidate EMPLOYEE BASED SCHEME The Teacher The student Enlist the employee-
employers’ teaches the will listen based scheme and
i. Defense scheme
health scheme employee-based other health
ii. Railway scheme attentively to
and some other scheme and schemes?
schemes. iii. Private agencies other health the teacher
schemes to the
OTHER HEALTH SCHEMES: student in the
class.
i. Ayushman Bharat
ii. National Health Protection
Scheme
iii. Pradhan MantriSuraksha Bima
yojana
iv. Universalhealth insurance scheme
v. National AYUSH Mission
vi. RastriyaSwasthyaBima yojana
vii. Senior Citizen Insurance Scheme
(SCHS)

SUMMARY
The central or state Government powered scheme that is designed to provide adequate health cover at a low-
priced insurance cover. Such health insurance policies are usually offered on a yearly basis. The Central
Government Health Scheme offers healthcare facilities to employees and pensioners of the Central
Government of India who are registered under the scheme. The scheme offers reimbursement and cashless
facilities to enrolled members. Employees of the Central Government are eligible for this coverage.

The health scheme comprises of:

Mandatory Health Insurance schemes
The two mandatory government run schemes includes:
 Central Government Health Schemes (CGHS)
 Employee's state insurance scheme (ESIS)
Employer based scheme
The railways, defence and security forces provide medical benefits to the employees
Voluntary Health Insurance Schemes or Private for-Profit Scheme
 CONCLUSION
One of the primary duties of a government in India is to look after its citizen's health and welfare benefits.
That is why various sections of government are constantly trying to improve their health care unit or sector.
Moreover, they provide better facilities to all the patients who need them.

India is an entirely vastly populated country, where poor people can be found at many corners of the road if
you try to find some. For those people, it becomes impossible to find suitable treatment with the money they
have. Hence, it is the responsibility of the government in India to look after such people.

They must ensure they also receive the same treatment at the right time as other country citizens. Thus, after
reading this article, you can now gather all the information you have been looking for regarding the list of
government health insurance schemes introduced to date
 BIBLIOGRAPHY
BOOK REFERENCE
Park k, Textbook of preventive and social medicine, Edition23 , Bhanot Publication, Jabalpur,
Madhya Pradesh-2021 , Page number -621-624

Veerabhadrappa GM, The short textbook of community Health Nursing, Edition-2nd, Volume -
2nd, Jaypee Brothers medical publisher, New Delhi -2022, Page number-224-229

NET REFERENCE
https://www.slideshare.net/slideshow/health-scheme-54087150/54087150