Government Unveils ‘Paripoorna Mediclaim Ayush Bima’ For CGHS Beneficiaries

The government has introduced a new optional health insurance product called Paripoorna Mediclaim Ayush Bima, aimed at enhancing hospitalization and treatment coverage for Central Government Health Scheme (CGHS) beneficiaries, according to a recent press statement by the Ministry of Finance.

The product has been launched by the Department of Financial Services and is meant to sit alongside CGHS services rather than replace them. By offering cashless facilities, wider treatment access, and new coverage options, the scheme tries to address medical expenses that often fall outside the CGHS umbrella.

Designed Around CGHS Households

CGHS beneficiaries, comprising serving and retired central government employees and their families, typically rely on the system for outpatient consultations and tie-ups with empanelled hospitals. But hospitalization and longer treatment cycles can still leave gaps, prompting many households to look for additional cover from the private market. The new scheme attempts to bridge that space with an indemnity-based hospitalization product available for up to six members per policy.

Two sum insured options have been announced: Rs 10 lakh and Rs 20 lakh. The policy also introduces co-payment choices, allowing subscribers to split the cost of claims with the insurer in either a 70:30 or 50:50 ratio. Though co-payments are not always viewed favourably by retail buyers, the ministry has positioned them as a tool for reducing the premium burden and making the cover accessible across different income bands of government employees.

Room rents have been standardised at one per cent of the sum insured per day for normal rooms and two per cent for ICU admissions. The cover includes a 30-day pre-hospitalization period and a 60-day post-hospitalization period, which can be particularly useful for ongoing medication, tests, and rehabilitation after major procedures.

Ayush And Modern Treatment Features

One of the more distinctive elements in the scheme is the emphasis on Ayush-based in-patient care. The statement notes that Ayush treatments will be covered up to the full sum insured, reflecting both policy support for traditional systems of medicine as well as rising patient interest in integrated care pathways. Modern treatments have been capped at 25 per cent of the sum insured, though an optional rider can push that to 100 per cent for those who want broader protection.

To encourage renewal and stability, the policy includes a cumulative bonus of 10 per cent for each claim-free year, up to a ceiling of 100 per cent of the sum insured. The Ministry has also highlighted affordability measures such as zero GST and discounts of 28 per cent and 42 per cent on premiums for the 70:30 and 50:50 co-payment variants when compared with a regular retail product.

For many CGHS families, especially pensioners, the affordability angle may prove decisive. Medical inflation in India has outpaced headline inflation for years, and household budgets have had to absorb more of the cost of surgeries, diagnostics, and post-operative care. A scheme that ties directly into an existing framework like CGHS could make health financing more predictable for beneficiaries who already use government facilities for primary and outpatient care.

The policy will be offered by New India Assurance through both offline offices and digital channels. The Ministry has said availability will begin shortly.