On Wednesday, National Health Protection Mission or Ayushman Bharat also referred as Modicare has received cabinet go-ahead. Here's a summary of few important facts on the most ambitious healthcare initiative of the Modi govt.
1. Program highlights: Through the scheme, the govt seeks to provide Rs. 5 lakh health insurance per year per family to 10 crore families from the economically weaker section of the society based on the Socio Economic and Caste Census (SECC) database.. The scheme was announced in the Union Budget 2018 on February 1st, 2018.
As per the tweet yesterday, the targeted beneficiaries of the scheme will be equivalent to 40% of the population in accordance with the govt. estimate.
The program shall will hence on cover the existing centrally-sponsored healthcare schemes of the govt. including Rashtriya Swasthya Bima Yojana (RSBY) that offers a cover of Rs. 30000 and enior Citizen Health Insurance Scheme (SCHIS).
2. Launch of the scheme: Though the exact date of the launch of the scheme remains still clear, as per sources the scheme can be rolled on August 15 or by the end of this year. There are also chance that the scheme becomes effective from October 2018.
3. Benefits under the scheme: With the Ayushman Bharat scheme in place, the healthcare cover will increase from the existent Rs. 30000 per year to Rs. 5 lakh per family per year to 10 crore families. The scheme will provide for secondary care as well as tertiary care procedures.
The statement by the govt. said, "To ensure that nobody is left out (especially women, children and elderly) there will be no cap on family size and age in the scheme. The benefit cover will also include pre and post-hospitalisation expenses. All pre-existing conditions will be covered from day one of the policy". It is to be noted that most insurance policies do not provide cover pre-existing ailments.
The scheme also covers for expenses incurred 3 days prior to hospitalization and 15 days of post hospitalization.
The defined travel allowance shall also be payable every time the patient gets hospitalized.
At the onset of the scheme only the in-patient expenses shall be covered and not the out-patient expenses.
The scheme can also be ported across states and UTs in the country. Cashless benefits shall be offered at private or public empanelled hospitals all through the length and breadth of the nation.
4. Cost of the programme: Rs. 20000 to Rs. 25000 odd crore shall be required for the implementation of the scheme that shall be borne by both the state and the centre in the ratio of 40% and 60%. The states can either adopt an insurance company or a trust similar to current health scheme of the govt.
5. Premium payments: In contrast to the current scheme, under which govt. pays a premium of Rs. 500, the scheme will entail a premium equivalent of around Rs. 1000-1200. Citing the lower premium than as deemed to be fair by insurance companies, they are reluctant to bid for the scheme and also demand advance payment of premium towards the scheme.