By Neeraj Mahajan
One of the most significant announcement by Prime Minister Narendra Modi in his Independence Day speech from Red Fort was the intention to formally launch the Ayushman Bharat also known as Pradhan Mantri Jan Arogya Abhiyaan or National Health Protection Mission (AB-NHPM) – on 25 Sept 2018.
The scheme will provide much sought after and free medical aid to over 10.74 crore beneficiaries and about 50 crore Indian citizens belonging to poor and vulnerable sections of the population in government or empaneled private hospitals all over India.
The treatment packages and package rates for health coverage to beneficiaries under the Ayushman Bharat – National Health Protection Mission (AB-NHPM), have been finalized by a Committee of Experts headed by Director General of Health Services, Ministry of Health and Family Welfare, after extensive consultations with all the stakeholders.
Beneficiaries covered up to Rs 5 lakh per family per year:
- The cover includes almost all secondary care and most of tertiary care procedures.
- No cap on family size and age to ensure that – women, children and elderly are not left out.
- All pre and post-hospitalization expenses included.
- No waiting period like private mediclaim policies.
- All pre-existing conditions – covered from day one of the policy.
- A defined transport allowance per hospitalization will also be paid to the beneficiary.
- Cashless benefits in public/private empanelled hospitals anywhere across the country under the scheme.
- The cost of treatment including all the expenses would be based on package rate –defined by the Government in advance.
- The beneficiaries will be eligible for– cashless and paper less transactions.
- An Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) Chaired by Union Health and Family Welfare Minister will be set up to give policy directions and healthy coordination between Centre and States. Secretary (HFW) and Member (Health), NITI Aayog will jointly chair the Ayushman Bharat National Health Protection Mission Governing Board. AB-NHPMA will be headed by a full time CEO and Member Secretary—equivalent to the level of Secretary/ Additional Secretary, Government of India.
- The Central Government will deposit the money directly in an escrow account. The State Governments will be required to contribute their share of grants within a defined time frame- to ensure a smooth flow of funds.
- A sturdy IT platform and Grievance Redressal Mechanism developed in collaboration with the NITI Aayog will help to ensure paperless and cashless transactions and prevent any potential misuse or fraud.
- An all-inclusive print, electronic and social media platform supported by IEC materials and outdoor activities will ensure that the scheme reaches the targeted beneficiaries and stakeholders.
- The Ayushman Bharat scheme would cover over 1,354 medical and hospitalization packages for almost all procedures like coronary bypass, knee replacements and angiopathy. The insurance amount payable under the scheme would be sufficient to cover ailments like stroke, minor surgeries or accidents but may be inadequate in case of major diseases like cancer, organ replacements or major accidents/surgeries.
In-patient hospitalization expenditure in India has increased 300% in the last ten years. More than 80% of this is met by out of pocket (OOP). Rural households depend (68%) on their ‘household income / savings’ and (25%) on ‘borrowings’ while the urban households rely more than (75%) on their ‘income / saving’ for hospitalization expenditure and ‘(18%) on borrowings. This — over 60% out of pocket (OOP) expenditure is the main reason why almost 6 million families remain struck in the poverty trap because of spiraling health expenditure in India.
AB-NHPM will cut down the Out Of Pocket (OOP) expenditure :
- Benefit the poorest and the economically weaker sections of the society — nearly 40% of the population.
- All types of secondary and tertiary hospitalization covered.
- Cashless treatment in any public/private empaneled hospitals anywhere in the country.
- About 50 crore Indian citizens– Top of Form
- will be covered for up to Rs 5 lakh per family per year:
This will lead to timely treatment, improved patient satisfaction, higher productivity, increased access to quality health care and overall improvement in the quality of life—for about 50 crore Indian citizens.
The expenditure incurred will be shared between Central and State Governments in a specified ratio as per Ministry of Finance guidelines from time to time.
All districts in all States/UTs will be covered under the AB-NHPM umbrella. The eligible beneficiaries will be issued cards and will not be required to pay any charges for any pre and post-hospitalization expenses. Each impaneled hospital will have an ‘Ayushman Mitra’ to assist patients and check their documents to verify their eligibility under the scheme. The patient and their family members can call the helpline number 1455 for any further assistance.
As announced by PM, the benefits under AB-NHPM will soon be extended to the middle class and other social groups—but not for free. They will have to pay a small premium to avail the benefits under the scheme.
Eligibility criteria under the Ayushman Bharat scheme:
In rural areas:
- Families living in only one room with “kuchcha walls and kuchcha roof”
- Families with no adult members aged between 16 and 59
- Female-headed family with no adult male member in the 16-59 age group
- Families having at least one disabled member and no able-bodied adult member
- SC/ST households
- Landless households deriving major part of their income from manual casual labour
- Destitutes and those surviving on alms
- Manual scavenger families
- Primitive tribal groups
- Legally-released bonded laborers
In urban areas:
The list of 11 occupational workers selected by the government to benefit under the scheme are:
- Rag pickers
- Domestic workers
- Street vendors – cobblers/ hawkers/ other service providers on the streets
- Construction workers/ plumbers/ masons/ labors/ painters/ welders/ security guards/ coolies and other head-load workers
- Sweepers/ sanitation workers or gardeners
- Home-based workers/ artisans/ handicrafts workers or tailors
- Transport workers/ drivers/ conductors/ helpers/ cart or rickshaw pullers
- Shop workers/ peons / helpers/ delivery boys and waiters in small establishments
- Mechanics/Electricians/ assemblers and repair workers
- Washer-man and security guards
Aadhaar card desirable but not must for availing the benefits of Ayushman Bharat scheme.
Using the Aadhaar Card will be desirable to verify the beneficiary’s identity but not must to avail benefits under the Ayushman Bharat – National Health Protection Mission.
According to the Union Health Minister J P Nadda, “we will provide services to all eligible beneficiaries with or without Aadhaar cards.”
Other alternate identity proofs like — Ration Card, Voter ID Card, MGNREGA Card would serve the purpose, in case the beneficiary does not have an Aadhaar Number.