The Union Cabinet chaired by Prime Minister Narendra Modi has approved launch of Ayushman Bharat-National Health Protection Mission (AB-NHPM). The scheme will integrate two on-going centrally sponsored schemes viz. Rashtriya Swasthya Bima Yojana (RSBY) and Senior Citizen Health Insurance Scheme (SCHIS).
Key Features of AB-NHPM
AB-NHPM aims to target over 10 crore families belonging to poor and vulnerable population based on Socio Economic and Caste Census 2011 (SECC) database. It will cover of Rs 5 lakh per family per year, taking care of almost all secondary care and tertiary care procedures. There will be no cap on family size and age in the scheme.
Benefit cover: It includes pre and post-hospitalisation expenses. It will cover all pre-existing conditions from beginning of the policy. It will also pay defined transport allowance per hospitalization to the beneficiary.
Cashless benefits: The scheme allows the beneficiary to take cashless benefits from any public or private empanelled hospitals across the country. The payment for treatment will be done on package rate which will be defined by Government in advance basis. The package rates will include all the costs associated with treatment.
Role of state governments: They will be allowed to expand the scheme both horizontally and vertically. Thye will be free to choose modalities for implementation. They can implement through insurance company or directly through Trust/ Society or a mixed model.
Implementation: States/UTs will have also flexibility to modify these rates within limited bandwidth. For beneficiaries, it will be cashless and paper less transaction. States will be required to form State Health Agency (SHA) to implement scheme and at district level also, a structure for implementation of the scheme will be set up
Escrow account: To ensure that funds reach SHA on time, transfer of funds from Central Government through AB-NHPMA to State Health Agencies may be done through an escrow account directly.
IT platform: The scheme will work in partnership with NITI Aayog to operationalise a robust, modular and interoperable IT platform which will involve a paperless and cashless transaction.
Council: For giving policy directions and fostering coordination between Centre and States, Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) will be set up at apex level. It will be chaired by Union Health and Family Welfare Minister.
Entitlement: It is entitlement based scheme with entitlement decided on basis of deprivation criteria in SECC database. Different categories of families covered under scheme are Families having only one room with kucha walls and kucha roof, families having no adult member between age 16 to 59, female headed households with no adult male member between age 16 to 59, disabled member and no able bodied adult member in family, SC/ST households, landless households deriving major part of their income from manual casual labour. It will also automatically include families in rural areas having any one of the following- households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups or legally released bonded labour. For urban areas, 11 defined occupational categories will be entitled under scheme.