Ayushman Bharat PMJAY-like health insurance scheme for those not covered on the cards!

Rajeev Kumar
ayushman bharat pmjay scheme for all

Individuals not covered under Ayushman Bharat-PMJAY may soon benefit from a Central government-backed contributory health insurance scheme. Centre’s top thinktank Niti Aayog is developing a health insurance scheme that would provide cover to those not benefitting from Narendra Modi government’s flagship Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (PMJAY), which provides a cover of up to Rs 5 lakh per family per year. Ayushman Bharat-PMJAY currently covers 40 per cent of the population. Niti Aayog is working on a scheme to provide health cover to the remaining population, the thinktank said in its Annual Report 2019-20.

The report, which was released last week, noted that as per the 71st round of the NSSO survey, 80 per cent of Indians are not covered under any health insurance plan and only 18 per cent (government-funded 12 per cent) of the urban population and 14 per cent (government-funded 13 per cent) of rural population are covered. PMJAY covers 40 per cent of the population.

"It is envisaged to provide health cover to the remaining population. NITI Aayog is working towards evolving a scheme to cover this uncovered population, which is characteristically not poor and often referred to as the 'deprived above poverty-line class," the annual report said.

"This segment of the population, despite having the financial capacity for contribution, remains prone to catastrophic health expenditure that can essentially push them below the poverty line. A large part of this 'missing middle' is engaged in the informal sector and mostly based in urban areas," it added.

Niti Aayog has played a key role in the launch of the Ayushman Bharat-PMJAY. It did the detailed groundwork for conceptualizing PMJAY and played a role in shaping the organizational and governance structure of the National Health Authority, the nodal agency for PMJAY, for smooth implementation of the scheme, the report said.

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) currently provides a cover of up to Rs. 5 lakhs per family per year, for secondary and tertiary care hospitalization to over 10.74 crore vulnerable entitled families (approximately 50 crore beneficiaries). PMJAY provides cashless and paperless access to services for the beneficiary at the point of service.

Under PMJAY, there are 1,578 health benefit packages with defined rates. Over 21,000 hospitals and health care providers have been empanelled across the country to provide healthcare services as per these packages.

Around 82 lakh treatments worth over Rs. 11,000 crore have been provided under PMJAY so far, according to NHA.