by Elton Gomes
In his Independence Day speech, Prime Minister Narendra Modi announced that the Pradhan Mantri Jan Arogya Abhiyaan, also known as Ayushman Bharat or the National Health Protection Mission (AB-NHPM), will be launched on September 25. Marking the birth anniversary of Deen Dayal Upadhyay, the complete roll-out of the scheme, famously known as Modicare, will begin from September 25 onwards. The policy was previously announced by finance minister Arun Jaitley in February 2018 when the last full budget of the NDA government was presented.
What is the scheme?
The National Health Protection Scheme aims to cover more than 10 crore vulnerable families (which means that the scheme could help approximately 50 crore people) and provide a yearly health cover of up to Rs 5 lakh to each family. The programme has been regarded as the worlds biggest free health insurance scheme and is claimed to be better than Obamacare. The schemes benefits can be used throughout the country. A beneficiary under the scheme can receive cashless benefits from any public/private hospitals across India.
Who can avail the scheme?
Since the scheme is largely meant to cater to the poor and the economically-deprived, everyone will not be eligible to receive free medical insurance under Ayushman Bharat scheme. On the basis of the SECC (Socio-Economic Caste Census) database, the scheme will target over 10 crore families. In order to ensure that no individual from the vulnerable group is left out, there will not be a limit on family size and age. The insurance scheme will look after pre and post-hospitalisation expenses.
How to check eligibility?
To check whether you are eligible for insurance cover under the Ayushman Bharat, follow the below procedure:
Log on to the Ayushman Bharat website
Click on the Download Beneficiary List tab
Depending on your location, select Rural or Urban
Enter your mobile number to receive a one-time password
The list that appears can be downloaded once the OTP is entered
The list can be saved for future reference
An entitlement based scheme
It has to be kept in mind that the Ayushman Bharat is an entitlement-based mission, which means that there wont be any enrolment process. On the basis of deprivation and occupational criteria, as per that stated in the SECC database, families will be entitled for the scheme. Currently, the database is based on the census for the year 2011.
A list containing eligible families has been shared with the respective state governments as well as state level departments of relevant areas. Eligible families will have a dedicated family identification number, and only those families whose name is on the list will receive benefits under the Ayushman Bharat.
Families with active Rashtriya Swasthya Bima Yojana (RSBY) cards as of February 2018 can also avail benefits of the scheme. New families cannot be added under the scheme, but names of additional family member can be included for families already on the SECC list.
Making it work
Writing for Firstpost, Dinesh Unnikrishnan states that adequate machinery should be present for assessment. The 2011 census data may be outdated to identify families who can avail the scheme. Additionally, there could be chances of fraudulent activities by using forged documents to claim the insurance amount.
Unnikrishnan further states that the government has to keep a thorough check on the quality of treatment. He opines that a group of medical experts and law enforcement officers should ensure that hospitals offer adequate treatment.
An article in Live Mint states that a major hurdle for the Ayushman Bharat is for it to be economically sustainable. The article claims that presently, hospitals seem unhappy as package rates fixed by the government appear to be loss-making. Furthermore, insurers are concerned that they will be left out because states have the option to choose a trust model that does not require insurers to participate.
Insurance companies were reportedly disappointed over the way in which the bidding and the trust model was finalised. It is now clear NHPM, which was expected to be a big business for the domestic general insurance industry, is turning out to be a damp squib for them as governments are preferring the trust model, a senior official from an insurance company told the Indian Express.
Elton Gomes is a staff writer at Qrius