Ayushman Bharat health insurance scheme: Who all it covers and how

Prime Minister Shri Narendra Modi announced in his State of the Union address on the occasion of the Independence Day 2018 the launch of the National Health Protection Plan (AB-NHPS). The national health insurance scheme would be implemented on a pilot basis in some states. The project is expected to be implemented on a large scale by the end of September.On September 23, 2018, Prime Minister Narandra Modi Ayushman Bharat Yojna, the world’s largest health plan funded by the government in the capital Jharkhand, launched Ranchi. The center’s master plan was renamed PM Jan Arogya Yojana (PMJAY). The scheme will begin on September 25 on the anniversary of the birth of Pandit de Endial Obadhiya.

According to various government websites, the following is a description of what the healthcare insurance policy.

Who is the AB-NHPS aimed at?
The program aims at poor and disadvantaged rural households and in a specific occupational category for the families of urban workers. So, if we want to use the SECC data from 2011, 8.03 million households in rural areas and 2.33 people in urban areas will be covered in this plan, which will cover about 50 people.AB-NHPS will cover specific benefits of Rs 5 per family (family-based) each year for secondary and tertiary care in the hospital. It will provide interest coverage of Rs 5 per thousand families per year. Rashtria Swastya will host the existing Bima Yugana (RSBY), launched in 2008 by the United Progressive Government.

How will the entitlement be decided?
AB-NHPM will be a rights-based scheme and will be determined based on the deprivation criteria in the SECC database. The beneficiaries are identified according to the deprivation categories (D1, D2, D3, D4, D5 and D7) identified in the SECC database for rural areas. For urban areas, the 11 occupational standards will determine the right. In addition, beneficiaries of Rashtria Swatya Pima Yugna (RSBY) are also included in the states in which they are active.

Rural area categories: The various categories in rural areas include families with only one room with the walls of kucha and the roof of kucha; families that do not have an adult aged between 16 and 59 years; families headed by a woman without an adult man between the ages of 16 and 59. Disabled members and adult non-disabled persons in the family; SC / ST homes and households with no land and which derive much of their income from occasional manual labor.

In addition, these families will be included in rural areas, which include any of the following elements: homeless homes, homeless people, living alms, handicraft families, primitive tribal groups and legal slavery.

Urban area categories: For urban areas, every 11 specific occupational categories are entitled under this system. The main source of income for the home in urban areas has been clarified in the name of beggars; raiders; domestic workers; street vendors / shoemakers / other street vendors; construction workers / plumbers / construction workers / workers / painters / welders / guards Safety workers / chillers and other head-load workers Hygiene workers / sanitation workers / males; domestic workers / artisans / artisans / tailors; transport workers / drivers / drivers / assistants to drivers and drivers / extractors from rickshaw carts / in a Small businesses / helpers / delivery assistants / assistants / waiters; electricians / mechanics / collectors / repairers; laundry / chowkidars; other work /

What is the hospitalisation process?
Beneficiaries will not be required to pay any fees and premiums for hospitalization expenses in healthcare insurance policy. Interest also includes pre and post hospitalization expenses.Each designated hospital will have “Ayushman Mitra” to assist patients and coordinate with the beneficiaries and the hospital. They will run the Help Desk, review the documents to verify eligibility and register in the scheme.In addition, all recipients will receive messages with QR codes to be scanned and demographic documentation will be implemented for identification and verification of their eligibility to benefit from the benefits of the plan.Benefits of the plan are transferable throughout the country and the beneficiary covered by the plan can receive non-cash benefits from any public / private hospital across the country.

What are the inclusions?
AB-NHPM will cover medical and hospitalization expenses for all secondary care procedures and most specialist care procedures. The Ministry of Health included 1,354 packages in the program, which will provide treatment for the coronary artery, knee replacement and stent placement among other things at prices ranging from 15 to 20 percent cheaper than the health plan of the central government (CGHS).

What is the eligibility criteria for a beneficiary?
There is no registration process in AB-NHPM as it is a rights-based task. Ayushman Bharat Yojna Families defined by the government on the basis of deprivation and professional standards using the SECC database, in both rural and urban areas, are entitled to AB-NHPM. The database is currently based on the 2011 census.A list of eligible families was shared with concerned state governments, as well as with state-level administrations such as ANM, BMO and BDO for relevant areas. The AB-NHPM Family ID will be allocated to eligible families. Only families whose name is on the list are entitled to the benefits of AB-NHPM.In addition, families with active RSBY cards will be covered as of 28 February 2018. No new additional families can be added under AB-NHPM. However, additional family names can be added to families that are already listed in the SECC list.The official website of AB-NHPM is www.abnhpm.gov.in. One can visit the site to view and download the eligibility of beneficiaries and the list of selected hospitals when updated..

Hospital eligibility
Services under this system can be used in all public hospitals and in private health care facilities. In addition, the basic standards of empowerment allow the establishment of a hospital with at least 10 beds, with flexibility provided to the states for further relaxation if necessary. Hospital management will be carried out under the AB-NHPM framework through a government portal. Information on existing hospitals will be provided through various means, such as government websites and mobile applications. Beneficiaries can also call the help line number on 14555.

To control costs, treatment payments will be made on the basis of the package price (which the Government will specify in advance). However, hospitals with NABH / NQAS accreditation can be stimulated through higher package rates subject to procedures and cost guidelines.

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