Ayushman Bharat National Health Protection Mission.

“It is health that is real wealth and not pieces of gold and silver!” – Mahatma Gandhi

Ayushman-Bharat-Scheme

INTRODUCTION:

Keeping in mind the health and well being of the countrymen  i.e the actual wealth of the nation ,The Union Cabinet chaired by Prime Minister Narendra Modi has approved launch of Ayushman Bharat-National Health Protection Mission (AB-NHPM).The insurance scheme under the name  of “Namocare or Modicare” was announced in Union Budget 2018 and was approved by Union Cabinet in March 2018 with budgetary support of Rs 10,500 crore. It is world’s largest government-funded healthcare programme.It is Centrally Sponsored health insurance scheme of Ministry of Health and Family Welfare (MoHFW).Ayushman Bharat programme has been described by the government as the world’s largest government-funded healthcare programme.

It is an umbrella scheme which includes two sub schemes:

1. National Health Protection Scheme (NHPS) and Health and Wellness Centre Initiative for preventive care.
2. Senior Citizen Health Insurance Scheme (SCHIS)

Under the National Health Protection Scheme an Insurance Programme, government aims to provide healthcare protection for over 10 crore “poor and vulnerable” families, or an estimated 50 crore individual beneficiaries based on Socio Economic and Caste Census 2011 (SECC) database — with coverage of up to Rs 5 lakh per family per year. Under the Health and Wellness Centre initiative, government aims to establish 1.5 lakh centres for preventive care services.This will help to bring a visible relief to the target families by mitigating financial risk arising out of catastrophic health episodes.The government intended to achieve ‘Universal Health Cover’ at one go, but covering 1.3 billion population with the existing healthcare infrastructure and human resource is an impossible task. This prompted the government to settle at covering 40 per cent of the population — 50 crore people in the first phase. Described as “the world’s largest government-funded healthcare programme”, the sheer scale of this programme magnifies many its systemic challenges.

For giving policy directions and fostering coordination between Centre and States for implementation of scheme, 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.

MORE ABOUT THE SCHEME:

Aim:

Listed below are aim of  Ayushman Bharat – National Health Protection Mission:

•  The scheme structure will ensure appropriate integration with the existing health insurance or protection schemes of various central ministries/departments and state governments (at their own cost). The state governments will be allowed to expand AB-NHPM both horizontally and vertically.
• AB-NHPM will have a major impact on the reduction of Out Of Pocket (OOP) expenditure on the ground of an increased benefit cover to nearly 40 per cent of the population, which will lead to an increased access to quality health and medication. In addition, the unmet needs of the population which remained hidden due to lack of financial resources will be catered to.
• The Ayushman Bharat scheme will lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency, job creation thus, leading to an improvement in the quality of life.
• A major spin-off the scheme is the likely boost it is going to give to creation of state of the art health infrastructure in the many towns and cities across the country. It is also likely to generate employment.

Eligibility: Who will get cover Under Ayushman Bharat Health Insurance Scheme?

Under Ayushman bharat  scheme, government India to provide health insurance to 10 crore families of India. Approx 50lac people of India will get benefit of this scheme. This is world’s largest government-funded healthcare programme (after Obama care).

• 50 crore people of 10 crore families will get full health cover under ayushman bharat health programme.
• All Indian citizens (with valid documents) will get benefit of ayushman bharat scheme.
• It will provide Rs. 5 lakh insurance cover 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.
• Pre and post-hospitalisation expenses. It also covers all pre-existing conditions from beginning of policy. It will also pay defined transport allowance per hospitalization to beneficiary.
• The beneficiaries can avail benefits in both public and empanelled private facilities.

 premium amount for the health insurance

Approx Rs.1000-1200 of yearly premium needs to be paid for ayushman bharat health insurance scheme. This amount of yearly premium is quite nominal; it almost frees health insurance in India which covers all family members.

Cashless treatment health insurance

In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction.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 all the costs associated with treatment.It will be done on package rate (to be defined by the Government in advance) basis. The package rates will include all costs associated with treatment.

 Payer for insurance amount:

The amount of insurance will be shared between central government and state governments on the ratio of 60:40. 60% fund for the ayushman bharat scheme will be provided by Government of India.

The premium pay for Ayushman bharat scheme will be taxed

Under IT Section 80D (just like IT Section 80D), one can claim tax rebate for the amount you pay for ayushman bharat health insurance.

Listed below are aim of  Ayushman Bharat – National Health Protection Mission:

•  The scheme structure will ensure appropriate integration with the existing health insurance or protection schemes of various central ministries/departments and state governments (at their own cost). The state governments will be allowed to expand AB-NHPM both horizontally and vertically.
• AB-NHPM will have a major impact on the reduction of Out Of Pocket (OOP) expenditure on the ground of an increased benefit cover to nearly 40 per cent of the population, which will lead to an increased access to quality health and medication. In addition, the unmet needs of the population which remained hidden due to lack of financial resources will be catered to.
• The Ayushman Bharat scheme will lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency, job creation thus, leading to an improvement in the quality of life.
• A major spin-off the scheme is the likely boost it is going to give to creation of state of the art health infrastructure in the many towns and cities across the country. It is also likely to generate employment.

To apply: CLICK HERE

Role of State Government:

One of the core principles of Ayushman Bharat – National Health Protection Mission is to co-operative federalism and flexibility to states.They are allowed to expand scheme both horizontally and vertically. They are also free to choose modalities of its implemenent. They can implement through insurance company or directly through Trust/ Society or a mixed model.Thus, Ayushman bharat (under National Health Protection Scheme or Modi care) will be run as trust model or insurance model which will be non-profit trust.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 and at district level also, a structure for implementation of the scheme will be set up.

Recent updates on the scheme:

Four States and one Union Territory have signed first MoU with National Health Mission, Government of India for implementing Ayushman Bharat Pradhan Mantri Rashtriya Swasthya Suraksha Mission (PMRSSM). These states/UTs are Himachal Pradesh, Haryana, Jammu & Kashmir, Uttarakhand and Chandigarh (UT).These MoUs were signed during Ayushman Bharat Northern Region’s first workshop on PMRSSM at Shimla, Himachal Pradesh. Through these MoUs, these four states and UT will formally commit to implement PMRSSM. The MoU clearly outlines roles of Central and State/UT Governments for implementation of PMRSSM Similar regional workshops are also planned in due course of time across the country to sign MoU with States/UTs for rolling out of PMRSSM in each region.

Accelerating the commissioning of a brand new health insurance scheme, the state government has constituted a six-member committee to work out the procedures and cost to be covered under the said scheme.The committee, headed by Dr D Narayana, director, Gulati Institute of Finance and Taxation, has members drawn from Directorate of Medical Education, Directorate of Health Services, Comprehensive Health Insurance Agency of Kerala and Karunya Benevolent Fund. It is learnt the new scheme envisages to bring more beneficiaries under health insurance and promises to provide them with better medical insurance cover.

Also read:

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Rashtriya Swasthya Bima Yojana

Pradhan Mantri Bhartiya Janaushadhi Pariyojana