The Union Cabinet on March 21, 2018 approved the launch of the Centrally sponsored 'Ayushman Bharat -National Health Protection Mission (AB-NHPM)'.
The scheme will integrate two on-going centrally sponsored schemes- Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
Features of Ayushman Bharat- National Health Protection Mission
• The scheme has the benefit cover of Rs 5 lakh per family per year. This cover will take care of almost all secondary care and tertiary care procedures.
• The scheme aims to target over 10 crore families belonging to poor and vulnerable population based on Socio Economic and Caste Census 2011 (SECC) database. There will be no cap on family size and age in the scheme.
• The benefit cover will also include pre and post-hospitalisation expenses. All pre-existing conditions will be covered from day one of the policy.
• A defined transport allowance per hospitalization will also be paid to the beneficiary.
• 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 the Government in advance basis. The package rates will include all the costs associated with treatment.
• The States and UTs will have the flexibility to modify these rates within a limited bandwidth.
• For beneficiaries, it will be a cashless and paper less transaction.
• States will be required to form a State Health Agency (SHA) to implement the scheme and at the district level also, a structure for implementation of the scheme will be set up.
• To ensure that the funds reach SHA on time, the transfer of funds from Central Government through AB-NHPMA to State Health Agencies may be done through an escrow account directly.
• 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.
Entitlement based scheme
The AB-NHPM will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database.
Here are the different categories of families in rural areas that can be covered under the scheme:
• Families having only one room with kucha walls and kucharoof
• 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 the family
• SC/ST households
• Landless households deriving major part of their income from manual casual labour
• The scheme will 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 are entitled under the scheme.
• The beneficiaries can avail benefits in both public and empanelled private facilities. All public hospitals in the States implementing AB-NHPM, will be considered empanelled for the Scheme.
• Hospitals belonging to Employee State Insurance Corporation (ESIC) will also be empanelled based on the bed occupancy ratio parameter.
• While, the private hospitals will be empanelled online, based on defined criteria.
Co-alliance of States
• One of the major features of the scheme is that it will offer mutual federalism and flexibility to states. There is provision to partner the States through co-alliance.
• This will ensure appropriate integration of the scheme with the existing health insurance schemes of various Ministries and Departments and State Governments at their own cost.
• State Governments will be allowed to expand the scheme both horizontally and vertically.
• States can implement the scheme through insurance company or directly through Trust/ Society or through a mixed model.
Formation of Ayushman Bharat National Health Protection Mission Council (AB-NHPMC)
The scheme proposes to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister.
It will have an Ayushman Bharat National Health Protection Mission Governing Board (AB-NHPMGB) which will be jointly chaired by Secretary (HFW) and Member (Health) of NITI Aayog, Financial Advisor under Ministry of Health, Additional Secretary & Mission Director of AB-NHPM and Joint Secretaries of AB-NHPM and MoHFW as members.
The CEO of Ayushman Bharat Scheme will be the Member Secretary and the State Secretaries of Health Department will also be members as per the requirement.
It will establish an Ayushman Bharat - National Health Protection Mission Agency (AB-NHPMA) to manage the scheme at the operational level in the form of a Society. AB-NHPMA will be headed by a full time CEO.
Implementation Strategy for the Scheme
• At the National level, an Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) will be established.
• States and UTs will implement the scheme by a dedicated entity called State Health Agency (SHA).
• States and UTs can also implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model.
Who: Union Cabinet