Awareness of Ayushman Bharat scheme still low in TN

Ahead of her visit to Billroth private hospital in Chennai for coronary artery bypass grafting (CABG), Girija had no clue to the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS), which had been running in the State for more than seven years.

The treatment that carries a package cost of ₹92,500 was done free of cost for her at the hospital, with the health insurance scheme making payments to the hospital. The card, issued in Girija’s husband’s name many years ago, had never been used in the past.

In fact, after her husband’s demise, she wasn’t even sure if the card could be used at all. Charulatha’s mother, who approached the Government Kilpauk Medical College, in Chennai, for treating her daughter’s severe bronchiolitis and pneumonia, was also unaware of the health scheme in the State.

All she had was the letter issued by the Centre carrying the name of the scheme (PMJAY), with Prime Minister Narendra Modi’s picture and lotus logo of the scheme in the regional language.

Many patients who visit hospitals in Chennai and Kanchipuram have little or no knowledge of the scheme. Though many had the card with them, it remained unused for many years and, hence, were unaware of the benefits.

Now, the State’s CMCHIS health scheme has been integrated with the Centre’s Ayushman Bharat (Pradhan Mantri Jan Arogya Yojana – PMJAY), which offers a cover of up to ₹5 lakh (up from ₹1-2 lakh earlier). The letter issued by the Centre to beneficiaries across the State has helped create awareness, or at least has succeeded in getting people to take note of a scheme.

But more needs to be done. “The overall utilisation has been 3-4 per cent over the past few years – that is, of the 1.4 crore families – about six lakh have been availing benefits under the CMCHIS,” says TS Selvavinayagam, Additional Director of Public Health and Preventive Medicine.

“This is usually the norm across most States that have a health scheme, as not all will avail the benefits in a year. Nonetheless, we are actively looking to increase awareness in the State,” adds Selvavinayagam.

What is the scheme?

The State’s CMCHIS offered a coverage of ₹1 lakh to ₹2 lakh for specified procedures for those with an annual income of less than ₹72,000. The 1.4 crore families that were under the scheme could be treated free of cost in any hospital (both government and private).

Ayushman, which piggybacks on the existing CMCHIS scheme, offers a higher coverage of up to ₹5 lakh. Of course, the procedure needs to be covered and the hospital has to be empanelled.

But with the integrated PMJAY-CMCHIS covering about 1,400 procedures and 2,100 hospitals empanelled under the scheme (of which about 1,100 are government and the balance private, according to the PMJAY website), the wide coverage is a key positive for patients in the State.

A beneficiary can produce the CMCHIS card to claim benefits under Ayushman. On the CMCHIS website under the beneficiary/member ID tab, a person can check his/her eligibility using either the URN number mentioned on the CMCHIS card or ration card number (if card is not available).

If one does not have a card, he/she needs to get enrolled by obtaining income certificate for the family from the VAO (Village Administrative Officer). The family head/member should carry the original ration card with Xerox copy, along with income certificate to the district kiosk (at the District Collector’s office).

After verification of the documents, the person will be enrolled by capturing the demographic and biometric details. The e-card is then generated and issued to the beneficiary. In many other States, there are common service centres (CSCs) set up to help the beneficiary identify his/her name in the database and print the Ayushman Scheme card.

In Tamil Nadu, since the card is issued only at the District Collector’s office, there are challenges in some of the districts.

In Chengalpattu Medical College Hospital, of Kancheepuram district, since the District Collector’s office is an hour away, patients find it difficult to get the card made in certain critical situations.

Of course, in emergency cases, there is a provision for hospitals to proceed with pre-authorisation without the card, which, when issued, can be subsequently submitted.

“Since the number of enrollment in most of the district kiosks are in single-digit, CSC opening may not help. The issue is the availability of card at the moment of need, which is being addressed through e-card,” says Selvavinayagam.

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