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The Centre’s ambitious Ayushman Bharat scheme to provide a ₹5-lakh health cover to 10 crore families is likely to be rolled out from October, with efforts to ensure that both insurers and customers get reasonable rates.
The government is understood to have assured insurers that the scheme will be a tender-driven process, allowing them to quote a premium based on past experience and sickness rates in each State.
“The price will vary from State to State depending on the experience of the State. There will not be a cap; it will be a tender-driven process,” said a senior official with a general insurer, adding that since the size of the scheme is large, it would be difficult for insurers to face heavy losses.
“For instance, the Pradhan Mantri Suraksha Bima Yojana is a small scheme. So, even if there is under-pricing and the loss ratio is about 200 per cent, we are not affected by it,” he said, pointing out that Ayushman Bharat, given its scale, will have to be properly priced.
An executive with another general insurer also noted that reasonable pricing will ensure that the scheme is managed efficiently and does not lead to lapses or delays.
Sources said that while the government is also on board, the focus will still be to ensure that the premium rate does not exceed ₹1,000-₹1,100 (per family of five) annually. “It will have to be a market-driven process,” said the government source.
Insurers also said that most States have shown a keenness for the insurance model, rather than the trust model, as it would mean easier administration of the scheme.
“The tender document is being finalised. States will issue the tender for either the whole State or clusters in the State, and whoever gives the best bid will be selected,” said the executive from the first insurer.
Date of implementation
Indications are that the national health insurance scheme is likely to be formally announced on August 15 by Prime Minister Narendra Modi but will be operationalised from October.
“Preparations are on but there is a lot of work that still needs to be done before it can be implemented,” noted the insurance executive.
Twenty States have already signed a memorandum of understanding with the Union Ministry of Health and Family Welfare to implement the scheme.
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