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The Union Cabinet on Wednesday approved the launch of ‘Ayushman Bharat — National Health Protection Mission’ (AB-NHPM).
This scheme has the benefit cover of ₹5 lakh per family per year. The target beneficiaries of the proposed scheme will be more than 10 crore families belonging to poor and vulnerable population based on SECC database.
The Union Cabinet also approved the continuation of the National Health Mission with effect from April 1, 2017 to March 31, 2020 with a budgetary support of ₹85,217 crore as Central share over this period.
It also gave its approval for moving official amendments in the ‘Surrogacy (Regulation) Bill, 2016’, an official release said.
This Bill proposes to regulate surrogacy in India by establishing National Surrogacy Board at the central level and State Surrogacy Boards and Appropriate Authorities in the States and Union Territories.
Meanwhile, AB-NHPM will subsume the on-going centrally sponsored schemes — Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS), the release added.
Salient features
The ₹5 lakh per family a year cover will take care of almost all secondary care and most of tertiary care procedures. To ensure that nobody is left out (especially women, children and elderly) 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 hospitalisation will also be paid to the beneficiary.
Also, benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospital across the country.
AB-NHPM will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database.
The different categories in rural area include families having only one room with kucha walls and kucha roof; families having no adult member between age 16 and 59; female-headed households with no adult male member between age 16 and 59; disabled member and no able bodied adult member in the family; SC/ST households; and landless households deriving major part of their income from manual casual labour,
Also, automatically included are families in rural areas having any one of the following: households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups, legally released bonded labour. For urban areas, 11 defined occupational categories are entitled under the scheme.
Public and private
The beneficiaries can make use of benefits in both public and empanelled private facilities. All public hospitals in the States implementing AB-NHPM, will be deemed empanelled for the Scheme. Hospitals belonging to Employee State Insurance Corporation (ESIC) may also be empanelled based on the bed occupancy ratio parameter.
As for private hospitals, they will be empanelled online based on defined criteria.
Package rate
To control costs, the payments for treatment will be done on package rate (to be defined by the government in advance) basis. The package rates will include all the costs associated with treatment. For beneficiaries, it will be a cashless, paper-less transaction. Keeping in view the State specific requirements, States/ UTs will have the flexibility to modify these rates within a limited bandwidth.
One of the core principles of AB-NHPM is co-operative federalism and give flexibility to States. There is provision to partner the States through co-alliance. This will ensure appropriate integration with the existing health insurance/ protection schemes of various Central Ministries/Departments and State Governments (at their own cost), State governments will be allowed to expand AB-NHPM both horizontally and vertically. States will be free to choose the modalities for implementation.
They can implement through insurance company or directly through Trust/ Society or a mixed model, the release added.
Expenditure
The expenditure incurred in premium payment will be shared between Central and State Governments in specified ratio as per Ministry of Finance guidelines in vogue.
The total expenditure will depend on actual market determined premium paid in States/UTs where AB-NHPM will be implemented through insurance companies.
In States/UTs where the scheme will be implemented in Trust/Society mode, the Central share of funds will be provided based on actual expenditure or premium ceiling (whichever is lower) in the pre-determined ratio.
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