New Delhi (India), March 15 (ANI): Only four states, including Tamil Nadu and Jharkhand, are implementing the Ayushman Bharat scheme through public-sector insurance companies, sources said.
Instead, a few states are engaging private sector insurance companies while most have set up trusts to run the Pradhan Mantri Jan Arogya Yojana (AB PMJAY), the government’s flagship health insurance scheme.
The remaining have opted for the Hybrid model (a combination of insurance model and trust model).
As per the data assessed by ANI, three states are running the scheme on the insurance model and six on the hybrid model.
Out of these nine states, only four, namely–Tamil Nadu, Maharashtra, Rajasthan and Jharkhand, have opted for public-sector general insurance companies.
Since the launch of the AB-PMJAY in September 2018, states have been given the flexibility to adopt trust, insurance, or a combination of both, termed the Hybrid mode of implementation. States can also modify their implementation models over time based on their specific requirements and experiences.
When asked about the involvement of public insurance companies in the scheme, sources at the finance ministry said that public sector general insurance companies are “very actively” participating in the scheme.
“The Public Sector General Insurance Companies are running PMJAY in 4 states out of 9 who have opted for insurance model or hybrid model, so it is evident that the PSGICs are very actively participating in the PMJAY,” the sources told ANI.
The sources also explained that when states opt for an insurance model, insurance companies are emboldened in return for a fixed premium per beneficiary family unit covered after the due tendering process.
“As such, all insurance companies compete in the tender process as per their pricing mechanism and other considerations. The contract between State Health Agencies (SHAs) and Insurance companies ensures that undue profits are not made by keeping a cap on administrative costs and requiring the return of unspent balances to the SHAs,” the sources clarified.
Uttar Pradesh, Haryana and Himachal Pradesh are among the statements that have opted for a trust model, where a dedicated trust or society is set up to manage the scheme.
The trust directly reimburses hospitals for the treatment provided to beneficiaries.
Ayushman Bharat Pradhan Mantri – Jan Arogya Yojana (AB PM-JAY) crossed the milestone of 30 crore Ayushman cards on January 12, 2024, the government of India said.
The flagship scheme being implemented by the National Health Authority (NHA) aims to provide health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalisation to 12 Crore beneficiary families. (ANI)
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