Union Cabinet Approves Ayushman Bharat – National Health Protection Scheme

Published Date - 22 March 2018 12:30:10 Updated Date - 15 April 2018 02:13:51

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).

The two key initiatives of Ayushman Bharat are the implementation of the National Health Protection Scheme (NHPS), which offers insurance cover of Rs 5 lakh to every vulnerable family, and strengthening of the country’s primary healthcare delivery system. Over 10 crore families and 50 crore people are expected to benefit. Beneficiaries will be able to avail of cashless service at any government or private empanelled hospital across the country. There is no cap on family size, and nobody will be denied benefits in the absence of an Aadhaar number.

Beneficiaries will be allowed to take cashless benefits from any Public / Private empanelled hospitals. Central govt. will provide payment on Package Rate basis. Package Rates will include all the costs associated with treatment. It will be a cashless, paperless transaction for beneficiaries.

The target beneficiaries of the proposed scheme will be more than 10 crore families belonging to poor and vulnerable population based on Socio Economic Caste Census Data 2011.

 

Ayushman Bharat National Health Protection Mission (AB-NHPM)

The important features and highlights of Ayushman Bharat Programme are as follows:-

  • To ensure that nobody is left out, there will be no cap on the family size and age in this scheme.
  • The benefit cover will also include pre and post-hospitalization benefits.
  • AB-NHPM will have a defined benefit cover of Rs. 5 Lakh per year per household.
  • NHPS benefits are portable across the country.
  • Beneficiaries can avail benefits in both Public and Private empanelled facilities.
  • Under this Ayushman Bharat Scheme, govt. will make payment for treatment on “Package Rate Basis”.
  • All the treatment cost will get included in Package Rates.
 

Ayushman Bharat Scheme is a Mega Health Insurance Scheme which will cover 10 crore families which includes around 50 crore people.

 

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.

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Empanelled Hospitals

• 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 casual labour through a mixed model.
• 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.

Empanelled Hospitals

• 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.een 2008–12 and 2013–17


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.

AB-NHPM Implementation

Cabinet Committee has made the following decisions to successfully implement the Ayushman Bharat Scheme.

  1. One of the core principles of AB-NHPM is Co-operative Federalism and Flexibility to states. There is a provision to partner the states through co-alliance.
  2. Under AB-NHPM, states will be free to choose the modalities for implementation. States can implement through Insurance Company or directly through Trust / Society or a Mixed Model.
  3. For giving policy directions and fostering coordination between Centre and States, cabinet committee proposed to setup Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level chaired by Union Health and Family Welfare Minister.
  4. State would need to have State Health Agency (SHA) to implement the scheme.
  5. In partnership with NITI Aayog, a robust, modular, scalable and Inter-operable IT Platform will become operational which will entail a paperless and cashless transaction.
 

State / Districts Covered under AB-NHPM

AB-NHPM will get rolled out in all States / UTs in all districts with an objective to cover all targeted beneficiaries. NHPS Council will cooperate with various central government ministeries and State / UT governments who have already launched their own Health Protection Schemes for their own defined set of beneficiaries. There is a critical need to converge these schemes to achieve improved efficiency, reach and coverage.

Commission for OBC categorization

The Cabinet also approved the second and final extension of the term of the commission constituted to examine the issue of sub-categoriation of Other Backward Classes in Central List. The commission has been granted an extension up to June 20.

Other Major Cabinet Decisions

— Cabinet Committee approves moving amendments in the “Surrogacy (Regulation) Bill, 2016”. This bill proposes to regulate surrogacy through establishment of National Surrogacy Board at the central level and State Surrogacy Board / Authorities in States / UTs. This bill prohibits commercial surrogacy but allows surrogacy for the needy infertile couples.
— Cabinet Committee also approves the inclusion of Parivara and Talavara Communities in the List of Scheduled Tribes (ST) in Karnataka.
— The other decision was to approve the North East Industrial Development Scheme (NEIDS), 2017 with an outlay of Rs. 3000 crore till March 2020.
— Moreover, govt. will continue Rashtriya Uchchatar Shiksha Abhiyan (RUSA) Till March 2020.
— Cabinet Committee has also approved “Integrated Scheme for Development of Silk Industry” for the next 3 years (2017-2020).
— Central Govt. also approves the Revision of Energy Norms under the New Urea Policy.
— Furthermore, Cabinet Committee also approves revision of agreement between India and Qatar for the avoidance of Double Taxation and for the prevention of Fiscal evasionwith respect to taxes on income.

 


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