Aam Aadmi Swasthya Bima Yojana – A Universal Health Insurance Scheme by Delhi Government,To Cover 40 lakh Families

Published Date - 06 September 2017 01:04:54

The Delhi government is launching a universal health insurance scheme that will cover an estimated 40 lakh families in the capital, for four years in its first stage.

The Health Department has opened a Request For Qualification (RFQ) to shortlist insurance companies who can bid for the scheme till end of May, in the first stage of screening.

Titled the Aam Aadmi Swasthya Bima Yojana, the scheme will be open to families below an income group that have not been specified in the RFQ.

According to the terms, families above the threshold income level can also apply for the scheme, if they can pay the premium which the government will be covering for all families below this income level.

“The scheme will cover treatment in identified empanelled hospitals, which will include all government hospitals, and some identified private centres. We estimate at least 1,700 packages of hospitalisation during the contract with the government,” a senior health official explained.

A senior health department official said the coverage of the number of families and the estimated packages can, however, be revised later.

The project was conceived by the Delhi Dialogue Commission (DDC), a policy think tank associated with the Delhi government. The proposal for this wider insurance scheme was suggested by the DDC keeping in view the gap in coverage of existing treatment support provisions like the Delhi Arogya Nidhi and the Rashtria Swasthya Bima Yojana.

Officials said a “token premium” may be charged from beneficiaries below the threshold income. According to officials, the project is estimated to cost around Rs 500 crore annually.

The companies which apply for the initial screening for the project, will have to identify the packages they can cover.

“We are looking at coverage for diseases like cancer and neurological diseases, cardiac problems or organ transplants which are cost intensive and often complete treatment cannot be met under existing health insurance schemes,” the health department official said.

Officials said they were also looking at expanding the ambit of treatment to tertiary level private hospitals.

“We are waiting for the kind of packages that companies mention in their proposal. But we are looking at coverage at an economy-level ward for diseases that existing government health coverage schemes do not meet,” the official said. Sources said the government was looking at provision of cashless treatment for identified beneficiaries.

 According to the RFQ,after the first stage, around six companies will be shortlisted, who will have to bid in the second stage of the program.

Features of the Scheme

  • Families belonging to a low-income group will be provided medical facilities at nominal cost under the Scheme.
  • About 40 lakh families are to be benefitted under the scheme.
  • About Rs, 500 crores have been allocated for the scheme.
  • Public, as well as private hospital, will provide health services under the scheme.
  • About 1,700 hospitalization packages have been created under the scheme.
  • The first phase of the scheme is to be for 4 years and about six insurance companies will join the mission. In the 2nd phase, more companies will be added to it.
  • The scheme will provide free health insurance to the poor whose family income is below the threshold. Others whose family income is above the threshold limit also can join it, but they will have to some premium as decided by the government.

Coverage under the Aam Admi Swasthya Bima Yojana

Under the scheme, treatment will be provided at all government hospitals as well as private hospitals listed under the scheme. The health insurance scheme is aimed to help those not covered under the already existing health insurance schemes such as Delhi Arogya Nidhi and Rashtria Swasthya Bima Yojana.
Medical treatment under the scheme will cover several diseases such as cancer, cardiac issues, organ transplants, neurological problems etc. Treatment for such diseases are very costly and out of the reach of the poor if no assistance is provided.
The government state government is to provide assistance of up to Rs 50,000 for the treatment of secondary diseases; whereas Rs 4 lakh is to be provided for treatment of critical illnesses.

Aam Admi Swasthya Bima Yojana, is implemented well, can be a great relief to the poor. They can get medical treatment for secondary diseases as well as a critical illness; which otherwise they can’t think of.


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