The Maharashtra government will soon invite tenders for a Rs 2000-crore contract to select an insurance company to manage the state-sponsored universal health insurance scheme called Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY). This is the largest such tender in the country. MJPAY is a mixed model. The state government identifies beneficiaries, decides on coverage, package rates, empanels hospitals and then calls for tenders to select insurance company to run the scheme. The government funds the scheme, and the insurer who quotes the lowest premium is awarded the contract. Currently, National Insurance Company is providing insurance for MJPJAY at Rs 690 per family. “It’s largest contract in health insurance awarded by a state; in a few days we will come out with the tender,” said Sudhakar Shinde, CEO of MJPJAY. Shinde said since inception, the state government has spent around Rs 5000 crore on premiums and 52 lakh people benefited. Launched in 2012 as Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY), the scheme was renamed in April 2017 to Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY). The scheme provides medical coverage of up to Rs 150,000 per family per year on cashless basis. Around 2.25 crore families or 90 percent of Maharashtra population with orange and yellow ration cards are eligible for the scheme that covers around 971 medical procedures.
Shinde said he is happy with National Insurance Company in terms of settling claims, but the volumes are expected to grow as they expand procedures, empanel more hospitals and more people become aware of the scheme. Most states including Maharashtra are integrating Ayushman Bharat with their state-level schemes for common beneficiaries, while for beneficiaries outside the purview of Ayushman Bharat, the states are continuing to extend their existing schemes. National Insurance Company earlier this year got the Ayushman Bharat account of Maharashtra, for a premium of Rs 640 per family per year. Ayushman Bharat covers around 83 lakh families or 37 percent of families currently covered by Maharashtra government under MJPJAY. Sources told Moneycontrol that Maharashtra may see both public sector as well as private companies taking part in the tender. “The claims experience has been benign with no major losses. Loss ratios are said in the range of 100-105 percent which is much better than the other health insurance schemes. This means that for every Rs 100 collected as premium, Rs 100-105 is paid out as claims,” said a senior official. – Money Control