More Than 10 Crore Families to be Subsumed Under Ayushman Bharat

The Union Cabinet has approved the launch of a new centrally sponsored Ayushman Bharat-National Health Protection Mission (AB-NHPM) having  a central sector component under Ayushman Bharat Mission anchored in the MoHFW. The 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 the poor and vulnerable population based on the SECC database. AB-NHPM will subsume the ongoing centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

This cover will take care of almost all secondary care and most of tertiary care procedures and will ensure that nobody is left out (especially women, children, and elderly). The benefit cover will also include pre and post-hospitalization expenses. All pre-existing conditions will be covered from day one of the policy. A defined transport allowance per hospitalization will also be paid to the beneficiary. 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 empaneled hospitals across the country. AB-NHPM will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database.

To control costs, the payments for treatment will be done on package rate (to be defined by the government in advance) basis. 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 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 an insurance company or directly through a trust/society or a mixed model.