New Health Insurance Scheme Soon

Kerala has moved a step closer to achieving universal health coverage by integrating the numerous health-care protection schemes in the State, including the Karunya Benevolent Fund (KBF), into a new comprehensive health insurance scheme. The new scheme, Karunya Suraksha Padhati, will replace the state’s current comprehensive health insurance scheme (RSBY-CHIS/CHIS Plus) and KBF.

Will cover services

Aligning with the center’s newly announced National Health Protection Scheme (NHPS), which offers a health protection coverage of ₹5 lakh for a BPL family, the new scheme will cover all major secondary and tertiary medical care services, including the treatment of cancer or cardiac diseases, in all empanelled public or private hospitals. Integration of the various health beneficiary schemes had been a promise made in the 2016 revised state budget presented by Finance Minister TM Thomas Isaac. At present, Kerala has at least nine beneficiary schemes.

Overlap in schemes

These schemes are run by different departments, with separate guidelines and there is considerable overlap between these schemes in terms of coverage, benefit package and delivery of services. This overlap has resulted in duplication of resources for the same schemes. “Integration of these schemes means that the state can utilise the same budgetary allocation to give better health protection for the people. All states have been given flexibility in implementing the NHPS. We are thus using the NHPS framework and its robust IT platform to integrate and monitor all existing schemes,” a senior health official said. From a patient’s perspective, he no longer need worry about which scheme or the extent of coverage he is eligible to claim. Neither does he have to run from one department to another to get his application processed. The new scheme ensures cashless hospital services at a single point delivery.

It will have a fool proof system with mechanisms for pre-authorisation of procedures, clinical audit, clear list of medical procedures and its cost, and floated on an integrated e-health platform. The center will provide the Pradhan Mantri Rashtriya Swasthya Suraksha Mission (PMRSSM) software. The government has appointed a six-member committee with D Narayana, Director, Gulati Institute of Finance and Taxation, as chairman to determine the procedures and to rationalise the costs under the NHPS. The NHPS is offering some 1350 packages, including 651 super-speciality procedures and covering 23 specialities. “The committee will now examine the packages which are fairly comprehensive and choose the best options for the state. The center-state financing of the NHPS will be in the 60:40 ratio. The committee will also work out the costs and determine the approximate financial commitment of the state for the scheme,” a senior official said. – The Hindu