The first meeting of the governing body of the newly constituted National Health Authority (NHA), tasked with the implementation of the ambitious Pradhan Mantri Jan Arogya Yojana (PMJAY), will take place on March 16. On its agenda is the fixation of ceiling rates for the premium of the health insurance programme that offers an annual cover of Rs 5 lakh per family per year.
NHA is proposing a ceiling rate of Rs 1,052. The Cabinet approval for PMJAY, in March last year, clearly mandated that ceiling rate fixation would need to happen. That was the remit of the Ayushman Bharat National Health Protection Mission Council – replaced last month by the NHA Board – that has met only once since PMJAY got Cabinet approval.
In that meeting too, the NHA had proposed Rs 1,052 as the ceiling rate. Without the ceiling rate being fixed, the potential costs of the scheme seem to be headed far more northwards than originally estimated.
The governing board of the NHA is chaired by the Minister for Health and Family Welfare and has among its members the CEO of Niti Aayog, Expenditure Secretary, the CEO of NHA, Health Secretary, domain experts and five principal secretaries (Health) of different State governments.
Data available with The Indian Express shows that the current premium rates in many states are over the Rs 1,052 mark – even when the insurance amount is much less and the rest is covered through an assurance model. Till now just about 2.32 crore of the 10.74 crore targetted families have been given PMJAY beneficiary cards for the scheme.
Tertiary care programmes traditionally have a tendency of overshooting budgets, as had happened with the Aarogyashri scheme in Andhra Pradesh.
In Chhattisgarh, the premium for Rs 50,000 insurance quoted by Religare Health Insurance is Rs 1,100 per year per family. The rest of the amount will be disbursed through a trust.
The Centre and State governments contribute to the scheme in a ratio of 60:40. For trust mode implementation, the NHA pays its ceiling price while the state health authority pays the rest. For now Rs 1,052 is being treated as an “unofficial” ceiling.
In Daman & Diu and Dadra & Nagar Haveli, Oriental Insurance quoted Rs 1,712 per family per year. In Meghalaya, Reliance General Insurance quoted Rs 1,630 and in Mizoram, Bajaj Alliance quoted Rs 1396.
In Tamil Nadu, United India Assurance quoted Rs 699 premium for a cover of Rs 2 lakh. In West Bengal, Bajaj Alliance and Iffco Tokio quoted Rs 690 for a cover of Rs 1.5 lakh.
As the number of people covered in the scheme goes up, premium rates would come down but as usage goes up with awareness and more registrations, there will be a countervailing effect.