If the PMC administration has its way, the existing health insurance scheme for the urban poor will be implemented by an insurance company instead of the civic administration.
The PMC launched the scheme for the urban poor in 2011 to enable them to seek medical treatment for serious ailments at private hospitals. The civic body ensured that medical bills up to Rs 1 lakh per beneficiary was paid for treatment of heart disease, cancer and kidney ailments.
Over one lakh urban poor benefited under the scheme in the last 10 years and the PMC incurred a cost of Rs 222 crore towards medical bills of eligible people. The number of beneficiaries has increased each year and a maximum 21,037 beneficiaries were added in the last financial year with the PMC incurring an expenditure of Rs 54 crore. In the first seven months of the current fiscal, the PMC spent Rs 42 crore under the scheme as 7,556 beneficiaries availed the facility.
The expenditure by the PMC on the implementation of its 10-year-old scheme for incurring medical bills for the treatment of urban poor has increased every year. It is presently implemented by the civic administration by directly paying the amount to concerned private hospitals.
A senior civic officer said, “The plan to rope in an insurance company to implement the health insurance scheme for the urban poor has come up to professionally manage the scheme. This would help reduce the expenditure and enable more beneficiaries avail the health cover for serious ailment.”
According to the civic health department staff, elected representatives interfere in the implementation of the scheme. “There is pressure on the civic staff to clear the maximum amount submitted by the private hospital,” he said, adding an insurance company implementing the scheme would manage it professionally.
“The PMC has been facing shortage of funds for implementing the scheme on its own. It has to divert budgetary funds meant for other purposes to pay the medical bills. Now, the PMC will pay the fixed annual premium to the insurance company for providing health cover to the urban poor for treatment of serious ailments,” the civic officer said.
The PMC has planned to implement the comprehensive group mediclaim insurance scheme for the urban poor, economically backward class (EBC) scheme card holders and their family members, which would provide health cover of Rs 2 lakh for each person for treatment of Covid-19 and other diseases.
Beneficiaries include the family of EBC scheme card holders. It would comprise self and five members, including spouse, first two dependent children up to age 25 and two dependent parents. The civic administration has asked the insurance company to provide separate quotes for 20,000 and 40,000 families with one lakh and two lakh lives, respectively, with a cover of Rs 2 lakh for each person. It stated that 39 per cent population is approximately up to age 35, 32 per cent between age 36 and 50 and 29 per cent above age 50.
In November, the civic administration sought an application from insurance companies to implement the Covid Suraksha Kavach scheme for incurring medical expenditure of the urban poor being hospitalised for treatment. The PMC did not receive a good response to the proposal as only one insurance company submitted a proposal despite an extension of the deadline for accepting applications. Some objections were raised by corporators of the opposition party citing that the peak in the viral infection was over and the urban poor were the worst affected in the initial phase of the pandemic. Thus, implementing the health insurance scheme for Covid-19 treatment for the urban poor would not yield results and instead would be a financial loss to the civic body.
“The Covid-19 outbreak has slowed down in the civic jurisdiction and it was realised that the health insurance cover only for its treatment would not be feasible. Thus, it has been decided to club other health insurance schemes implemented by the PMC for the urban poor,” the civic officer said.
The officer added, “The insurance companies have been asked to submit their proposal to implement the comprehensive group mediclaim insurance scheme that would cover Covid-19 and other diseases for the economically backward card holders and their family members.”
The civic administration is in the process of appointing an insurance broker as “strategic consultant” for implementing insurance schemes of the civic body. The officer said the two plans were different to appointing an insurance broker as a consultant and a comprehensive group mediclaim. “The process for appointing consultants is on. The PMC has received some proposals for the responsibility of a strategic consultant,” he said, adding that the insurance broker would oversee the strategic conceptualisation and initialisation of the yearly insurance programme that would include property, health, accidental, projects, liabilities and events.
The PMC has health insurance schemes for retired as well as serving employees and their families, former and sitting corporators and their families, accidental insurance scheme for regular property taxpayers in the civic jurisdiction and health insurance scheme for the urban poor.
The opposition NCP and Congress in the civic body has opposed the PMC move to appoint an insurance broker as consultant to implement insurance schemes of the civic body.
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