The state government is set to sign a memorandum of understanding (MoU) with the Centre within a week, assuring that it will implement the National Health Protection Scheme (NHPS) across Maharashtra, benefiting over 83 lakh people with a medical cover of Rs 5 lakh.
Maharashtra, however, will not surface in the first list of 10 states that are implementing the scheme. Officials said that with the scheme set to incur a huge financial burden on the state, the government would now assess whether it can implement a hybrid insurance model or needs to opt for a trust model for the beneficiaries.
The Union Health Ministry has capped the insurance premium at Rs 1,000 per family for the first year, and split the cost in a 60:40 ratio with the state government. State health department officials, however, said that among the quotations invited from four public sector undertakings in 2017, the lowest bid received was Rs 1,796. “In such a case, the state will have to pay a higher premium than the Centre,” an official said.
In case the hybrid model is followed, the state government will merge the existing Mahatma Jyotiba Phule Jan Arogya Yojana with the NHPS. While the premium will be high, the entire cost will be covered by the insurance company. In the trust model, where officials claim medical coverage beyond Rs 1.5 lakh will be covered through a trust, high premium cost will be avoided but risk will remain with the state. “Trust model will also require intense monitoring,” an official said.
So far, Andhra Pradesh, Telangana, Goa and Gujarat have experimented with the trust model in insurance schemes.
Health officials said premium in each state will vary. “In Nagaland, the number of patients benefiting will be less. Maharashtra has greater awareness and a larger beneficiary pool,” an official said. The Nagaland government pays a premium of Rs 444 per family under the scheme.
Sudhakar Shinde, the CEO of Mahatma Jyotiba Phule Arogya Yojana, said Maharashtra’s current health insurance scheme costs the government Rs 1,500 crore with an annual premium of Rs 690. “So far, we have agreed to implement the NHPS. The details of how we will implement it are yet to be worked out,” said Principal Secretary (Health) Dr Pradeep Vyas.
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