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Ayushman cards can be used for state schemes
Context
The Centre recently announced a plan to create a unified card that can be used to avail benefits of both the central government-run Ayushman Bharat-PMJAY as well as the health insurance schemes run by state governments individually.
About
- The move was meant to ease confusion for citizens between which schemes apply to them. According to the health ministry, close to 20 schemes are being currently run by several states.
- It will be a unified card that will be called Ayushman Card.
- The government is in the process of generating new cards that will have both the central and state government logos, and ‘Ayushman Bharat Pradhan Mantri Jan Arogya Yojna-MukhyaMantri Yojna’ imprinted on it to suggest the unification.
- As part of the new arrangement, eligible beneficiaries of any of the government insurance schemes will be able to get coverage at any of the 25,000 empanelled hospitals under the central scheme.
- Even though it is not legally mandatory for states to implement the changes, all states, except Delhi, Odisha, and West Bengal, have agreed to adopt it.
Ayushman Bharat programme:
- The Ayushman Bharat programme was launched in the year 2018.
- The prime concern of this program was to address health issues at all three levels – primary, secondary, and tertiary. This program has two components:
- Pradhan Mantri Jan ArogyaYojana (PM-JAY), which was earlier known as the National Health Protection Scheme (NHPS)
- Health and Wellness Centres (HWCs)
- PM Jan Arogya Yojana beneficiaries get an e-card that can be used to avail services at an empanelled hospital, public or private, anywhere in the country. With it, you can walk into a hospital and obtain cashless treatment.
Salient Features
- Ayushman Bharat - National Health Protection Mission will have a defined benefit cover of Rs. 5 lakh per family per year.
- 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 empanelled hospitals across the country.
- Ayushman Bharat - National Health Protection Mission will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database.
- The beneficiaries can avail benefits in both public and empanelled private facilities.
- To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis.
- One of the core principles of Ayushman Bharat - National Health Protection Mission is to co-operative federalism and flexibility to states.
- For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister.
- States would need to have State Health Agency (SHA) to implement the scheme.
- To ensure that the funds reach SHA on time, the transfer of funds from Central Government through Ayushman Bharat - National Health Protection Mission to State Health Agencies may be done through an escrow account directly.
- In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction.
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