Centre looks to expand Ayushman Bharat reach by reducing premium

The Union government is considering expanding coverage of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, its health insurance scheme, and offer it at a nominal premium to new beneficiaries, officials in the health ministry familiar with the matter said.

The scheme, launched by Prime Minister Narendra Modi in 2018, is currently applicable to poor and vulnerable groups and provides an insurance cover of ₹5 lakh to 107.4 million families.

“We are in the process of further strengthening the scheme to be able to benefit all those who are in need of it. It is being strongly considered whether to extend the facility at a nominal premium to those who can pay, which would be over and above the current list of identified beneficiaries,” a senior government functionary said on condition of anonymity.

“The missing middle income group, which is neither rich nor poor and perhaps not covered under any health insurance scheme, is a considerable chunk and needs attention. Further changes are being envisaged,” the official added.

The scheme currently covers those under the poor and vulnerable category who are identified using the socio-economic caste census (SECC) and Rashtriya Swasthya Bima Yojana (RSBY) database.

The premium of the health insurance currently stands at around ₹1,200 – ₹1,300 and borne by the central and state governments in a 60:40 ratio, officials said.

“There are people earning ₹1,00,000 a year, and also those earning ₹10,00,000 a year, and if you look closely, the latter may be earning more but may not be able to afford all medical expenses. Therefore, we need to expand the list of beneficiaries and this plan is being seriously considered,” the official said.

The official also pointed at how benefits under the scheme was recently extended to members of the transgender community.

Currently, close to 28,000 hospitals across the country are part of the Centre’s scheme.

As part of its expansion plans, the government has already begun empanelling more private and public hospitals to provide cashless treatment, the official said.

The National Health Authority, the apex body that looks after the implementation of the scheme, has created at least 1,600 packages for speciality and super-speciality treatment. These packages are revised on a regular basis, keeping in mind latest demands and increasing cost of healthcare delivery.

Last year, the NHA had revised the beneficiary packages of around 400 procedures under the scheme and included surgical treatment for mucormycosis that grew in numbers during the second Covid-19 surge.

The revised packages, however, witnessed an increase in rates by 20 to 40% to meet market standards.

Certain packages to include procedures such as sex reassignment surgery were also drafted last month, taking into consideration the transgender population after it was included as beneficiaries under the scheme.

Among nearly 1,670 treatment procedures, about 1,080 are surgical and 588 medical.

“There is a major chunk, I think about 60% of the population, that doesn’t fall under the Ayushman Bharat category and accessing private insurance isn’t easy for everyone. Therefore, the government’s idea will be a good step,” Dr KK Talwar, former director, PGI-Chandigarh, said.

“The other thing that I believe they should work on is revising rates as prices have gone up sharply over the past year or so,” Talwar added.