Ayushman Bharat-National Health Protection Mission (AB-NHPM) – UPSC Prelims

Ministry/Department :  Ministry of Health and Family Welfare
Scheme:
  • It is Centrally Sponsored health insurance scheme.
  • The scheme will integrate two on-going centrally sponsored schemes viz. Rashtriya Swasthya Bima Yojana (RSBY) and Senior Citizen Health Insurance Scheme (SCHIS).
  • AB-NHPM aims to target over 10 crore families belonging to poor and vulnerable population based on Socio Economic and Caste Census 2011 (SECC) database.
  • It will provide cover of Rs 5 lakh per family per year, taking care of almost all secondary care and tertiary care procedures.
  • There will be no cap on family size and age in the scheme.
  • Benefit cover:¬†
    • It includes pre and post-hospitalisation expenses.
    • It will cover all pre-existing conditions from beginning of the policy.
    • It will also pay defined transport allowance per hospitalization to the beneficiary.
  • Cashless benefits:
    • The scheme allows the beneficiary to take cashless benefits from any public or private empanelled hospitals across the country.
    • The payment for treatment will be done on package rate which will be defined by Government in advance basis.
    • The package rates will include all the costs associated with treatment.
  • Role of state governments:
    • They will be allowed to expand the scheme both horizontally and vertically.
    • They will be free to choose modalities for implementation.
    • They can implement through insurance company or directly through Trust/ Society or a mixed model.
  • Implementation:
    • States/UTs will have also flexibility to modify these rates within limited bandwidth.
    • For beneficiaries, it will be cashless and paper less transaction.
    • States will be required to form State Health Agency (SHA) to implement scheme and at district level also, a structure for implementation of the scheme will be set up
  • Council:
    • For giving policy directions and fostering coordination between Centre and States, Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) will be set up at apex level.
    • It will be chaired by Union Health and Family Welfare Minister.
  • Entitlement:¬†
    • It is entitlement based scheme with entitlement decided on basis of deprivation criteria in SECC database.
    • Different categories of families covered under scheme are
      • Families having only one room with kucha walls and kucha roof,
      • families having no adult member between age 16 to 59,
      • female headed households with no adult male member between age 16 to 59,
      • disabled member and no able bodied adult member in family,
      • SC/ST households,
      • landless households deriving major part of their income from manual casual labour.
    • It will also automatically include families in rural areas having any one of the following-
      • households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups or legally released bonded labour.
    • For urban areas, 11 defined occupational categories will be entitled under scheme.

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