NEW DELHI: The Union cabinet on Wednesday approved the ambitious government’s plan to cover hospitalisation expenses of up to Rs 5 lakh per family per year, outlining the eligibility criteria which said that even pre-existing diseases will be covered from day one.
The cabinet chaired by Prime Minister Narendra Modi approved the Ayushman Bharat National Health Protection Mission (AB-NHPM) that aims to provide health insurance to about 10.7 crore families which will be from poor and vulnerable populations.
The AB-NHPM is intended to address concerns that in-patient hospitalization expenses in India have increased 300 percent over the past 10 years and nearly 80 percent of this expenditure comes from household’s personal, or out-of-pocket spending.
The government is hoping that the NHPM will significantly reduce out-of-pocket spending on health by providing the Rs 5 lakh cover to nearly 40 percent of the population paying for almost all diseases requiring secondary and tertiary care.
“To ensure nobody is left out, there will be no cap on family size and age in the scheme,” the government said today in a press release on the cabinet decision. “The benefit cover will also include pre- and post-hospitalisation expenses. All pre-existing conditions will be covered from day one of the policy. A defined transport allowance per hospitalization will also be paid to the beneficiary.”
Under the scheme, famillies may seek hospitalization services from public and private hospitals anywhere in the country empanelled by the government.
The eligibility critieria will depend on households’ deprivation levels. In rural areas, for instance, families with only one room with “kucha walls and kucha roofs,” families with no adult members between ages 16 to 59, female-headed households with no adult male member between 16 and 59, household with no able-bodied adult members, Scheduled Caste and Scheduled Tribe households, and landless households that derive most of their income from manual casual labour will be covered.
In urban areas, families in 11 occupation categories will be covered in the scheme, the note said without listing these occupations. Households without shelter, destitutes and those living on alms, manual scavenger families and primitive tribal groups will also be covered in rural areas.