Journalism of Courage
Three months after the launch of Pradhan Mantri Jan Arogya Yojana (PMJAY) or Ayushman Bharat scheme in the state, the Maharashtra government is now set to enrol private hospitals in the cashless health scheme.
As many as 1,100 private hospitals, including 30-bedded nursing homes, from across the state have been waitlisted under the Ayushman Bharat programme. The programme already has 79 government hospitals empanelled in the state, in addition to the 500 hospitals enrolled under its state health insurance scheme — Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY).
Officials said a fresh list of hospitals wanting to enrol in the Ayushman Bharat has been submitted to the state government.
The scheme, launched in September 2018, covers 83 lakh beneficiaries and provides cover for 1,300 medical procedures with a cap of Rs 5 lakh. Till now, over 2,500 procedures have been conducted.
With the current tenders for MJPJAY about to end for the existing state health insurance scheme in January, the government plans to call fresh tenders quoting Rs 640 from insurance companies per family, a reduction from Rs 690 per family in current tender. “We will save Rs 100 crore annually by reduction in premium cost,” said Dr Sudhakar Shinde, CEO of MJPJAY.
State officials said that if insurance companies agree with the new rates, a hybrid model would be used to run PMJAY and MJPJAY. Maharashtra follows the hybrid model, a combination of insurance and trust scheme, to run the latest scheme, on the lines of Gujarat and Chhattisgarh governments. While treatment cost up to Rs 1.5 lakh is covered under the insurance model, the cost escalating beyond Rs 1.5 lakh is covered under the trust model.
“If we get insurance premium at our rates, we will continue with the hybrid model. Negotiation is on,” Shinde added.
The Niti Aayog has fixed insurance premium of Rs 1,032 per family under Ayushman Bharat.
