TN health insurance merges with Ayushman Bharat scheme

Chennai: With Prime Minister Narendra Modi launching the game-changing scheme – Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) – to enhance healthcare facility across the nation, the Tamilnadu government has signed a memorandum of understanding (MoU) to merge with existing Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) of the State, introduced way back in 2009 by former Chief Minister M Karunanidhi.

Since Tamilnadu already has a robust health insurance scheme that covers 1.57 crore families and gives up to Rs 5 lakh every year, per family, on a par with PMJAY scheme, the State has decided to merge the scheme with the Centre.

Explaining the scheme to ‘News Today‘, Uma Maheshwari, Project Director, Tamilnadu Health Systems Project (TNHSP), said, “In 2011, an enumeration conducted all over the country. The study covered the Socio-Economic and Caste Census (SECC) of the population based on several deprivation categories. Among the prescribed categories, six have been taken for covering the health insurance under PMJAY insurance policy. The count of SECC population comes to around 77 lakh families which have already been covered by CMCHIS policy.”

State Minister for Health and Family Welfare C Vijayabaskar, Health Secretary Dr J Radhakrishnan and Tamilnadu Health Systems Project (TNHSP), Project Director, Uma Maheshwari launching the Ayushman Bharat scheme in Chennai recently.

The CMCHIS insurance covers around 1,027 ailments, 157 diagnostic procedures and eight high-end complicated surgeries. The surgeries run to Rs 32 lakh which has been brought under the cap of Rs 5 lakh per family. In addition to government hospitals in the State, selective hospitals outside Tamilnadu also get covered in the scheme.

“Since we do not want to discriminate some by increasing the coverage, we decided to call for a merger. In addition, the Prime Minister has ordered to bring the 77 lakh-odd beneficiaries under the same Rs 5 lakh scheme which we have already been doing,” she said.

Currently, the service provider is United India Insurance Company which is authorised by the government. The State is paying a premium of Rs 699 per family, per annum. It is a four-year contract that can be extended to another year and is currently in the second year of contract.

Talking about the hybrid insurance model, Uma Maheshwari added, “A general insurance coverage is given up to Rs 2 lakh and the remainder – Rs 2-Rs 5 lakh – is covered under the assurance mode. When the bill exceeds the cap amount, the corpus fund provided by the government would be utilised to meet the need.”

KNOW ABOUT IT
Ayushman Bharat is a national health scheme that will have a defined benefit cover of Rs five lakh per family per year all over the country. The beneficiaries can enjoy the benefits of the programme from any public/private empanelled hospitals across the country.

 

77 LAKH FAMILIES TO BE COVERED
“The Centre has permitted to co-brand the Ayushman Bharat – Pradhan Mantri Jan Awas Yojana (AB-PMJAY) with the existing Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS). No fresh empanelment will be done. Around 77 lakh families will be covered under the Central scheme,” said Tamilnadu Health Secretary Dr J Radhakrishnan.

Bhavani Prabhakar