Ayushman Bharat Health Scheme to Double Insurance Cover to INR 10 Lakh

The objective is to extend coverage to serious illnesses requiring expenditures exceeding INR 5 lakh, including high-cost cancer treatments and transplants.

In a move to bolster healthcare accessibility, the government is actively working on finalising a proposal to double the annual insurance coverage under its flagship Ayushman Bharat Health Scheme from the current INR 5 lakh to INR 10 lakh per family.

According to official sources, this expansion aims to ensure comprehensive support for critical illnesses such as cancer and transplants that entail higher expenditures. An official announcement regarding this proposal is anticipated in the interim Union Budget scheduled for February 1.

This adjustment is set to take effect from the financial year 2024-25 onwards. The objective is to extend coverage to serious illnesses requiring expenditures exceeding INR 5 lakh, including high-cost cancer treatments and transplants.

Broadening the Beneficiary Base

In addition to doubling the insurance cover, the government aims to expand the beneficiary base of AB-PMJAY to 100 Cr individuals over the next three years.

The plan includes incorporating Kisan Samman Nidhi recipients, construction workers, non-coal mine workers, and ASHA workers into the scheme. This expansion is in line with the government's commitment to make healthcare accessible to a broader demographic.

The proposed increase in the annual coverage to INR 10 Lakh per family and the expansion of the beneficiary base to 100 Cr individuals would necessitate an additional allocation of INR 12,076 Cr per annum, according to official sources.

Despite the financial implications, the government is keen on fortifying AB-PMJAY to address the evolving healthcare needs of the population.

AB-PMJAY Transforming Healthcare Delivery

Since its launch in 2018, the AB-PMJAY has successfully facilitated 6.2 Cr hospital admissions, amounting to more than INR 79,157 Cr. Notably, if beneficiaries had sought the same treatment outside the scope of AB-PMJAY, the total cost of treatment would have nearly doubled.

The scheme, with a budget allocation of INR 7,200 Cr for the financial year 2023-24, is expected to witness a substantial increase to around INR 15,000 Cr in the financial year 2025.

The AB-PMJAY recently achieved a milestone by generating over 30 Cr Ayushman cards as of January 12. Uttar Pradesh leads the states with 4.83 Cr Ayushman cards, followed by Madhya Pradesh and Maharashtra at the second and third positions with 3.78 Cr and 2.39 Cr Ayushman cards, respectively. Eleven states now boast more than one crore Ayushman cardholders.

The AB-PMJAY, implemented by the National Health Authority, is also making concerted efforts to achieve gender parity, regional parity, and income parity in healthcare services.

Approximately 49% of Ayushman cards have been issued to female beneficiaries, and 48% of the treatments provided under the scheme have been availed by females. Gender equity is integral to the core design of the scheme, reflecting the government's commitment to inclusive healthcare.

The proposed enhancements to the Ayushman Bharat health scheme underscore the government's dedication to providing comprehensive and accessible healthcare to a broader section of the population.

The anticipated announcement in the interim Union Budget is expected to set the stage for a more resilient and inclusive healthcare system in India.

In another development in the insurance space, just days back, leading hospital chain Narayana Health secured approval from the Insurance Regulatory and Development Authority of India (IRDAI) to set up its wholly-owned subsidiary, Narayana Health Insurance Limited.

This regulatory nod allows the healthcare provider to diversify its operations into the health insurance sector through the subsidiary, offering integrated healthcare solutions.