Ayushman Bharat, touted as world’s largest health insurance scheme, may not be able to bring in big business for the domestic insurers. With most state governments bypassing the local insurance companies and establishing trusts to implement the mission, the insurance firms are failing to bag any substantial share from the National Health Protection Mission (NHPM), George Mathew writes in The Indian Express. Prime Minister Narendra Modi on Wednesday announced the launch of Ayushman Bharat (now Jan Arogya Abhiyan) on September 25 from the ramparts of Red Fort on the occasion of India’s 72nd Independence Day.
The scheme offers Rs 5 lakh free health cover to 10 crore poor families. The country’s insurers are failing to bag a significant pie because of the way bidding is being done and insurance model is being selected by different states, he writes.
NHPM was earlier expected to bring in large amount of business for the insurance industry. However, the industry is now in a worry as state governments are preferring the trust model, George Mathew writes citing an unidentified source from an insurance company.
As per sources, out of the 26 states which signed MoUs with the government for participating in the insurance scheme, only four namely Jharkhand, Nagaland, Manipur and West Bengal own the normal insurance model, he writes further.
Under the trust-based model, each state will form its own trust to look after the insurance scheme and claims get paid out from a corpus created from Central and state government contributions at a ratio of 60:40.
It will through the help of Third Party Administrators (TPAs) the claims made will be settled. In pure insurance model, insurance firms handle the cover which also includes claims. The hybrid model is a combination of both insurance and trust models. The states of Gujarat and Chhattisgarh have chosen for the hybrid model.