Modicare: Government to let market decide NHPS rate

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New Delhi | Published: July 3, 2018 5:59:29 AM

To be rolled out from August 15, the scheme would provide 10 crore families a free healthcare policy of Rs 5 lakh/annum.

health, health sector, health industryThe Centre’s model tender document for empanelment of insurance companies under the NHPS have invited criticisms for not putting in a mechanism to equitably share both the profits as well as the burdens.

Whatever the cost of the ambitious National Health Protection Scheme (NHPS), the government is committed to bear it, NITI Aayog member Vinod K Paul said on Monday. To be rolled out from August 15, the scheme would provide 10 crore families a free healthcare policy of Rs 5 lakh/annum.

Even though the NITI Aayog had estimated an annual cost of Rs10,000-12,000 crore for the scheme (Rs1,000-1,200 per family) to be shared between the Centre and state governments at 6:4 ratio, many analysts had predicted the premium burden on the government to be roughly twice that. Paul said the scheme’s actual cost could be known only after insurers are awarded contracts to run the scheme through competitive bidding.

Speaking at the Express Group’s Idea Exchange programme, Paul said of the 25 states that have so far come on board for the scheme, about half have opted for the ‘insurance model’ while others have chosen a ‘trust model’.

In the trust model, the claims would be settled from a corpus created from the contributions from the Centre and the state concerned. Many states including Karnataka currently run healthcare schemes under the trust model.

The Centre’s model tender document for empanelment of insurance companies under the NHPS have invited criticisms for not putting in a mechanism to equitably share both the profits as well as the burdens. According to a clawback policy, insurers would have to refund premiums to the government if claims ratio is less than 100%. However, if the claims ratio exceeds 120%, the excess amount will be equally shared by the insurance company and the state government.

Paul defended the mechanism as a means to prevent cartelisation and frauds by various stakeholders in the scheme. “Globally, 8-9% cost is lost to fraud in similar schemes,” he said. The government, he said, was mindful of the issues and would take remedial measures based on experience.

Haryana, which has opted for insurance model, has already invited bids from insurance companies to provide health insurance coverage for secondary and tertiary treatments for 40-45 lakh families, nearly 98% of the families in the state. Of these, the Centre/state would provide full premium contributions for the 15 lakh families identified under the Socio Economic Caste Census (SECC) 2011. The remaining families to be covered under the scheme will have to share a part of the cost.

While Odisha has opted out of the NHPS and is implementing a similar scheme on its own, the Centre is in talks with other states including West Bengal that have yet not committed themselves to the scheme.

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