Apollo Munich Health Insurance Company Limited has made the lowest bid for Ayushman Bharat-National Health Protection Mission (AB-NHPM) for the state of Nagaland at Rs 444 per family. While Bajaj Allianz General Insurance was second lowest bidder at Rs 506, it is likely that Apollo Munich will handle the health scheme for the state of Nagaland.
Interestingly, Rajasthan’s Bhamashah health insurance scheme appears to have had an impact on the bidding with leading PSU insurers either staying away or bidding much higher premium amounts for the Rs 5 lakh of cover promised under the NHPS. New India, the insurer for Bhamashah, did not submit a financial bid while National Insurance bid Rs 1,944 per family and United India Rs 1,944. Reliance General Insurance and Religare Health Insurance Company Ltd had bid for Rs 1,020 and 1,060 per family respectively.
In the case of Rajasthan, as FE has reported earlier, high claims ensured the premiums rose from Rs 370 in the first two years of the scheme to Rs 1,263 when the contract was renewed for another two years. Despite the much higher premium, however, claims ratios for FY19 are likely to be well above 100%. Claims in 2016-17, before the premium was raised, were 176%.
Claims rose from around Rs 1.6 crore per day in December 2017 when the current scheme began to Rs 3.7 crore in May 2018. In June, in fact, when New India de-empanelled 66 hospitals for fraud, the hospitals were reinstated within a few hours. At that time, the Rajasthan government had argued that only the government could invoke the de-empanelment provision, not the insurance company.
Even the central government’s NHPS retains this feature of de-empanelment where the government will remain the final authority on de-empanelment. In the central government’s model, while the insurance company will have a nominee on the panels that will deal with this, the majority of the members will be affiliated to the government.