Ayushman Bharat: States rush to merge old schemes with new; some drop out

Though it's been six months since the government's flagship health insurance programme Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched, uncertainty still clouds the states who wanted to integrate their schemes with the one announced by the Centre.

When it was announced in September last year, the insurance scheme was expected to be merged with similar state-run programmes 'within weeks'. But that hasn't happened.

While sources told Moneycontrol it may take at least four more months to merge the schemes, there was also confusion over its provisions.

“There is still some confusion on whether both the sum assured (of the Centre and state schemes) can be added to make it one scheme. Also, the claims under process of the state schemes will have to be settled till a merger occurs,” said a senior official.

Further, states have also sought access to additional funds from the Centre for implementing the scheme.

The governments of Odisha, Telangana as well as Delhi are not yet part of the scheme. West Bengal, Chhattisgarh and Karnataka, who were initially part of it, have decided to pull out of the scheme. Others like Maharashtra and Andhra Pradesh run their own health insurance schemes though they have also joined PMJAY.

Tamil Nadu is the only state that has merged central and state schemes.

In Maharashtra, a senior insurance official said the state's Mahatma Jyotiba Phule Jan Arogya Yojana will be merged with Pradhan Mantri Jan Arogya Yojana (PMJAY) as early as mid-2019.

Overall, over 12 lakh patients have benefited from the scheme as of February 17.

Sources said the claims experience for most state schemes have been benign with no major losses. Loss ratios are said to be in the range of 100-105 percent, which is much better than other health insurance schemes. This means that for every Rs 100 collected as premium, Rs 100-105 is paid out as claims.

A majority of states have opted for the trust route under the PMJAY. This includes each state setting up a trust to manage the funds collected for the schemes and claims payouts are done through this trust.

Under this scheme, also referred to as Modicare, about 100 million families will receive access to Rs 5 lakh worth of health insurance completely free of cost. This will include families from lower income groups that fall under the socio-economic caste census (SECC) data of 2011.