Govt to expand Ayushman Bharat to cover 'missing middle'

NEW DELHI: The Centre plans to expand the Ayushman Bharat health insurance framework to include 45 crore ‘non-poor population’ who are currently not covered under any government or private insurance scheme and are only a little better off than the PM-JAY beneficiaries.

While the proposed plan is to offer coverage on ‘self-pay basis’, it aims to reduce insurance premium by around one-third of the existing retail price and cover the “missing middle” against financial risk of hospitalisation using the Ayushman Bharat ecosystem, official sources said.

“The idea is to reduce the average insurance premium so that it is affordable to people who are just above the poverty line and are currently neither covered under the government scheme or by their employers and are also unable to afford market prices,” an official said.

Apart from Ayushman Bharat and other government schemes, around 12.5 crore people are covered under private health insurance. Of this, around 7-8 crore people access schemes offered by employers and rest buy a policy from retail market. However, for a policy of Rs 3-5 lakh, the average premium for a young family is around Rs 10,000-15,000 annually. Those involving elderly have higher premiums.

The proposed scheme is likely to reduce the premium to Rs 4,000-Rs 5,000 per year for a cover of Rs 5 lakh, the official said. Under the proposal, it will be mandatory for insurers to maintain basic features of AB-PMJAY scheme such as a family floater of Rs 5 lakh per annum with no cap on the number or age of family members in a group. The policy cover will be sold to groups like RWAs (for their employees), delivery groups and cab integrators to ensure a “cross risk” pool through a mix of individuals of all age groups and with variety of disease profiles that should make it viable for insurance companies too. The scheme should help persons in informal employment or gig workers.

The National Health Authority — the implementing agency of the government-run scheme — has invited expressions of interest from insurance companies that are interested in participating in the project targeting the “missing middle”. At present Ayushman Bharat provides a free annual cover of Rs 5 lakh to around 10.74 crore ‘deprived’ families, covering 50 crore people.