Lok Sabha Question No. 2831 (UNSTARRED), answered on 2018-12-28
Subject: Health Insurance
Ministry: HEALTH AND FAMILY WELFARE
Asked by: R. PARTHIPAN

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 2831 TO BE ANSWERED ON 28 TH DECEMBER, 2018

## HEALTH INSURANCE

## 2831. SHRI R. PARTHIPAN:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a)  whether  National  Health  Protection  Scheme  (NHPS)  in  India  aims  to  be  the  larg Government- funded health insurance programme in the world, if so, the details thereof;

(b) whether as in the existing Government - fu nded  health  insurance schemes, health insurance companies are likely to play a crucial role in the implementation of the NHPS, if so, the details thereof; and

(c) whether the number of Indians purchasing health insurance (on their own) has grown i past few years, if so, the details thereof?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

(a): Yes. Pradhan Mantri Jan Arogya Yojana (PMJAY), earlier known as National Health Protection Scheme, provides benefit coverage of upto Rs. 5 lakh per annum per family to a 10.74 crore identified poor and vulnerable families for secondary and tertiary hospitalisation. This  is  an  entitl ement  based  scheme  and  the  families  are  identified  based  on deprivation and occupational criteria as per Socio Economic Caste Census (SECC) data. PMJAY has been launched on 23.09.2018. Salient features of PMJAY are annexed as Annexure - I.

- (b): The scheme is being implemented by the State Governments/UTs who have been given flexibility to decide mode of implementation of PMJAY. They can implement PMJAY either through Insurance Companies or directly through Trust/Socity or in a mixed mode. Out o States/UTs who have signed the MoU for implementation of the Yojana as on 21.12.2018, have chosen to implement in Insurance mode whereas 17 have chosen to implement in Trus mode and the rest are implementing in mixed mode.

(c ): Yes. The number of p ersons covered under Health Insurance (excluding Personal Accident & Travel) has grown in the past few years. The details are placed are at Annexure - II.

## Annexure - I

## Salient  features  of  PMJAY  launched  on  23.09.2018  for  families  belonging  to  poor, vulnerable and disadvantage sections of populations are as under:

1. Cashless and paperless access to services for the beneficiary at the point of service public and private) empanelled hospitals across India.
2. The  benefit  coverage  of  PMJA Y  is  Rs.  5,00,000/ - covering  around  10.74  crore  beneficiary families (identified through SECC database). This cover of Rs. 5.00 lakh is able to t almost all secondary care and most of tertiary care procedures.
3. No family size, ensuring all members of designated families specifically girl child and citizens get coverage. It is suggested to preferably make woman as the head of family.
4. This Scheme is on entitlement basis. Every family figuring in defined SECC Database entitled to claim benefit under the scheme. The beneficiaries are encouraged to brin for the purpose of identification. However, no person is denied benefits under the sch absence of Aadhaar.
5. Implementation Arrangement -States have the option to use an existing Trust/ Society/ Not Profit Company [SNA] or set up a new Trust/ Society/ Not for Profit Company [State Protection  Mission  Agency]  to  implement  the  scheme.  With  respect  to  implementation States are free to choose the modalities for implementation. They can implement the sche through insurance company or directly through the Trust/ Society or mixed model.
6. A  well - defined  Complaint  and  Public  Grievance  Redressal  Mechanism,  actively  utili electron ic,  mobile  platform,  internet  as  well  as  social  media,  has  been  put  in  plac which  complaints/  grievances  are  registered,  acknowledged,  escalated  for  relevant resolved and monitored.
7. While ensuring user convenience, robust safeguards have been created to prevent misuse/ fraud abuse by providers and users. Pre - Authorisation has been made mandatory for all tertiary ca and selected secondary care packages.

## Annexure II

Number of persons covered under Health insurance (excluding PA & Travel): (in '000)

| Class of Business                           | 2015- 16   | 2016- 17   | 2017- 18   |
|---------------------------------------------|------------|------------|------------|
| Government Sponsored Schemes including RSBY | 273272     | 335015     | 359262     |
| Group Business(other than Govt. Business)   | 57039      | 70469      | 89448      |
| Individual Business                         | 28652      | 31962      | 33275      |
| Grand Total                                 | 358963     | 437446     | 481985     |
| Growth(%)                                   |            | 22%        | 10%        |