Around Rs 4,405 crore worth of claims by over 3 lakh patients have been made for health insurance under the Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme since it was launched in September last year.
According to the latest data tabled in Parliament on Tuesday, Gujarat tops the list with claims worth Rs 915 crore followed by Tamil Nadu at Rs 618 crore and Karnataka (Rs 553 crore).
The scheme has been most availed in Chhattisgarh where 611,216 patients enrolled for the claim followed by Kerala (574,448) and Gujarat (523,011).
However, states like Bihar, Uttar Pradesh, Uttarakhand and Madhya Pradesh, which have poor health indicators, are not the biggest users of the scheme as just 56,139, 130,721 and 107,718 patients registered under the scheme respectively, contrary to the expectations. In fact, in as many as four States less than hundred patients used the scheme. Similarly, Northeastern States except Assam too are yet to warm up to the scheme.
In West Bengal, which was initially reluctant to implement the scheme had 17,636 patients registered under the scheme with claim of over Rs 17 crore. (See table)
Only Delhi, Odisha and Telangana have not signed the MoU for implementation of AB-PMJAY. Replying to a query, Ashwini Kumar Choubey, Minister of State for Health said that under the scheme, the States have the flexibility to choose the mode of implementation.
They can either implement it in insurance mode, or through a trust or in a mixed mode ie both the insurance and trust mode. The States implementing scheme through Insurance mode select Insurance Company through open tendering process.
The private insurance companies are allowed to bid in the open tendering process to allow level playing field, said the Minister.
However, he added, the decision lies with the State Government concerned and the government has no role in the selection of Insurance company. Choubey further said that under the scheme, 1393 procedures have been laid down for treatment of beneficiaries.
AB-PMJAY provides a cover of up to Rs 5 lakhs per family per year, for
secondary and tertiary care hospitalisation to over 10.74 crore vulnerable entitled families (approximately 50 crore beneficiaries).
PMJAY provides cashless and paperless access to services for the beneficiary at the point of service.
Over 15,000 hospitals and health care providers have been empanelled across the country to provide healthcare services as per these packages, as per the Ministry.