Pointing out that at least 30 percent of the population, or 40 crore of individuals – called the “missing link” – lack any financial protection for health, NITI Aayog suggested that the Pradhan Mantri Jan Arogya Yojana (PMJAY) program be extended to cover part of people without health insurance.

In a report titled “Health Insurance for Missing Center of India” released on Friday, NITI Aayog said, “Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) launched in September 2018 and programs for State government extensions provide comprehensive hospital coverage. to the bottom 50% of the population – about 70 crores of individuals. About 20% of the population – 25 million people – are covered by social health insurance and private voluntary health insurance. The remaining 30% of the population have no health insurance; the actual uncovered population is higher due to existing coverage gaps in PMJAY and the overlap between plans.

The report recommended three models for increasing health insurance coverage in the country. The first model focuses on educating consumers about Medicare, while the second model involves “developing a modified and standardized health insurance product” such as “Arogya Sanjeevani”, a health insurance product standardized launched by the Insurance Regulatory Development Authority of India (IRDAI) in April 2020.

A “slightly modified version” of the Aarogya Sanjeevani standardized insurance product will help increase the update among the missing link, according to the report.

“The modified product should have shorter waiting periods. It should also include outpatient benefits through a subscription model to increase the value of the healthcare provided, ”he said.

Explaining the third model, the report states: “The third model extends government-subsidized health insurance through the PMJAY program to a greater number of beneficiaries. This model can be used for segments of the missing link that remain uncovered, due to the limited ability to pay for the voluntary contributory models described above. It is the only one of the three proposed models that has fiscal implications for the government. While this model ensures coverage of the poorest segments of the missing intermediate population, the premature expansion of PMJAY may overwhelm the program.

“A combination of the three models, phased in at different times, can ensure coverage of the missing intermediate population,” the report says. “In the short term, the focus should be on expanding private voluntary insurance through commercial insurers. In the medium term, once the supply and use of PMJAY and ESIC is strengthened, their infrastructure can be leveraged to enable voluntary contributions to a PMJAY plus product or to existing medical services of ESIC. In the long term, once the market for low-cost, voluntary contributory health insurance is developed, expansion of PMJAY to the poorest and uncovered segments of the missing link should be considered. “

The report also suggested sharing public plan data with private insurance companies. Government databases such as the National Food Security Law (NFSA), Pradhan Mantri Suraksha Bima Yojana or Pradhan Mantri Kisan Samman Nidhi (PM-KISAN) for farm households can be shared with private insurers after obtaining consent of these households, according to the report, propose an awareness strategy.

“Such databases will help facilitate the identification and awareness of potential customers by insurers,” the report says.


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