Ministry/Department : Ministry of Health and Family Welfare
Scheme:
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It is Centrally Sponsored health insurance scheme.
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The scheme will integrate two on-going centrally sponsored schemes viz. Rashtriya Swasthya Bima Yojana (RSBY) and Senior Citizen Health Insurance Scheme (SCHIS).
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AB-NHPM aims to target over 10 crore families belonging to poor and vulnerable population based on Socio Economic and Caste Census 2011 (SECC) database.
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It will provide cover of Rs 5 lakh per family per year, taking care of almost all secondary care and tertiary care procedures.
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There will be no cap on family size and age in the scheme.
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Benefit cover:
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It includes pre and post-hospitalisation expenses.
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It will cover all pre-existing conditions from beginning of the policy.
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It will also pay defined transport allowance per hospitalization to the beneficiary.
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Cashless benefits:
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The scheme allows the beneficiary to take cashless benefits from any public or private empanelled hospitals across the country.
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The payment for treatment will be done on package rate which will be defined by Government in advance basis.
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The package rates will include all the costs associated with treatment.
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Role of state governments:
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They will be allowed to expand the scheme both horizontally and vertically.
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They will be free to choose modalities for implementation.
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They can implement through insurance company or directly through Trust/ Society or a mixed model.
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Implementation:
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States/UTs will have also flexibility to modify these rates within limited bandwidth.
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For beneficiaries, it will be cashless and paper less transaction.
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States will be required to form State Health Agency (SHA) to implement scheme and at district level also, a structure for implementation of the scheme will be set up
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Council:
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For giving policy directions and fostering coordination between Centre and States, Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) will be set up at apex level.
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It will be chaired by Union Health and Family Welfare Minister.
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Entitlement:
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It is entitlement based scheme with entitlement decided on basis of deprivation criteria in SECC database.
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Different categories of families covered under scheme are
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Families having only one room with kucha walls and kucha roof,
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families having no adult member between age 16 to 59,
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female headed households with no adult male member between age 16 to 59,
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disabled member and no able bodied adult member in family,
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SC/ST households,
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landless households deriving major part of their income from manual casual labour.
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It will also automatically include families in rural areas having any one of the following-
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households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups or legally released bonded labour.
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For urban areas, 11 defined occupational categories will be entitled under scheme.
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