Source: NFHS-5 Phase-I (2019-20)
1. Health insurance coverage still remained well below half the population in most of the Indian states and union territories, according to the latest National Family Health Survey (NFHS-5). The COVID-19 pandemic made us realise that future is uncertain, and medical emergency can take place anytime. Health Insurance is must to protect us from any medical emergency, we all are following social distancing and taking health precautions, measures but along with precautions, we need health insurance as well.
2. The health insurance policy holder/s get the benefits of pre and post hospitalisation coverage, reimbursement of hospitalisation expenses and in case of critical illnesses, the policy even pays out lumpsum benefits. Further, cashless hospital facility is helpful at the time of emergencies so that the medical treatments would start immediately without delay and without getting stress in arranging money to make advance medical payments.
Ayushman Bharat, a flagship scheme of Government of India, was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC).
Key Features of PM-JAY (https://pmjay.gov.in)
• PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government.
• It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
• Over 10.74 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
• PM-JAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
• PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
• It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
• There is no restriction on the family size, age or gender.
• All pre–existing conditions are covered from day one.
• Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
• Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
• Public hospitals are reimbursed for the healthcare services at par with the private hospitals.