Inside Punjab’s Mega Health Insurance Scheme

The full potential of a nation can only be realised if its citizens are strong and healthy. However, in a country where about 276 million people are living below the poverty line, ensuring adequate healthcare access across various sectors is indeed a tough job. A number of government sponsored schemes have been introduced in the past, but most of them were ridden with numerous flaws, which posed consistent and significant challenges. It was primarily in order to counter these difficulties and provide an efficient healthcare system that the Ayushman Bharat health insurance scheme was launched recently. The scheme is the world’s largest fully government-funded health insurance programme.

It aims to provide health insurance to nearly 10 crore beneficiaries, by offering coverage of up to Rs. 5 lakh to vulnerable families every year for availing any form of primary, secondary, and tertiary healthcare services. The number of beneficiaries is almost equal to the population of Canada, Mexico and the US taken together. It is meant to be an umbrella scheme, which will subsume the existing senior citizen health insurance scheme and the Rashtriya Swasthya Bima Yojana.

A number of states have incorporated Ayushman Bharat and their own schemes. The Punjab Government also recently launched a mega health insurance scheme in a bid to further bolster healthcare delivery system of the state, enabling people at large to avail accessible and affordable care in hassle free manner.

India’s highest reaching insurance state plan

The scheme, called ‘Mahatma Gandhi Sarbat Sehat Bima Yojana’ has clubbed both Centre’s Ayushman Bharat and existing insurance scheme of the State, benefitting 46 lakh families—around 76% of the state’s population. After this, Punjab has now become the first state to offer medical insurance for such a large proportion of its population. The PMJAY by the Central Government was rolled in September 2018, however, the state of Punjab took several months to draw a clear-cut road map for the implementation of a scheme that would extend over76% of its population. This is in sharp contrast to the 12% that would have been covered under the Centre’s PMJAY. Similar schemes in other states cover only up to a mere 30% of their population. 

Scheme highlights

The ‘Mahatma Gandhi Sarbat Sehat Bima Yojana’ incorporates the PMJAY with its own mega health insurance scheme. Surgical packages under the scheme include pre-hospitalisation expenses for three days and for a 15-day post-hospitalisation period.

Going by the last Socio Economic and Caste Census (SECC), Ayushman Bharat-PMJAY would have covered 14.86 lakh families in the state. The Punjab scheme has extended this to cover 31 lakh more families, taking the total to nearly 46 lakh families. 

Recently, 11 people from Mohali district were handed over their e-cards, becoming the first beneficiaries of the scheme. Like the original PMJAY, the Punjab government will provide cashless health insurance cover of Rs. 5 lakh per year. The Centre and the state government will bear the cost of the annual premium for 14.86 lakh families in the ratio of 60:40. For the remaining beneficiaries, the Punjab government will bear the entire expense. The state government will shell out Rs. 276 crore, or 83%, of the annual premium of Rs. 333 crore. The Centre will pay the remaining Rs. 57 crore. The scheme with 1,396 treatment packages, will be implemented through over 450 empanelled hospitals, including 200 government hospitals.