The Central Government has outlined eligibility criteria based on deprivation levels of households for the national health protection scheme that seeks to cover hospitalisation expenses of up to Rs 5 lakh a family each year.
In rural areas, families with only one room with “kuchcha walls and kuchcha roof” and families with no adult members aged between 16 and 59 will be among those who qualify for the Ayushman Bharat National Health Protection Mission (AB-NHPM).
The scheme, announced in the Union budget in February, was cleared by the cabinet recently. The others eligible in rural areas include female-headed households with no adult male member between 16 and 59, households with no able-bodied adult member, Scheduled Caste and Scheduled Tribe households and landless households that derive most of their income from manual casual labour.
Households without shelter, destitutes and those living on alms, manual scavenger families and primitive tribal groups will also be covered in rural areas.
In urban areas, families in 11 occupation categories will be covered in the scheme, a government statement said without listing the occupations.
Pre-existing diseases will be covered from the first day itself. “To ensure nobody is left out, there will be no cap on family size and age in the scheme,” the government said. “A defined transport allowance per hospitalisation will also be paid.”
Families may seek hospitalisation services anywhere in the country from public and private hospitals empanelled by the government.
The Centre is hoping to work with states in implementing the project but the states can expand the scheme at their own cost and choose their implementation route – either through insurance companies or trusts.
The expenditure for premium payment will be shared between the Centre and the states on an expected ratio of 60:40.
The Centre proposes to work out “package rates” for various treatments but states will have the flexibility to modify the rates within limited bandwidths.
