Even as the state of Nagaland has been awarded to Apollo Munich Health Insurance at Rs 444 per family, some states like Gujarat and Chhttishgarh have opted for a hybrid model- mix of insurance and Trust model- to implement the Modi government’s flagship health insurance scheme, National Health Protection Scheme, that offers Rs 5 lakh health insurance cover to poor and vunerable population for free.
Going by the hybrid model, the Trust that will be controlled by the state government will provide cover up to Rs 4.5 lakhs and insurers, who will be selected by the competitive bidding, will provide cover only for the rest .
Once insurers are decided, these two states will also involve third party administrators (TPA) to implement the scheme through the trust model.
The bidding process for Chhattisgarh will be completed on Aug 3 while for Gujarat and Daman Diu, it will be done on Aug 4 and Aug 6 respectively.
Daman like Nagaland will be going for purely for insurance model.
Gujarat and Chhattisgarh have opted for hybrid model as according their analysis, average claims per family may not exceed Rs 50,000 which will be taken care by the insurers.
Also, the states are unwilling to allocate the higher amount for insurers as they think, if insurers create problems in settling claims, it will be a political issue, said the industry analysis.
Prime Minsiter Narendra Modi will announce the mega health insurance scheme on Aug 15.
Under the scheme, the premium cost of the scheme will be divided between the centre and the state at 60:40.
It is not yet known how many states will go for purely insurance model or trust mode or hybrid model.
In Nagaland, the private sector general insurers had outbid the public sector general insurers.
United Insurance Company had bid at Rs 1850 while New India Assurance, Oriental Insurance Company and National Insurance Company had quoted at Rs 2000, Rs 2000 and Rs 1944 crore respectively.
The target beneficiaries of the proposed scheme will be families belonging to the poor and vulnerable population based on Socio-Economic Caste Census (SECC) database.
So far, 20 states have agreed to implement the scheme and have signed a memorandum of understanding (MoU) with the centre government.
The scheme will subsume the on-going centrally sponsored schemes — Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
The states will need a State Health Agency (SHA) to implement the scheme. They will also have the option to use an existing trust as an SHA.