Context
- The Union government has announced that transgender people will be eligible for Rs 5 lakh in annual health insurance under the Ayushman Bharat scheme.
- In this regard, the National Health Authority, which is part of the Health Ministry, has signed an agreement with the Ministry of Social Justice.
Relevance
GS Paper 2: Issues related to health.
Mains Question
Examine Ayushman Bharat’s advantages over its predecessors, as well as its major challenges. (250 words)
Ayushman Bharat Pradhan Mantri (ABPM) Yojana Jan Arogya (AB-PMJAY)
- Launched in September 2018, the scheme aimed to provide secondary and tertiary care services to the society’s poor and vulnerable population.
- It was launched as the second component of the ‘Ayushman Bharat’ scheme.
- This scheme aimed to provide medical coverage worth Rs. 5 lakh per family per year.
- It covers nearly 40% of the population. The scheme is intended to benefit 10.74 crore rural families as well as identified occupational categories of urban worker’s families.
- Beneficiaries are identified using the most recent Socio-Economic Caste Census (SECC) data.
Benifits
- It provides the beneficiary with cashless access to health care services at the point of service, i.e. the hospital.
- It provides Health Benefit Packages that cover surgery, medical and day care treatments, as well as the cost of medications and diagnostics.
The National Health Authority’s Role
- The National Health Authority (NHA) is the apex body in charge of implementing India’s flagship public health insurance/assurance AB-PMJAY scheme.
- It has been tasked with:
- designing strategy, building technological infrastructure, and
- implementing the National Digital Health Mission to create a National Digital Health Eco-system.
Performance
- The government plans to launch a dedicated health insurance scheme for transgender people in September to provide a comprehensive health package.
- According to the Social Justice Ministry, India has 4.8 lakh transgender people. These people will be eligible for the scheme’s benefits.
Eligibility
- The scheme will cover all transgender people who are not receiving benefits from other government or state-sponsored programmes.
- Those who have a transgender certificate issued by the national portal for transgender people will be eligible for benefits.
- Health insurance is available.
- The health package available to transgender people will include hormone therapy and gender reassertion surgery.
- This package can be redeemed at any private or public healthcare facility accredited by the AB PMJAY.
- Verified beneficiaries will receive new cards.
- For verified beneficiaries, a ‘Ayushman Bharat TG Plus Card’ will be generated.
- The definition of family has changed o The Rs 5-lakh cover under the Ayushman Bharat scheme is for an entire family.
- However, the government changed the definition of the family in order to provide transgender people with full yearly coverage.
- Health cards issued to trans persons will not cover their family members.
Other Ayushman Bharat Card changes announced
- The Ayushman Bharat card will now include the logos of both the Centre and the state.
- The NHA has permitted co-branding of the new cards with the logos and names of both schemes (Ayushman Bharat and State Health Insurance Scheme).
- Until now, cards issued to eligible beneficiaries only bore the Centre’s logo. Many states objected because they contribute 40% of the funds needed to implement the scheme, while the Centre pays the rest.
- As a result, the Ayushman Bharat beneficiary card can now be used to access benefits from any existing state health insurance schemes as well.
