Tamil Nadu tops the claims charts un­der Ayush­man scheme

The State cov­ers about 1.47 crore fam­i­lies, which is dou­ble the num­ber tar­geted by the flag­ship in­sur­ance scheme

The Hindu Business Line - - NEWS - RAD­HIKA MERWIN

Tamil Nadu, which has in­te­grated its Chief Min­is­ter’s Com­pre­hen­sive Health In­sur­ance Scheme (CMCHIS) with the Cen­tre’s flag­ship Ayush­man Bharat scheme, has sub­mit­ted the largest amount of claims to­talling ₹159 crore so far, with Gu­jarat a close sec­ond with ₹153 crore. While Tamil Nadu ranks third in terms of num­ber of claims (at about 90,300) trail­ing Ch­hat­tis­garh (1.24 lakh) and Gu­jarat (1.05 lakh), a higher av­er­age claims of about ₹17,600 per ben­e­fi­ciary, has put the State in the lead spot. The av­er­age claim per pa­tient at the ag­gre­gate level for the coun­try as a whole is about ₹13,000. A wide cov­er­age un­der Ayush­man, thanks to large num­ber of fam­i­lies al­ready cov­ered un­der the Tamil Nadu’s CMCHIS, has helped. Ayush­man pro­vides ₹5 lakh cover to de­prived ru­ral fam­i­lies and iden­ti­fied oc­cu­pa­tional cat­e­gories of ur­ban work­ers’ fam­i­lies as per the lat­est So­cio-Eco­nomic Caste Cen­sus (SECC) data.

Ac­cord­ing to this, about 77 lakh ben­e­fi­cia­ries must be cov­ered un­der Ayush­man in Tamil Nadu. How­ever, close to 1.47 crore fam­i­lies are be­ing cov­ered upto ₹5 lakh in the State, as it chose to en­hance the cover for all ben­e­fi­cia­ries un­der the ear­lier CMCHIS. The State’s scheme of­fers cover of ₹1 The State’s scheme of­fers cover of ₹1 lakh-2 lakh/ year for spec­i­fied pro­ce­dures for peo­ple with an­nual in­come of less than ₹72,000

lakh to ₹2 lakh per year for spec­i­fied pro­ce­dures for peo­ple with an­nual in­come of less than ₹72,000.

“Ben­e­fi­cia­ries not in­cluded un­der Ayush­man, but un­der the CMCHIS have also been ex­tended the en­hanced ₹5 lakh cover, the cost of which will be borne by the State,” says TS Sel­vav­inayagam, ad­di­tional

di­rec­tor of Pub­lic Health and Pre­ven­tive Medicine.

In­sur­ance/hy­brid model

For a ben­e­fi­ciary noth­ing much changes, as he has to pro­duce the CMCHIS card to claim ben­e­fits un­der Ayush­man. At the back-end though, the bur­den of the en­hanced cover for larger num­ber of ben­e­fi­cia­ries will fall un­der the State. United In­dia In­sur­ance, which is the State’s in­sur­ance part­ner for the ear­lier CHCHIS, will cover only spec­i­fied pro­ce­dures up to to the sum in­sured of ₹1 lakh or 2 lakh. “As per the ex­ist­ing ten­der which is up to 2022, the in­sur­ance com­pany will take care of spec­i­fied pro­ce­dures up to the sum in­sured of ₹1 lakh or ₹2 lakh. For un­cov­ered pro­ce­dures be­yond the sum in­sured, re­im­burse­ment will be done by the State,” ex­plains Sel­vav­inayagam.

The State has re­tained its pack­age rates un­der the ear­lier CMCHIS rather than go­ing with those un­der Ayush­man, which has led to seam­less em­pan­el­ments of hos­pi­tals for Ayush­man.

Cur­rently Tamil Nadu (at about 1,700 hos­pi­tals) ranks sec­ond after Gu­jarat in terms of num­ber of em­pan­el­ments.

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