Shri Indu Bhushan, CEO, Ayushman Bharat-PMRSSM along with Shri Alok Saxena, Joint Secretary, Ministry of Health and Family Welfare and Dr. Dinesh Arora, Director (Ayushman Bharat) held consultations with representatives from leading general and standalone health insurance companies, and hospitals (Super speciality, General, Multi-speciality and hospitals from Tier 1 and Tier 2 towns). Representatives from industry bodies such as CII, FICCI, IRDA, NABH, NatHealth and QCI also participated in the consultations and provided valuable inputs to the discussion.
The representatives were appreciative of the initiative being undertaken in PMRSSM and of the substantial engagement of all the stakeholders covering all the aspects like operational guidelines, model tender document, empanelment criterion, package details and rates etc.
Shri Indu Bhushan emphasized that, “We need to design the scheme to ensure that the targeted beneficiaries get maximum benefits and we can expand access to quality health services in rural areas and Tier-2 and 3 cities. This can be done only when Government, hospitals and insurance companies work together as partners”
The deliberations with the insurance companies were focussed on how to get the most competitive rates without compromising the quality of healthcare services and prevent frauds. Representatives from hospitals highlighted the need for timely payments for their services by insurance companies/ trust. They were appreciative of the claim management process that has been incorporated in the Mission.
Ministry of Health & Family Welfare has invited comments/inputs on the model tender document and the guidelines. The stakeholders have sought extension keeping in view that the issues raised are complex and requires detailed deliberations. In view of the requests, it has been decided to extend the last date for submission of comments to 5th May, 2018.
PMRSSM has been designed to provide financial protection and prevent catastrophic health care expenditures to over 10 crore poor and vulnerable families and endow a cover for cashless hospitalization services of up to Rs. 5 lakh per family per year.
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