A health centre in Bavla taluka in Ahmedabad district. (Photo: Chandan Nandy/ The Quint)

Bidding To Select Insurers For PM’s Health Insurance Plan To Start From June 1

From June 1, states can start calling bids from insurers under Prime Minister Narendra Modi’s health insurance scheme that will cover around 40 percent of Indians.

“We will finalise the request for proposal to float tenders by June 1, and after that states can start the bidding process for insurers based on their own preparedness,” Indu Bhushan, chief executive officer of Ayushman Bharat National Health Protection Mission, said. “They should do it in a way that allows them to start the scheme by Aug. 15.”

The Pradhan Mantri Rashtriya Swasthya Suraksha Mission will provide cashless medical cover of Rs 5 lakh each to about 10 crore families living below the below poverty line. In its draft tender document, the government had identified 1,354 medical and surgical packages categorised under 25 specialties such as cardiology, neurosurgery, oncology (chemotherapy for 50 types of cancers), mental disorders, burns, reconstructive surgeries, among others.

Insurers bidding to offer the scheme will have to quote premium. The upper limit for premium for every family can be Rs 1,082, the Economic Times reported on May 28.

“NITI Aayog had carried out an exercise to find out potential premium rates in order to make provisional estimates for the budget, which it had prepared as background information data for the scheme,” said Vinod Kumar Paul, member of the government’s think tank. The final premium, however, will be determined only after the bidding is complete, he said.

The premium cost will be funded by the Centre and states in the 60:40 ratio. States and union territories can either opt to bring on board insurance companies or create a trust to run the scheme. So far, nearly 10 states each have opted for the trust and the insurance model and eight have chosen a combination of both. “We hope to sign memorandums of understanding with all the states and union territories by June 8,” said Bhushan.

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Technology Backbone

The health insurance scheme will run on an information technology platform that will mainly manage empanallement of hospitals, identification of beneficiaries and payments and other transactions. “A company will be selected through the bidding process to run a call centre for addressing queries,” said Bhushan. All major functions of the IT platform will be operational by mid-July.

The IT platform is modelled on the Telangana government’s state health insurance website. Tata Consultancy Services Ltd. will expand it for the nationwide scheme. “A long-term IT solutions provider will also be selected through the bidding route once a consultancy firm is brought on board.”

The government plans to spend Rs 350 crore to implement the insurance scheme, of which Rs 20 crore have been set aside to develop the IT platform.