Editorial Team

Family Health Plan Insurance TPA Limited (FHPL) is happy to announce its support for the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) Scheme, in an effort to bring health coverage to an additional 50 crore Indians who are currently exposed, with no health coverage.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is an initiative that has substantially expanded health coverage in India to approximately 10.74 crore families. The total covered population under all other schemes such as ESIS, CGHS, ECHS, Railways and private insurance etc. including PMJAY, is approximately 80-85 crore. As per the IRDAI Annual report 2018-19, the number of people covered under private paid insurance policies through insurance companies stood at 11.50 crore (individuals/families/group covers). This still leaves approximately 50 crore Indians without any financial protection against health shocks, especially of the catastrophic kind, potentially pushing these people to poverty or to avoid seeking appropriate healthcare. The COVID-19 pandemic, along with high ‘out of pocket spend,’ has further increased the vulnerability of the uncovered population. This segment of the population is often referred to as the ‘missing middle,’ in the discussions on financial protection and Universal Health Coverage in India.

The missing middle comprises of varied sections of the non-poor population – informal sector workers, self-employed, professionals, employees in MSMEs etc., spread across occupations, geography and income strata. Lack of penetration of overall health insurance for this segment, in particular, is due to many reasons – lack of awareness, low affordability, difficulty in reach & distribution, complex products, high premium levels (due to high claim cost for insurers), lack of incentive/mandate to purchase health insurance etc. to name a few key reasons.

To address the needs of the ‘missing middle’ The National Health Authority (NHA) floated an ‘Expression of Interest’ for insurance companies to participate in insurance pilots.

The NHA will extend support as outlined in the PMJAY framework for insurance companies to rate the risk and determine actuarial premium levels. IT systems and anonymized actuarial data for the relevant State/territory will be curated for the insurance company that intends to carry out pilots. Under insurance pilots, it is proposed that the insurance company shall offer coverage to the uncovered population on a self-pay basis, having the liberty to innovate, to attract and service the needs and aspirations of the profile of customers in this segment.

Says Upasana Kamineni Konidela, MD, Family Health Plan Insurance TPA Limited (FHPL), “The idea of universal health coverage and affordable healthcare is close to becoming a reality thanks to the initiatives by the National Health Authority. This is a superb and timely move by the Government that we wholeheartedly support during these tough times. There is no one model that can be adopted; referrals to several existing models, up-gradation of technology and innovation are crucial in order for a final product to evolve.”

FHPL prides itself on being the county’s most sought-after and ethical TPA. The organization’s core competence lies in servicing health insurance policies of individuals, corporates and beneficiaries covered under Government health schemes. FHPL is pleased to announce its involvement in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (also known as PMJAY) scheme.

FHPL is one of India’s top TPAs managing PMJAY in the entire state of Assam, 11 districts in Punjab, 15 districts in Gujarat, the entire state of Uttarakhand and 5 districts in West Bengal’s state-run scheme, Swastya Sathi. In the past it has been an integral part of Arogya Bhagya- Karnataka police 2002-2008, Yeshaswini 2003-2010, Maharashtra police 2005-2014, Vajpayee Arogya Shree in Karnataka from 2009 to 2014.

FHPL’s exposure to different models of PMJAY projects functioning in various states has given the organization valuable experience in handling different models.

Says Bharathi G, CEO of FHPL, “At FHPL, we are keen to pledge our support by partnering and working with insurance companies to develop a best-suited model and continue our unmatched service delivery. This is combined with our ability to set up servicing offices in any part of the country, managed with ease under tight deadlines. Our vast network of medical services and expertise allows us to handle claims, frauds, excellence in hospital coordination and promises unmatched efficiency and speed to provide cashless and claims services.”

Related Articles