Building on the Ayushman Bharat platform, the Centre is looking to further expand health insurance to cover the “missing middle”. To this end, it is set to launch a pilot to understand the efficacy and costs of such a scheme. The Centre has invited expressions of interest from insurance companies that want to participate in this project.

“The government is coming out with another scheme for the ‘missing middle’, or basically those who are not eligible for Ayushman Bharat and do not have their own or a company-sponsored health insurance cover. These are persons such as self-employed and small businesses,” said PC Kandpal, Managing Director and CEO, SBI General Insurance.
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₹5-lakh health cover
Under the pilot, the insurer would provide ₹5 lakh floater health cover per family per annum with no cap on the number or age of family members. All insured persons will receive complete cashless treatment for procedures offered in the pilot project in hospitals empanelled under the Pradhan Mantri Jan Arogya Yojana (or, Ayushman Bharat). It would cover all pre-existing diseases, and the exclusions would be the same as those for Ayushman Bharat.

“The scheme will help India be fully insured. Often, people are pushed into poverty due to health costs, which can be minimised. We have sent our expression of interest to participate in the initiative, which can promote health insurance awareness and make more people get health cover,” said S Prakash, Managing Director, Star Health and Allied Insurance.

The government document inviting EoIs said: “The uncovered population comprises varied sections of non-poor population — informal sector workers, self-employed, professionals, employees in MSMEs, spread across occupations, geography and income strata.” Lack of awareness, affordability and distribution make it a challenge for them to buy health cover, it added.

Qualifying insurers will need to sign a three-year MoU with the National Health Authority, and submit individual pilot plans with the proposed group to be covered including size, family composition, demographics, geographical location, product features, inclusions, exclusions, additional packages, premium per family and hospital network (in addition to the PMJAY set).

The issue has also been raised by Ayushman Bharat CEO Indu Bhushan, who stressed the need to cover the ‘Missing Middle’. Ayushman Bharat scheme now offers insurance of ₹5 lakh per family and covers about 10.74 crore families or 50 crore beneficiaries.

Insurers say that another 10-11 crore have some health insurance cover, either purchased on their own or as part of their employment compensation package. But a large chunk does not have any cover.