Page 47 - The Insurance Times November 2024

universal health coverage at least for our senior citizens," government is working to add more geriatric packages," an
she added. official in the know said. The government will also come up
with exclusive awareness programmes including IEC
Probal Ghoshal, chairman, director and co-founder, Ujala
campaigns.
Cygnus Healthcare Services added that with the senior
population in India growing rapidly, the move addresses the "Since AB-PMJAY scheme is an application-based scheme,
specific healthcare needs of the elderly. people will need to register on the portal," the official added.
Sources indicate that a separate link will be provided for
"Many senior citizens require specialised, ongoing care, and
eligible senior citizens to enrol themselves in the scheme.
by extending coverage under Ayushman Bharat, the
government is ensuring that this demographic has access Sources in the Ministry of Health and Family Welfare added that
to vital treatments," he added. the financial outlay of Rs 3,437 crore marked for expansion of
coverage under Ayushman Bharat to all senior citizens aged
More geriatric packages in the offing 70 or above will be spread over one and a half years.

The Centre is targeting to include more geriatric packages
"The outlay is for the remaining six months of this financial
in the Ayushman Bharat program, according to sources.
year and the next full financial year," an official said. Business
"Currently there are 25 elder care packages. The Standard

Major impact unlikely on health insurers

I ndustry experts believe that health insurance scheme operates under three modes: trust, insurance, or

companies are unlikely to experience business
hybrid.
cannibalisation due to the central government's
Under the trust mode, the state health agency (SHA) pays
decision to extend health coverage to people aged
70 and above, regardless of their income level, under the empanelled health care providers (EHCPs) for approved
Ayushman Bharat scheme. claims. Under the insurance mode, an insurance company
appointed by the SHA makes payments to EHCPs for
The Union Cabinet expanded the Ayushman Bharat Pradhan approved claims.
Mantri Jan Arogya Yojana (AB-PMJAY) to include all senior
citizens aged 70 and older. This move is expected to benefit The hybrid mode involves the SHA appointing an insurance
nearly 45 million families, comprising 60 million senior company for a specific amount of coverage, with claims
citizens, by providing Rs 5 lakh in free health insurance exceeding the insurance limit paid directly by the SHA to
coverage per family. The government's outlay for this EHCPs. "I don't foresee much business cannibalisation, as
expansion is expected to be Rs 3,437 crore. the proportion of 70+ individuals covered by health insurance
is currently very low due to high premiums," said a senior
"The decision to include senior citizens over the age of 70
private sector insurance executive.
in Ayushman Bharat is unlikely to impact health insurance
companies," said Avinash Singh, senior research analyst at "In short term, insurance companies should not be overly
Emkay Global Financial Services. concerned. In the long term, the introduction of special
insurance products featuring co-payments to make
This is mainly because individuals in this age group are either
coverage more affordable could impact some insurance
already covered by central government schemes or have
private health insurance. The majority of the 70+ age group companies' plans," he added.
that will gain coverage under the new scheme typically does "For insurance companies, the volume of business from
not constitute the primary target audience for health such schemes is crucial. The government will specify
insurance companies. While the expansion is advantageous the packages, and hospitals will need to agree to them,"
for customers who lack coverage, insurers are not expected said CEO of a private sector general insurer. Business
to face major concerns about customer cannibalisation. The Standard

42 November 2024 The Insurance Times