Maha to divert over ₹270 crore saved in insurance premiums to strengthen medical facilities

A premium of around ₹1,600 crore or ₹797 per family is paid to the insurer under the scheme in which all families that have ration cards in the state are covered.

Mumbai: A unique tweak in the terms and conditions for the state government’s flagship medical insurance scheme has helped the state save over ₹270 crore, which in turn will be used to create tertiary medical care services like dialysis centres, cath labs and operation theatres across Maharashtra. This is the first time that the public health system is being strengthened through such alternate sources of funding.

The MPJAY extends blanket protection to all families in the state which hold ration cards. (REUTERS)

On Thursday, the state cabinet approved the strengthening of medical facilities through the ₹272.71 crore available with the State Health Assurance Society that administers the state’s Mahatma Jyotirao Phule Jan Arogya Yojana (MPJAY) which provides cashless medical care to beneficiaries in empanelled hospitals.

This capacity addition will include radiation oncology units at four places, namely Thane, Ratnagiri, Baramati and Jalna, and cath labs, cardiovascular and thoracic operation theatres, laminar flow theatres (which reduce infections in the air), Extracorporeal Shock Wave Lithotripsy (ESWL) machines used for non-invasive urinary and kidney-related procedures and 25 to 30 dialysis units in 19 districts with no medical colleges.

“At times, cancer patients have to wait for up to two months for radiation therapy in government hospitals, thus delaying their treatment as the number of these facilities is less,” noted Rajesh Tope, minister for public health.

“In 2020, when we signed a contract with the United India Insurance Company Limited, we inserted a clause wherein the insurance company will have to refund a part of the premium paid if the claims were less than 85% of the premium,” said Dr Sudhakar Shinde, CEO, MPJAY, adding that this was done for the first time in the country.

A premium of around ₹1,600 crore or ₹797 per family is paid to the insurer under the scheme in which all families that have ration cards in the state are covered. Shinde added that for instance, if the company paid 75% of this amount as claims, it would have to refund the gap (10%) between this and the ceiling of 85% to the government. “This way, we were repaid ₹272.71 crore in the financial year ending 2020-21. This was because non-Covid medical procedures and surgeries had fallen during the Covid-19 pandemic,” explained Shinde.

He added that conversely if the number of claims paid by the insurer exceeded 115% of the premium, half of the bridge amount above this threshold would be paid by the government. “This means that the insurance company’s risk is capped between 85% and 115% and this helped us get the most competitive quotes in the country,” explained Shinde.

The MPJAY extends blanket protection to all families in the state which hold ration cards.

The integrated Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) and Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) were launched in Maharashtra on 1 April 2020. While the MPJAY is fully funded by the Government of Maharashtra, the AB-PMJAY, which covers weaker sections like rag pickers, domestic workers, casual labourers and manual scavengers, is jointly funded by the central and state governments in a 60:40 ratio.

The MPJAY was earlier known as the Rajiv Gandhi Jeevandayee Arogya Yojana and was started on 2 July 2012 in eight districts and later expanded across Maharashtra from 21 November 2013. It covers all hospitalisation expenses up to ₹1.50 lakh per family per policy year on a floater basis and for renal transplants, this limit has been enhanced up to ₹2.50 lakh. However, AB-PMJAY provides a health cover of ₹5 lakh per family per policy year.

MJPJAY beneficiaries get the benefit of 996 medical and surgical procedures with 121 follow up procedures and the AB-PMJAY beneficiary are covered for 1,209 medical and surgical procedures.