In its bid to ensure free health services to the 93 per cent of the workforce, the Centre is likely to launch a cashless health insurance scheme for the unorganised sector from next financial year.
The pilot project would be launched in 30 districts across the country from April, 2008 and would cover all the BPL (Below Poverty Line) families without charging anything from them, a Labour Ministry official told Deccan Herald.
Assuming the cost of premium for each household per year would be Rs 600, it would be around Rs 1 lakh for each district and the total financial implications for the entire scheme for the first year would be about Rs 180 crore. The total cost would be shared by the Centre and the states at 75:25 ratio.
As part of the scheme, the workers and their families could get medical treatment in government hospitals and in selected networked private hospitals with the cost not exceeding Rs 30,000 (approx) per family of five members in a year.
Cashless facility
Elaborating on the scheme of cashless facility, the official said there would be a Third Party Administrator, who would be licensed by the Insurance Regulatory and Development Authority, and it would directly settle all eligible amounts with the network hospitals without the beneficiary paying any money.
As most of the BPL families are in rural areas a provision of add-on cover had been included in the scheme including out-of-pocket expenses of Rs 50 per day to a patient during hospitalisation (maximum up to 5 days) and transport facility up to Rs 50 in case the patient had to be shifted from residence to hospital or from one hospital to another one.
All pre-existing diseases would be covered and there would be no age limit for the beneficiaries. Maternity benefit up to Rs 5,700 per year would be given to one woman of the family who should be above 18 years of age.
However, limits of maternity benefit should be part of basic sum insured i.e. Rs 30,000.
An executive committee, under the chairmanship of District Magistrate should be constituted at district level for monitoring and review of implementation progress.
The state-level monitoring and quarterly review of the progress of the scheme should be carried out by a committee constituted under the chairmanship of principal secretary.
Based on the review, necessary advice should be given to insurance company and district officials. The annual evaluation of the scheme should be conducted by an independent third party agency.
The list of BPL families prepared by the Rural Development Department/Labour Department should be the basis of identification of beneficiaries. In the towns, BPL ration card owners and the list of BPL families prepared by District Urban Development Agency would be covered under the scheme.