In a bid to encourage more corporate hospitals to join the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), the National Health Authority (NHA) has revised the Health Benefits Package (HBP) by introducing a tiered incentive system to make package rates more attractive and viable for private sector healthcare providers.
Under the new plan, corporate hospitals in tier-I cities will receive a 10% incentive over and above the reimbursement of the cost of treatment, with an additional 15% for those fully accredited by the National Accreditation Board for Hospitals & Healthcare Providers (NABH).
In tier-II and III cities, hospitals will receive a 5% incentive and an additional incentive if they are NABH qualified.
Furthermore, hospitals in any city can earn up to an additional 10% incentive if they run a medical college. Incentivization will be provided to hospitals above and beyond the rates defined in the HBP.
Also read | Centre’s telemedicine service- eSanjeevani’ integrated with NHA’s Ayushman Bharat Digital Mission
HBP is a set of packages under PM-JAY that provides health coverage to eligible families. It includes a variety of medical procedures, including surgeries, diagnostics, and other services. The scheme offers policy holders 1,949 procedures under 27 different specialties.
“We have implemented a tiered structure based on the cities to attract more private hospitals by enhancing the health benefit package rates,” a senior NHA official said. For tier-1 cities, the health benefits package rates are 10% higher than the standard rates, and the bigger private hospitals fully NABH accredited will get a 15% additional incentive. Also, all the big corporate hospitals are in tier-1 cities. So, overall, a hospital will get an incentive of 25-30% over and above the claim reimbursement.
“We have added oncology and palliative care health packages. The main thing was the stratification of the package. Earlier, the same rate was applied to hospitals throughout the country. Hospitals expressed their disappointment about the health package rate in metro cities and those in tier-III cities. So that is why the tier system has been introduced. So, now the hospitals will be in a decent situation,” the official said.
Queries sent to the health ministry remained unanswered till press time.
Currently, the premium per family is ₹1,052 per year, which is shared between the Union and state governments in a 60:40 ratio.
Meanwhile, NHA is gearing up to implement PM-JAY in Delhi. NHA and the state government of Delhi will urge corporate hospitals to participate in the scheme as Delhi is one of the hubs of corporate hospitals.
The Delhi government has approved a decision to join the PM-JAY and provide poor and vulnerable families with an annual health cover of ₹5 lakh with a top-up of another ₹5 lakh. As part of the plan, the Centre will provide an initial ₹5 lakh, while the Delhi government will provide the balance ₹5 lakh.
