Why in News?
The government has told insurers that they will be under obligation to return part of the premium collected if they fall short of the 85-per cent claim ratio.
FACTS FOR PRELIMS
Claim ratio is calculated as the total value of all claims paid by the company divided by the total amount of premium collected in a financial year. A claim ratio of 75-90 is usually thought to be an indicator of a robust claim settlement system by an insurer.
Insurers in the National Health Protection Mission (NHPM) will have to return a share of the premium collected from the government for failing to meet a healthy claim ratio.
For any claim ratio below 85 per cent, the insurers can keep a maximum of 15 per cent of the unclaimed premium and return the rest to the government.
Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization.
Ayushman Bharat – National Health Protection Mission will subsume the on-going centrally sponsored schemes – RashtriyaSwasthyaBimaYojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
For giving policy directions and fostering coordination between Centre and States for implementation of the scheme, Ayushman Bharat National Health Protection Council (AB-NHPMC) will be set up at apex level. It will be chaired by Union Health and Family Welfare Minister.
State governments are allowed to expand scheme both horizontally and vertically. They are also free to choose modalities of its implementation. They can implement through an insurance company or directly through Trust/ Society or a mixed model.
Source-The Indian Express