The National Health Authority (NHA) has tied up with the Employees’ State Insurance Corporation (ESIC) for interoperability with PMJAY.
This means that any PMJAY beneficiary can be treated at an ESIC empanelled hospital and vice versa. Reimbursements will be made by the NHA or ESIC depending on the beneficiary’s entitlement but at PMJAY rates.
This, officials say, is the first step in bringing all government health schemes under a single umbrella, a vision that was presented by NHA CEO Indu Bhushan at the Ayushman Bharat Manthan event last week, which was addressed by Prime Minister Narendra Modi.
NHA had a meeting with the Health Ministry to work out the arrangement with the Central Government Health Scheme (CGHS) that covers all Central government employees.
The Employees’ State Insurance Act, 1948 (ESI Act), the first major legislation on social security for workers in independent India, encompasses certain health-related eventualities that factory workers are generally exposed to, such as sickness, maternity, temporary or permanent disability, occupational disease or death due to employment injury, resulting in loss of wages or earning capacity, total or partial.
ESIC currently covers 13 crore people through 3.5 crore health cards. PMJAY, which is the secondary and tertiary care arm of Ayushman Bharat — the flagship health programme of the NDA government — currently covers 10 crore people but intends to cover about 50 crore.
There are 18,000 hospitals empanelled under PMJAY, which has just completed a year. ESIC runs 147 hospitals of its own, and in addition, there are 1,400 empanelled hospitals. Beneficiaries from either scheme can go to any of these hospitals once the tie-up is enforced.
NHA last week signed two MOUs with ESIC but the final contours of the arrangement are still being worked out. “We will launch it first in some districts and see how it goes. The names will be finalised by the end of the week,” said a senior NHA official.
Sources said the PMO has indicated that it is in favour of all health schemes coming under a common platform. “Right now, the IT platform we have is the best in the country, not even private insurance companies have such a system. That is why we are working towards the eventual integration of all schemes such as CGHS and ECHS,” said an official.