The Niti Aayog has said that the health insurance scheme that is being implemented in Meghalaya has no mention of income brackets or coverage of the ‘missing middle’.
In its report ‘Health Insurance for India’s Missing Middle’, Niti Aayog said that the benefit packages in Megha Health Insurance Scheme (MHIS) are comprehensive.
“Though there is no mention of income brackets or coverage of the missing middle, the scheme is extensive enough to cover APL families. Benefit packages are comprehensive in terms of the fixed rates available for a variety of treatments,” Niti Aayog said in the report.
The report also said that MHIS is complementary to PMJAY and utilises the framework of RSBY and also promoted to provide financial aid to all the citizens of the State at the time of hospitalisation and reduce the out-of-pocket expenses.
The MHIS target population is for both BPL citizens and APL citizens and the sum assured after the convergence with PM-JAY is Rs 5 lakh per family per year on a floater basis.
There are 630 packages containing fixed rates for various treatments across specialities.
The Niti Aayog report also stated that at least 30 per cent of the population or 40 crore individuals, called the ‘missing middle’, are devoid of any financial protection for health.
The ‘missing middle’ is a broad category which lacks health insurance, positioned between the deprived poorer sections, and the relatively well-off organised sector. The deprived and poor sections receive government subsidised health insurance, while the relatively well-off in the organised sector of the economy are covered under social health insurance, or private voluntary insurance.
“The missing middle refers to the non-poor segments of the population who remain prone to catastrophic, and even impoverishing health expenditure, despite the financial capacity to pay for contributory health insurance,” the report said.
Niti Aayog said the ‘missing middle’ constitutes the self-employed (agriculture and non-agriculture) in rural areas, and a broad array of occupations – informal, semi-formal, and formal – in urban areas.
Niti Aayog also said that the expansion of health insurance or assurance coverage is a necessary step, and a pathway in India’s efforts to achieve Universal Health Coverage (UHC).
“Around 20 per cent of the population – 25 crore individuals are covered through social health insurance, and private voluntary health insurance. The remaining 30 per cent of the population is devoid of health insurance; the actual uncovered population is higher due to the existing coverage gaps in PM-JAY and overlap between schemes,” said the report.
In the absence of a low-cost health insurance product, the ‘missing middle’ remains uncovered despite the ability to pay nominal premiums, said the report.
The report further suggests that a comprehensive product designed for this segment, which may be an improvement upon the existing Aarogya Sanjeevani plan and offering the patient cover, can expand the health insurance coverage.