Fraud Mitigator No 01) – All Ayushman Mitras be provided with
India Post Bank Account. All the amounts due to Ayushman Mitras will be
credited to the India Post Bank account only.
There will be no need for the Disbursement
Office to deal with multiple banks.
Fraud Mitigator No 02) All the Family Card Holders be provided
with India Post Bank Account. The India Post Bank Account can be the unique
identifier in the AB-PMJAY database.
De-duplication will be done by India Post
Bank team before opening the India Post Bank Account.
All credits and debits under AB-PMJAY to
the eligible beneficiaries will be to the India Post Bank account only.
Ayushman Bharat comprises twin missions:
i. Operationalizing 1.5 lac health and
wellness centers offering preventive and primary care, on the supply side;
ii. Financial protection of up to 5 lacs
per year per family for the deprived 10 crores plus households towards
secondary and tertiary care, on the demand side. Today, Shri Narendra Modi set
the ball rolling for AB-PMJAY at Ranchi.
Rolling out the ambitious Ayushman Bharat
scheme on Sunday from Ranchi, Prime Minister Narendra Modi said the total
number of beneficiaries in this scheme would exceed the combined population of
US, Canada and Mexico.
Speaking at the launch, PM Modi said
Pradhan Mantri Jan Arogya Yojana-Ayushman Bharat was a "game-changer
initiative to serve the poor".
The scheme comes into effect from Sunday
i.e 23 Sept 2018
"PMJAY-Ayushman Bharat is the biggest
government-sponsored healthcare scheme in the world. The number of
beneficiaries is almost equal to the population of Canada, Mexico and the US
taken together," Modi said.
"No one needs to register for the
initiative. A health card would be provided to the beneficiaries for availing
of the benefits. A toll-free number will be made available to the people for
finding out more about the scheme," he said.
The Ayushman Bharat scheme will target
poor, deprived rural families and identified occupational category of urban
workers' families, 8.03 crore in rural and 2.33 crore in urban areas, as per
the latest SECC (Socio Economic Caste Census) data.
Like it or not, world over, health
insurance schemes/ programs are prone to fraud, abuse and leakages which have
to be nipped in the bud.
It is a cat and mouse game between the
Insurance implementation agency and the fraudsters.
National Health Agency (NHA), the nodal agency
for providing technical and managerial oversight to AB-PMJAY, has already started
the work to minimise frauds in AB-PMJAY.
NHA is clear on zero tolerance approach
towards fraud.
Frauds not only impact the program
financially but also often lead to endangerment of people’s health. Therefore, NHA
is determined to prevent, detect and deter fraud effectively through robust
processes, trained manpower and timely action backed by state-of-the-art IT
systems.
In this regard, NHA has released an Invitation
for Industry Consultation on Fraud Control under AB-PMJAY.
Ayushman Mitras are the human interface
between the patients and the empanelled institutions.
Ayushman Mitra Training Course
Aligning to Hon. Prime Minister Shri Narendra
Modi’s visions to provide universal health coverage to all Indians and to make
India, the skill capital of the world, an initiative was announced between
Ministry of Skill Development and Entrepreneurship and Ministry of Health and Family
Welfare where One Lakh Arogya Mitras will be trained by Skill India supporting
the recently announced Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana
(PMJAY).
Under PMJAY, NHA needs to empanel public
and private hospitals to provide health care services; it has been proposed to
hire/depute Arogya Mitra at each Empaneled Health Care Provider (EHCP) to
provide support in:
(i)
Beneficiary verification
(ii)
Beneficiary authentication (with internet and without internet)
Beneficiary
query management
(iv)
Grievance redressal, and
(v)
Handling emergency cases
National Skill Development Corporation
(NSDC), under the aegis of the Ministry of Skill Development and Entrepreneurship
(MSDE) and National Health Agency (NHA), have signed the MoU wherein the duo
will target to train these One Lakh Arogya Mitras utilizing Pradhan Mantri
Kaushal Kendra (PMKK) and other Skill Development Centres under the MSDE Skill
India Framework.
PMJAY has defined 1,350 medical packages
covering surgery, medical and day care treatments including medicines,
diagnostics and transport. The course module includes 45 hours of training (Online
and Oneto-one hands on training).
NSDC has already conducted pilot training
in select States to assess the impact and learnings. Training of Master
trainers has also been conducted to support training sessions across the country.
These Arogya Mitras will be the first level
of interface for the beneficiaries of the PMJAY, hence the quality of skilled
workforce will be critical to the success of the scheme.
The
funding of the trainings will be done under Pradhan Mantri Kaushal Vikas Yojana
(PMKVY).
Benefits to Ayushman
Mitras
For all the AMs working in public
facilities, benefits shall be paid by the SHA selected agency. The AMs shall receive
the following benefits:
●
Honorarium of Rs. 5,000
●
A commission of Rs. 50 on completion of every processed claim including the
verification and storage of beneficiary as a golden record.
The
variable commission will be paid from the Rogi Kalyan Samiti/NHM Funds. The
commission offered will be valid for an initial period of 2 years. The commission
offered shall be subjected to a review after 2 years.
●
Provision of Mobile Closed User Group (CUG) network by the Third-Party Agency
selected by the SHAs
For
all the AMs working in Private EHCP, benefits shall be paid by the Private EHCP
itself. The nature of benefits should be decided by the Private EHCP
Placement of Ayushman
Mitras
AMs will be placed at every public EHCP by
the agency selected by the SHA. The exact numbers of AMs to be placed shall be
dependent on the average case-load per day.
A tentative placement of AM based on cases registered
per day is given below.
(i)
0-10 Cases – 1 AM
(ii)
10-20 Cases – 2 AMs
(iii)
20-30 Cases – 3 AMs
(iv)
30-40 Cases – 4 AMs
After the initial placement, AMs shall be
reshuffled every 6 months within the same city /town as far as feasible.
The reshuffling of AMs shall be done by the
selected agency in consultation with the SHA officials.
Ayushman Bharat NHPM (AB-NHPM) Information Letter & Family
Card
AB-NHPM Information Letter & Family Card
means a printed letter for the beneficiary household with information about
AB-NHPM along with a perforated family card indicating the names of the family
members.
The QR code should have ABNHPM Unique ID –
AHL TIN (or any other key identifier so identified by NHA) embedded in it.
The
AB-PMJAY Family Card is the link between the identified beneficiaries and the AB-PMJAY
scheme.
The
AB-PMJAY Family Card will contain all the name of the family members eligible
for treatment under AB-PMJAY scheme.
The National Health Stack envisages the
creation of a unique ID for registered beneficiaries in the system — a ‘Digital
Health ID’. Upon the submission of a ‘national identifier’ and completion of
the Know Your Customer process, the patient would be registered in the system,
and a unique health ID generated.
Additional Reading:
Invitation
for Industry Consultation on Fraud Control under AB-PMJAY
