Assam’s New Health Insurance Scheme

Can Be A Model For Other States To

Follow

The Atal Amrit Abhiyan(AAA),named after former prime minister Atal

Vihari Bajpayee is a comprehensive health insurance rolled out by the
Assam government. It is touted as a game changer for the uninsured
mass of the state,especially people below poverty line(BPL). The
scheme which was inaugurated on 18th April by Vice President M
Venkaiah Naidu will provide coverage to around 92% of the state
population.

The Health Insurance Scheme, a brainchild of Himanta Biswa Sarma,

the state health minister, will cover the cost of treatment including
surgery of six disease groups and conditions: cardiovascular, cancer,
kidney, neurology, neonatal and burns. At the threshold, around 23
hospitals, both government and private apart from 13 super-speciality
hospitals in major metros- Kolkata,Delhi,Chennai and Bengaluru ,have
step up to provide medical benefits. For a sum of up to 2 lakh a
person can avail free treatment for a total of 438 procedures at these
hospitals. The goal of the health ministry is to empanel more hospitals
within and outside the state soon.
Apart from all adult members of all BPL (below poverty line) families in
the state, APL (above poverty line) families whose annual family
income is up to Rs 5 lakh will be covered by the scheme. Enrolment
kiosks have been set up in all district headquarters and 1.5 crore
beneficiaries have already been enrolled. After providing citizenship
documents, applicants will have their biometrics recorded and
embedded in a smart card that will be given to them and will have to
be produced to avail of benefits under the scheme. Children up to 18
years of age belonging to eligible families will not be issued separate
cards, but their names and biometric information will be tagged in the
AAA card of the head of the family.

The novelty of Assam’s health insurance scheme lies in its user-

friendliness. A 24x7 AAA call centre has been set up to guide
beneficiaries. Besides, help desks have been set up in all empanelled
hospitals and these will be manned by arogya mitrasround the clock.
“These arogya mitras will do the necessary hand-holding and shall
ensure that the patients or their accompanying attendants do not face
any problems. They will be the interface between the patients and the
empanelled hospitals,” said Sarma. He added that a lot of attention
will be given to ensure that patients covered by the scheme have a
seamless treatment experience in the empanelled hospitals. A round-
the-clock feedback and grievance redressal mechanism has also been
set up and senior officers of the health department as well as senior
doctors of government hospitals in the state will monitor the scheme
very regularly. Sarma said he would also personally monitor and
review the functioning of the scheme at regular intervals.

Beneficiaries who want to avail treatment in the empanelled hospitals

outside the state can call the AAA call centre, which will make all
necessary arrangements, including travel to the hospital outside the
state. Beneficiaries will be entitled to round-trip airfare of a maximum
of Rs 30,000 for treatment outside the state and a daily allowance of
Rs 1,000 a day for a maximum of 10 days. Within Assam, a patient
and an attendant will get a travel allowance of Rs 300 per visit to an
empanelled hospital subject to a maximum of Rs 3,000 a year.

Another unique feature of AAA is that unlike some other states’ health
insurance schemes, all diagnostic tests done 24 hours prior to the
admission of a beneficiary patient will be covered by it. “All one needs
to avail cashless treatment in any of the empanelled hospitals is the
AAA smart card which will have the beneficiaries’ data stored in them,”
said Sarma, adding that Rs 400 crore has already been allocated for
the implementation of the scheme in the current fiscal. Funds, he
added, will be no constraint. While the AAA scheme has been fine
tuned in consultation with government doctors and private healthcare
providers over the past few months, Sarma says that further fine-
tuning can be carried out whenever necessary. “Our prime concern is
to make it completely user friendly and fully responsive to the needs of
patients and their families,” he said.