“The Government of India is committed to provide a health cover of Rs 5 lakh for each beneficiary family and thus it is well within the rights of the beneficiary to avail the full cover in case the wallet is getting exhausted and other avenues of funding are available,” the source said, quoting the Governing Board’s decision.
However, to avoid any abuse of such provision, all such cases will first go through the mandatory audit.
For instance, consider a family that has utilised Rs 4 lakh given for treatment under the scheme. However, due to some other emergency, the family needs to go for another procedure and should be able to use the remaining Rs 1 lakh along with its own money.
Or, in case a package cost is higher than Rs 5 lakh such as for lung transplant, the beneficiary may be allowed to use their full wallet along with their self-contribution to avail such treatment under the scheme.
How The NHA Convinced the Governing Board
The NHA had told the Governing Board that with Ayushman Bharat already integrated with schemes such as Rashtriya Arogya Nidhi or Health Minister’s Discretionary Grant, this has created possibilities for funding of expensive treatment procedures.
Further, it said, several states and Union Territories have implemented schemes with provision for higher funding for rare or life threatening diseases.
“It mob therefore, proposed to provide the beneficiary with the option to use other sources of funding over and above the PM-JAY wallet, if required for availing healthcare services,” a senior government official said.
