The flagship scheme of the central government provides a cashless cover of up to ₹500,000 per family per year for secondary and tertiary care hospitalization to over 107.4 million poor and vulnerable families (about 530 million beneficiaries).

The governing board of National Health Authority (NHA), the implementing body of the scheme, on Thursday gave a go-ahead to conduct insurance pilots for covering ‘the missing middle’ or non-poor population of the country comprising varied sections such as informal sector workers, self-employed, professionals, employees in micro, small and medium enterprises (MSMEs etc that is spread across occupations, geography and income strata, utilizing the AB PM-JAY framework).

Union minister of health and family welfare Harsh Vardhan chaired the meeting aimed at reviewing the implementation of AB PM-JAY.

The government said that the insurance pilots for ‘the missing middle’ will help in understanding what works and what doesn’t, the complexities of self-pay covers on voluntary basis — especially for people engaged in informal sector — issues regarding adverse selection, health-seeking behaviour, affordability, reach and distribution, healthcare supply side participation, economies and efficiencies, customer feedback and other mechanisms etc.

Among the major agenda items discussed during the meeting was the impact of covid-19 on AB PM-JAY, ways to resolve the challenges that arose out of the pandemic in healthcare delivery and the performance of empanelled private healthcare providers in different states with respect to the pandemic.

The NHA governing board approved the proposal to integrate existing health schemes of central ministries with AB PM-JAY to employees including government and contractual staff and other beneficiary groups such as building and construction workers, manual scavengers, road accident victims and central armed police force personnel.

The governing board also gave in-principle approval for implementation of any healthcare scheme for employees including government employees and other beneficiaries extended by central ministries/ departments/ PSUs/ Autonomous bodies, based on their request, to be implemented on a common Ayushman Bharat platform.