Rise in claims may increase insurance premium under Ayushman Bharat in Tamilnadu

Tamil Nadu, which has integrated the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) with the Centre’s Ayushman Bharat scheme, has submitted 1.25 lakh claims so far totaling Rs. 274 crore. United India Insurance, the State’s insurance partner for the earlier CMCHIS, currently charges a premium of Rs. 699 per cover, which is borne by the State (under Ayushman, it is split between the Centre and the State in 60:40 ratio for 77 lakh beneficiaries).

The existing tender comes up for renewal in 2022. The fact that the State’s health scheme has been in operation for over seven years, and claims have more or less stabilised, lends comfort on the premium front. But integration of Ayushman with CMCHIS is likely to increase awareness and also lead to substantial rise in claims over the next two to three years. This could increase the premium costs significantly when the tender comes up for renewal.

Ayushman Bharat Scheme provides a wider coverage compared to CMCHIS.

Ayushman covers 1,393 procedures, while CMCHIS covered 1,027 packages. About 335 packages fall under both schemes, while 635 are covered in one and not the other. All three types – totaling 970 – are clubbed and covered under the new integrated health scheme called PMJAY-CMCHIS.

“The remaining 423 packages (1,393 less 970) have been reserved only for government hospitals. These are mainly low-end procedures. The re-jigging of the packages in such a way ensures minimal burden on the insurer as the procedures reserved for government hospitals are zero packages,” explains Selvavinayagam.