With states expected to contribute 40% towards funding the ambitious National Health Protection Scheme announced in the Budget, officials from the health ministry and Niti Aayog are now holding consultations with state officials, two weeks after the plan was announced.

While statements from two state governments – West Bengal and Karnataka – have raised doubts about whether they will actually join the scheme, health officials from Tamil Nadu and Kerala have told Scroll.in that they will seek clarifications from the Centre on various aspects of the plans. These range from the integration of the NHPS with existing state insurance schemes, the contribution by states towards insurance premiums, the Centre’s contribution towards administrative support and how the scheme would ensure insurance portability across states.

On Tuesday, West Bengal Chief Minister Mamata Banerjee, speaking at a public meeting in Krishnanagar, reportedly declared that the state had already started programmes for free treatment and hospitalisation and will not waste its resources on contributing to the NHPS. However, West Bengal’s principal secretary for health Anil Verma told the Indian Express that state health officers were at the meeting on the NHPS called by the centre.

On Thursday, Karnataka Health Minister Ramesh Kumar said that the Karnataka would focus on its own universal health assurance scheme that would be launched at the end of the month. The Karnataka government is proposing to bring seven existing state and central health schemes that are currently underway under one umbrella in this health assurance scheme.

Finance Minister Arun Jaitley announced the National Health Protection Scheme in his budget speech on February 1. The scheme is supposed to cover 10 crore families – that is 50 crore people or 40% of India’s population – providing up to Rs 5 lakh cover per family per year. The Centre has said that the NHPS will need funding of Rs 10,000 crore annually, 60% of which it will provide, leaving states to contribute the remaining 40%.

What happens to state schemes?

States like Kerala, Tamil Nadu, Andhra Pradesh, Telangana, Madhya Pradesh, Chhattisgarh and Rajasthan already have their own health insurance schemes. Many other states provide health insurance to below poverty line families through the Rashtriya Swasthya Bima Yojana – the existing national health insurance programme – while some states currently do not provide any public health insurance. States that already provide public health insurance will have to figure out how to integrate the NHPS with the existing schemes.

For instance, the Kerala offers health insurance under the Rashtriya Swasthya Bima Yojana that provides cover of Rs 30,000 and and a state level insurance programme providing cover upto Rs 2 lakhs. In an email to Scroll.in Rajeev Sadanandan, additional chief secretary for health at Kerala’s department of health and family welfare, said that Kerala will participate in the NHPS and will like to use whatever financial contribution it can get from the centre.

“We will continue with [the existing scheme] and cover an additional 30 Lakh families (in addition to the 20-odd lakhs supported by centre upto 60%). We might top it up for Rs 3 lakhs with the additional amount announced by the centre,” he said.

Similarly, Tamil Nadu, which has its own health insurance programme, is looking for details as to how its can use NHPS will to increase insurance cover in the state.

“Tamil Nadu already has a highly successful health insurance scheme and experience of an insurance model since 2009, which covers 1,027 procedures, 134 follow up procedures and 38 diagnostic procedures,” said J Radha Krishanan, health secretary for Tamil Nadu. “Since our present insurance scheme is there for the next four years we are more concerned and interested in knowing how the existing scheme can be integrated with the NHPS.”

Kerala is looking to the centre to clarify on the contribution specifically towards insurance premium and how much support it will get from the centre for administrative costs. Kerala is also looking for clarifications on states’ contribution to the insurance premium under the NHPS, particularly if they choose to run the program directly and not through an insurance company.

Portability across states

Other questions that states are likely to raise at the NHPS meeting with union health ministry and Niti Aayog officials are those of portability of insurance for people migrating between states and how the schemes will be branded.

“We might not have an issue of co-branding and we can iron out issues with regard to portability and procedures that may not fall under either system,” said Radha Krishnan.

“We might not have an issue of co-branding and we can iron out issues with regard to portability and procedures that may not fall under either system,” said Radha Krishnan.

Sadanandan said, “Portability will be difficult but if source states would like to cover migrants we will give them portability into Kerala.”

When asked about branding the schemes, he said, “We are not too bothered about claiming political credit.”