Parliament Question: Free Health Insurance to BPL People

GOVERNMENTOFINDIA MINISTRYOFHEALTH AND FAMILYWELFARE DEPARTMENTOFHEALTH ANDFAMILYWELFARE LOK SABHA UNSTARREDQUESTION NO. 2087 TOBE ANSWERED ON01STAUGUST,2025 FREE HEALTH INSURANCE TOBPLPEOPLE

2087. SHRIPVMIDHUN REDDY:

Will the Minister of HEALTHAND FAMILYWELFAREbe pleased tostate:

(a) whether the Government is considering any policy measures to provide free health insurance to categories of people Below Poverty Line (BPL) given that almost 28 percent of the populationinIndia isbelow the povertyline;

(b) if so, the detailsthereofand if not,the reasons therefor;

(c) whether the Government is raising awareness about health insurance and counteract misconceptionssurrounding it so that more people maytake it up; and

(d) if so, the detailsthereofand if not,the reasons therefor? ANSWER THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND FAMILYWELFARE

(SHRIPRATAPRAOJADHAV)

(a) and (b): Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a flagship scheme of the Government which provides health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization to 12 crore families constituting economicallyvulnerable bottom 40% of India’spopulation.

In March 2024, the eligibility criteria were expanded to include 37 lakh Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs), Anganwadi Helpers (AWHs), and their families. Recently, the scheme hasbeen expanded tocover 6crore senior citizens of age 70 years and above belonging to 4.5 crore families, irrespective of their socio-economic status, through VayVandanacard.

The keyfeaturesof AB-PMJAYare asunder:  Provides ₹5 lakh annual health cover per eligible family for 1,961 procedures across 27specialties.  Fullycashless andpaperless. Entitlement-based, coveringall eligiblefamiliesfrom dayone without enrolment.

 Benefitsare portable across the country.  No capon familysize, age,or gender.  Implemented through a three-tier model—National Health Authority, State Health Agencies, andDistrict Implementation Units.

 Funded by the Government with cost-sharing between Centre and States/UTs as per the extantdirectivesissued by Ministry of Finance, from time totime.  States/UTs have flexibilityinoperational models—Insurance, Trust or Mixed mode.

 Under AB-PMJAY, regular updation such as inclusion of new procedures, empanelmentofnewhospitals,inclusionofnewbeneficiariesandotherimprovements aredoneasperrequirementsfromtimetotime.

(c) and(d): Insurance Regulatoryand Development Authority of India (IRDAI) has informed that insurers are mandated to have in place a board approved policy for protection of policyholders’ interests which interalia shall include establishing a mechanism to create Insurance Awareness on an ongoing basis so as to educate prospects and policyholders about insurance products, benefits and their rights and responsibilities. The insurers are required to reviewthe policyannually.

Further, in order toenhance the awareness of the prospects/policyholders about the coverage, features, benefitsof the products, insurers are mandatedfor the following: i. toissue theprospectusforeveryretailproduct includingridersor add-ons,explaining allthe benefits, features, termsandconditionsof the product,andmake availablesuch prospectus ontheirwebsite.

ii. toputinappropriate frameworktoensurethatthe features, benefitsalongwithterms and conditions of the products being sold are represented correctly and fully and that the productsare not mis-stated or misrepresented toprospects or policyholders;

iii. to have in place well defined service parameters, turnaround times, procedure for expeditious resolution of complaints, steps to prevent mis-selling and un fair business practice; iv. to issue of a concise and updated Customer Information Sheet (CIS) to the policyholders with a view toenhancethe awareness of policyholderabout the benefits covered,termsandconditionsof the policy.

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