Ayushman Bharat beneficiaries not covered under various packages of the insurance programme and requiring high-cost treatment will be able to get financial assistance of up to Rs 15 lakh under the Rashtriya Arogya Nidhi (RAN) scheme, according to an office memo.

The Union health ministry has issued revised guidelines of the umbrella scheme of RAN in the wake of complaints that poor patients suffering from life-threatening diseases have not been able to avail treatment under it if they are beneficiaries of the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

The office memo has been sent to all government hospitals, all regional cancer centres, health secretaries of all states, department of expenditure and the National Health Authority (NHA), the apex body implementing the insurance scheme.

“If as per medical advice, the suggested treatment is not covered under any of the approved listed packages of AB-PMJAY, financial assistance up to Rs 15 lakh can be provided to AB-PMJAY beneficiaries out of umbrella scheme of RAN,” the memo said.

In such a situation, the beneficiary will get certified from the respective government hospital that his or her condition is not covered under the AB-PMJAY and thus the patient should be allowed to avail financial assistance under RAN.

What is the purpose of Rashtriya Arogya Nidhi?

Rashtriya Arogya Nidhi (RAN) Society was set up in 1997 to provide financial assistance to patients, living the below poverty line and who are suffering from major life-threatening diseases, to receive medical treatment at any of the super specialty government hospitals / institutes.

Financial assistance to such patients is released in the form of a one-time grant, which is released to the medical superintendent of the hospital in which the treatment has been / is being received.

In 2019, a new umbrella scheme of Rashtriya Arogya Nidhi was formulated. It has three components…

Rashtriya Arogya Nidhi: To provide financial assistance to poor patients living below the threshold poverty line and suffering from life-threatening diseases relating to heart, kidney, liver, etc for their treatment at government hospitals / institutes having super specialty facilities.

Health Minister’s Cancer Patient Fund: To provide financial assistance to poor patients living below the threshold poverty line and suffering from cancer, for their treatment at Regional Cancer Centres (RCCs) / Tertiary Care Cancer Centres (TCCCs) and State Cancer Institutes (SCIs).

Financial assistance scheme for poor patients suffering from rare diseases: To provide financial assistance to poor patients living below the threshold poverty line and suffering from specified rare diseases for their treatment at government hospitals / institutes having super specialty facilities.

The All India Institute of Medical Sciences and the NHA had written to the health ministry suggesting patients deprived treatment under AB-PMJAY could be covered in the RAN umbrella scheme.

They drew the ministry’s attention to cases of patients, who were refused treatment under PMJAY as they were suffering from ailments such as blood cancer, chronic liver disease and required organ and bone marrow transplants which do not figure among the 1,393 medical packages mentioned under the scheme.

Earlier, in November the health ministry had rejected their proposal and rather had suggested the NHA to consider inclusion of transplantation of organs under procedures covered under PMJAY and also enhancing the ceiling of Rs 5 lakh per annum so that patients eligible under PMJAY may avail facilities under the programme only.

The National Human Rights Commission recently had sought a report from the health ministry over complaints about patients holding BPL cards not getting RAN benefits if they availed benefits of AB-PMJAY even if they are suffering from life-threatening diseases whose expenditure is much more than Rs 5 lakh, the maximum permissible limit under the Ayushman Bharat scheme.

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