Modicare will offer 15%-20% lower costs for common treatments compared to CGHS scheme

The government-sponsored National Health Protection Scheme (NHPS), popularly known as Modicare, will offer common treatments such as coronary bypass, knee transplant and C-section at a rate which is around 15%-20% lower than Central Government Health Scheme (CGHS), which provides comprehensive medical care to government servants, pensioners and their dependants.
 
The health ministry has finalised the rates for 1,354 packages, which will be covered under NHPS. The packages include 23 specialties such as cardiology, ophthalmology, orthopaedics, urology and oncology, etc.
 
The health insurance scheme aims to cover nearly 50 crore beneficiaries from over 10.74 crore “deprived” families as per socio-economic and caste census (SECC) data with an annual health cover of Rs5 lakh per family per year. This cover will take care of almost all secondary care and most tertiary care procedures. There is no cap on family size and age in the scheme, ensuring that nobody is left out. Prime Minister Narendra Modi is expected to launch the scheme on 15 August 2018.
 
The basic risk cover includes hospitalisation expenses such as registration, nursing and boarding charges in general ward. Besides, consultation fees, surgical equipment and procedure charges and cost of implants, medicines, diagnostic tests and food to patients are also covered. The scheme also covers follow-up care along with pre- and post-hospitalisation expenses.
 
In case of multiple surgeries, the highest package rate will be waived for the first treatment, and 50% and 25% of the package rate will be provided for the second and third treatment. The rest will be borne by the policy holder.
 
The rate for vertebral angioplasty with single stent has been fixed at Rs50,000, whereas that with double stent will cost Rs65,000. Similarly, the price for total knee replacement is fixed at Rs80,000, whereas a C-section will be charged at Rs9,000. The list also includes paediatric surgeries, different packages for cancer treatment as well as mental disorders.
 
For comparison, an angioplasty would cost about Rs1.5-Rs2 lakh, a C-section around Rs1.5 lakh and a total knee replacement would cost around Rs3.5 lakh in any of the reputed private hospitals in Delhi city.
 
The policy document, finalised after consultation with Niti Aayog and Indian Council of Medical Research (ICMR), details the minimum number of days of hospitalisation required to make a claim as well as pre-surgery and post-surgery investigations needed for approval. The policy document has been shared with state governments for comments. It will also be circulated among the bidding insurers by the state governments.

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