Modicare cut prices around 15-20% from CGHS for medical services

The Indian government-sponsored scheme “National Health Protection Scheme (NHPS)”, known as Modicare will cover the new 1,354 fixed rate packages which are around 15-20% lower from the prices set by Central Government Health Scheme (CGHS).

Medicare News

The Indian government-sponsored scheme “National Health Protection Scheme (NHPS)”, known as Modicare will cover the new 1,354 fixed rate packages which are around 15-20% lower from the prices set by Central Government Health Scheme (CGHS).

The prices for 1,354 packages, include 23 specialties such as cardiology, ophthalmology, orthopedics, urology, and oncology, etc. are finalized by the Indian health ministry.The government doing its best to provide quality health services to Indian citizens at the best affordable price and in that move, government set new pricing standards for medical procedures which will be 15-20% lower than CGHS prices.

Now, with new rates people can get services like coronary bypass, knee transplant and C-section at lower rates than CGHS. CGHS scheme is working to provide comprehensive medical care to government servants, pensioners and their dependents at affordable rates.

With the new pricing, the government has fixed the prices like vertebral angioplasty with single stent will cost you only Rs 50,000 fixed, and with the double stent, its price will be fixed Rs 65,000. 80,000 fixed price for the total knee replacement and C-section will be charged at Rs 9,000 fixed.  The new list also includes the prices of other surgeries like pediatric surgeries, cancer treatment packages as well as mental disorders etc.

At present, if you get treatment for vertebral angioplasty, knee replacement, c-section, or any surgeries will cost you like Rs 1.5-2 lakh, Rs 1.5 lakh, and Rs 3.5 lakh respectively in any of the reputed private hospitals in Delhi. So, you can easily see the benefit of new fixed price scheme by Modicare.

This scheme is a part of the model tender document for the Pradhan Mantri Rashtriya Swasthya Suraksha Mission.

The list has been finalized after the approval of Niti Aayog and Indian Council of Medical Research (ICMR) and shared with the state governments to share their comments. The complete document also provides details how the patient can get benefit from it and the minimum number of days of hospitalization required to make a claim as well as pre-surgery and post-surgery investigations needed for approval. The list also has been circulated among the bidding insurers by the states.

Indu Bhushan, chief executive of Ayushman Bharat shared that the prices decided on the basis of the current rates of CGHS and Rashtriya Swasthya Bima Yojana (RSBY) and on average  fixed prices are 15-20% lower than that of CGHS. Every beneficial has limited price cover that he or she can avail and with the lower prices simply help beneficiaries to opt for more number of procedures under the same cover if required or can even enroll more family members for treatment.

Health expenditure will go down with this scheme and also produce pressure on healthcare providers to lower their rates for the general public.  

Besides that, The health insurance scheme introduced soon which aims to benefit nearly 50 crore beneficiaries with an annual health cover of Rs 5 lakh per family per year from over 10.74 crores “deprived” families as per socio-economic and caste census (SECC) data. This health cover amount can be used on almost all secondary care and most tertiary care procedures. This scheme is also free from family size and age cap, ensuring that nobody is left out.

The scheme is prepared with taking care of all the charges like hospitalization expenses such as registration, nursing, and boarding charges in general ward and will cover under the basic risk cover. It also includes consultation fees, surgical equipment and procedure charges and cost of implants, medicines, diagnostic tests and food to patients. Besides all, the scheme also covers follow-up care along with pre- and post-hospitalization expenses.

Let’s understand if a policyholder needs to undergo multiple surgeries, then the package with the highest rate will be waived for the first treatment, and then 50% and 25%  waived off on the subsequent package rate. The policyholder will pay the remaining amount.

This scheme expected to be launch on August 15, 2018, by the Prime Minister Narendra Modi.


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