Srinagar, October 14: In a press conference held today, Secretary for Health and Medical Education Bhupinder Kumar addressed questions and claims about the Pradhan Mantri Jan Arogya Yojana-SEHAT (PMJAY-SEHAT) programme’s execution.
A loss of Rs 500 crore was one of the main charges. The government said that during the policy term, which lasted from December 26, 2020, to March 14, 2022, total premiums paid to Bajaj Allianz General Insurance Company (BAGIC) were Rs. 304.59 crores, while BAGIC paid out Rs. 398.41 crores in total claims to hospitals (both public and private). As a result, the claim of a loss is unfounded since the insurance company suffered a 93.82 crore loss in money.
Misinformation has also been spread about the contract renewal and termination clauses. The State Health Agency and BAGIC entered into a contract with a maximum duration of three years, renewed every 12 months. The insurance company opted to end the contract after the first year owing to financial losses, even though the contract called for its extension beyond the first year to be based on mutual consent.
The State Health Agency of J&K agreed to a temporary agreement with BAGIC on a stop-loss basis until a new insurance provider was chosen in order to prevent service interruptions. The government assumed full responsibility for the loss of claims at this time. By guaranteeing the continuation of healthcare services, the partnership served the public interest and was economically advantageous.
The government stated that, contrary to claims that the number of eligible families was increased to the insurance company’s advantage, the number of eligible families remained constant throughout the policy period, which ran from December 26, 2020, to December 25, 2021, and the subsequent interim period of 79 days, totaling 21.24 lakhs.
In order to execute the plan, the government of J&K made a point of following the National Health Authority (NHA), Government of India, instructions. This covers the adoption of the Health Benefits Packages (2.2 version) for implementation as well as the usage of the Model Tender Document for the open selection of insurance providers.
The government has given insurance firms premium payments of Rs. 1175.32 crore since the PMJAY-SEHAT plan was introduced. In exchange, insurance companies paid out Rs. 1,249.33 crore in claims to hospitals that had signed up for their services, helping around 5.67 lakh patients. For individuals with fatal and life-threatening illnesses, the programme has provided essential medical treatment.
The risk has been transferred to insurance firms as a result of the insurance model, and as a result, they have agreed to pay about Rs. 74 crores to accredited public and private hospitals in addition to the premium. This concept has improved the UT healthcare system and greatly decreased out-of-pocket costs for families that need hospitalisation.
Nearly 99% of patients gave their treatment experience an Excellent or Good rating utilising a feedback method that combines QR codes and a 104 Call Centre.
The government emphasised that the accusations made against the plan are unfounded, inaccurate, and meant to damage its reputation. It reaffirmed its commitment to provide the public with access to high-quality healthcare services.
Ramesh Kumar, Divisional Commissioner for Jammu; Vishal Sharma, Additional Secretary in the Chief Secretary’s office; Naresh Kumar, Joint Director for HQ Information; and Dr. Vikas Sharma, Deputy Director for Information PR in Jammu, were also present at the press conference.
