JAMMU: The execution of the Pradhan Mantri Jan Arogya Yojana – SEHAT (PMJAY-SEHAT) scheme has been the subject of complaints and claims, according to the Secretary of Health and Medical Education, Bhupinder Kumar, who spoke at a news conference today. One of the main accusations included a loss of 500 billion rupees. According to the government, the entire premium paid to Bajaj Allianz General Insurance Company (BAGIC) for the policy period of December 26, 2020, to March 14, 2022, was Rs. 304.59 Crores, whereas 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 because the insurance company suffered a 93.82 crore loss in money.There has also been misinformation spread regarding the contract renewal and termination clause. The maximum duration was specified at three years and was renewed every 12 months, as per the agreement between BAGIC and the State Health Agency. The contract said that any extension beyond the first year would be subject to mutual agreement; nevertheless, the insurance company chose to end the partnership after the first year due to financial losses. The State Health Agency of J&K agreed into a temporary Stop Loss agreement with BAGIC in order to prevent service interruptions until a new insurance provider was chosen. The government took on all of the risk of losing claims during this time. The agreement serves the public interest by ensuring the continuity of healthcare services at a reasonable cost.According to the government, the number of eligible families remained the same 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 defiance of claims that it was increased to the insurance company’s advantage. The National Health Authority (NHA), Government of India, issued instructions for the execution of the scheme, which the Government of Jammu and Kashmir emphasised it would follow. This includes adopting the Health Benefits Packages (2.2 version) for implementation and using the Model Tender Document to transparently choose insurance providers.The government has paid insurance firms a total of Rs. 1175.32 Crores in premiums since the PMJAY-SEHAT scheme was introduced. In exchange, insurance companies paid out claims to affiliated hospitals totaling Rs. 1,249.33 crores, helping around 5.67 lakh patients. Patients with fatal and life-threatening illnesses have received critical medical attention thanks to the programme. The risk has been transferred to insurance companies as a result of the insurance model, which has caused them to pay almost Rs. 74 crores in addition to the premium to accredited public and private hospitals. The UT’s healthcare system has been reinforced by this model, which has also greatly decreased out-of-pocket costs for families who need hospitalisation.Additionally, a 104 Call Centre and a feedback system utilising QR codes have been put into place, and nearly 99% of patients gave their treatment experience an Excellent or Good grade. The government emphasised that the accusations are unfounded, fraudulent, and meant to damage the scheme’s reputation. It reaffirmed its dedication to offering the general population high-quality healthcare services. Jammu Divisional Commissioner During the press conference, Dr Vikas Sharma, Ramesh Kumar, Additional Secretary in the Chief Secretary’s office, Vishal Sharma, Joint Director of HQ Information, Naresh Kumar, Deputy Director of Information PR Jammu, and others were also present.
