Clarifies services under both schemes ‘fully operational’
Kohima, January 10 (MExN): The Nagaland Health Protection Society (NHPS), today reassured that the public that the services under both schemes are “fully operational” and not suspended. The NHPS, which is headed by the Chief Minister, is the governing body or executing agency for the CMHIS as well as the PM-JAY in Nagaland.
The reassurance came amidst concerns over the suspension of services under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) and the Chief Minister Health Insurance Scheme (CMHIS) by certain empanelled hospitals in Nagaland.
“We would like to reassure the public that the services under both PM-JAY and CMHIS are fully operational and have not been suspended,” stated a clarification issued by Thavaseelan K, Chief Executive Officer (CEO), NHPS. Instead, the clarification attributed the current concerns to a “miscommunication” from the Future Generali India Insurance Company (FGI), the insurer responsible tasked for implementing the health insurance under the AB PM-JAY CMHIS scheme in Nagaland.
The miscommunication has since been resolved, it stated.
Accordingly, all empanelled hospitals have been duly informed that these services will continue without interruption, it added. As per the NHPS, the PM-JAY and CMHIS services remain active “unless a hospital unilaterally decides to suspend them.”
However, such action would be in violation of the signed Memorandum of Understanding (MoU), it pointed out.
Over Rs 180 claims settled
In the clarification, the NHPS further stressed that a sum of Rs 53.64 crore for claims under AB PM-JAY & CMHIS (General) and Rs. 34.54 crore for claims under CMHIS (EP) has been paid to various empanelled hospitals during Financial Year 2023-24.
For the current fiscal (2024-25), claims amounting to Rs 38.92 crore under general category and Rs 33.52 crore under CMHIS (EP) have already been disbursed within Nagaland, it mainianted.
Further, claims paid for treatment availed outside Nagaland amounted to Rs 3.99 crore under PM-JAY and Rs 3.81 Crore under CMHIS (EP) in FY 2023-24, it stated.
So far in FY 2024-25, a sum of Rs. 1.95 crore under PM-JAY and Rs 10.16 crore under CMHIS (EP) has been paid.
The overall settlement of claims during the last two fiscal, thus amounted to around Rs 180.53 crore.
The utilisation of premiums is growing annually at a compounded rate of 17%, reflecting the increasing popularity of these schemes, which benefit patients across the State, the NHPS asserted.
However, the Society said that the there have been reports of alleged fraud and abuse/misuse, including financial exploitation of vulnerable patients by certain empanelled hospitals.
Such practices jeopardise the sustainability of these schemes, it held.
The Department has initiated investigation to examine all such allegations and ascertain the commitment of any fraud or abuse by hospitals, it added.
It further cautioned that strict actions will be imposed on any hospital found violating guidelines or statutory compliance.
In the meantime, the incumbent Insurance Company (FGI) is committed to release the claims amount of genuine cases, it added.
Public advisory
Meanwhile, the NHPS advised all stakeholders, including hospitals, not to issue hasty notices regarding service suspension without confirmation from the competent authority.
Such actions may cause unnecessary confusion among the public, it said.
It further encouraged concerned citizens are encouraged to report any unethical practices by hospitals.
The NPHS also highlighted that both PM-JAY and CMHIS schemes provide cashless services for beneficiaries at empanelled hospitals.
Beneficiaries are not required to make any upfront payment for treatments covered under the scheme unless the patients ask for services not entitled, it said. The treatment costs are directly settled between the empanelled hospital and the insurance company, ensuring that financial barriers do not prevent eligible households from accessing quality healthcare services, it added.
It therefore urged beneficiaries urged to verify their eligibility and visit any empanelled hospital for cashless treatments.
For any concerns, clarifications, or further assistance, the public and other stakeholders may contact the toll-free helpline number: 1800-202-3380, it added.
