Morung Express News
Dimapur | April 3
The contract between the Nagaland Government and Future Generali India Insurance Co. Ltd (FGI), the implementing insurance company for the Chief Minister’s Health Insurance Scheme (CMHIS), has expired, and the State Government is considering a new insurer.
This was among the key highlights of the court proceedings during the hearing of a Public Interest Litigation (PIL) concerning the CMHIS at the Gauhati High Court Kohima Bench (GHCKB) on April 2.
The PIL was filed after the Nagaland Private Doctors Association (NPDA) announced in a public notice on 10 February that private hospitals would cease providing services under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) and CMHIS from 15 February unless all pending claims were settled.
The Court had previously issued an interim order directing the association to continue providing all facilities to eligible beneficiaries in the public interest until the further order.
During the hearing on 2 April, the GHCKB Division Bench, comprising Justice Devashis Baruah and Justice Budi Habung, observed that the Government of Nagaland had introduced the scheme to provide cashless treatment in hospitals and had entered into an agreement with FGI following an open tender process.
In Court, the State Government claimed it had “paid 100% of the premiums,” yet the insurer, FGI, had failed to honour the claims of service providers represented by the NPDA, leading to the issuance of the public notice.
The counsel for the NPDA also contended that while private doctors, who are members of the association, were entitled to payment for their services, these payments had not been honoured by either the State Government or the insurer.
Accordingly, the Bench observed that the dispute in the PIL was primarily between the State Government and the insurer, FGI, which had led to the NPDA's unwillingness to provide services.
It was also noted in Court that the State Government is now considering issuing a fresh tender and entering into a new contract for providing cashless facilities, as its contract with FGI ceased to be in effect from 1 April.
In this regard, the Bench ruled that an extension of the interim order did not arise under the present circumstances.
However, it clarified that the pendency of the PIL would not affect the rights of the State Government to initiate legal proceedings against the insurer, if permissible under law. Similarly, the NPDA can also pursue its remedies against the State Government as well as the insurer FGI, if so advised, it added.
Meanwhile, the Nagaland Health Protection Society (NHPS), the agency implementing AB PM-JAY CHMIS in the State, submitted before the Court that until an alternative arrangement is in place through a new contract, the State Government would continue making due payments for services provided by the NPDA through the “Trust Mode.”
In light of these developments, the Bench disposed of an interlocutory application concerning the PIL and scheduled the next full hearing for 7 May.
The insurer, FGI, was also granted permission to file an affidavit by 29 April, with other parties to the PIL given liberty to submit their responses.
However, considering the PIL’s nature, the Bench remarked that if the Government of India and/or the State of Nagaland had announced schemes providing cashless benefits to citizens, it was their duty to fulfil these promises.
“We hope and expect that the respective Government shall do the same,” the Bench stated.
