CS chairs 5th Governing Council Meet: Over 25L families insured for AB-PMJAY Sehat scheme: Officials

Jammu, Sept 16: As many as 25.74 lakh eligible beneficiary families have been insured for the Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY)/AB-PMJAY Sehat in current policy period, officials said on Friday.
The information was given out in a meeting chaired by Chief Secretary Dr. Arun Kumar Mehta.
The CS chaired the 5th Governing Council Meeting of State Health Agency (SHA) to review its performance regarding the implementation of AB-PMJAY/AB-PMJAY Sehat here in the UT.
The meeting was informed, “Among the 196149 received claims amounting to Rs 353.74 crores, 147180 claims amounting to Rs 236.84 crores had already been disbursed with 35536 claims under the process at various EHCPs.”
It was given out, “a premium amount of Rs 1840 per family is paid by the government to provide free health care in 209 local hospitals (118 public+91 private) to our population across the 20 districts of J&K.”
Highest average claim size of Rs 18004 has been registered in this policy period from 15th of March to 31st August this year, as was informed in the meeting.
In the meeting the Council gave approval to SHA for introducing ‘e-RUPI Concept’ as a pilot project in selected Tertiary Care hospitals in the UT.
It was given out that the primary objective of using e-RUPI is reducing out-of-pocket expenditures (OOPE) borne by the beneficiaries on diagnostic tests not performed in these government run health facilities.
Dr Mehta impressed upon the officers to ensure that each person is facilitated to obtain the available benefits. He asked them to work for registering each person under the scheme so that the end person receives free medical care as envisaged under the scheme.
The Chief Secretary also emphasized upon the health authorities to work towards creating health history of the patients starting from those of students in our schools. He urged them to make it convenient for every person to register for the scheme at his doorsteps. He maintained that the scheme should be saturated fully in both urban and rural areas.
He exhorted upon them to conduct the Governing body meetings quarterly for timely confirmation of intervening decisions taken during this period. He made out that both audit and accounting of the scheme should be strengthened at every level for maintaining transparency in the effective implementation of this welfare scheme.
Dr Mehta advised the health agency to study the claims of other state to make the scheme more sustainable and promising for the beneficiaries. He asked them to work out the best sustainable model in consultation with different stakeholders for extending maximum benefit to the needy patients of the UT.
The ACS, Finance made out that the administration did best to extend the health benefits uninterruptedly to the people. He reiterated that it is the endeavour of the administration to devise policy that is in the best interest of people.
The meeting was attended by Additional Chief Secretary, Finance; Commissioner Secretary, Labour and Employment; Secretary, Health; Secretary, IT; Principals of Medical Colleges, Srinagar/Jammu; Directors of Health Kashmir/Jammu, Nodal Officer, SHA; SGNO, SHA; and other officers of the concerned Departments.
Earlier in the 4th Governing Council meeting of State Health Agency, J&K held on 08.11.2021 it was decided that State Health Agency, J&K will go ahead with the fresh tendering process by using a model tender document issued by National Health Authority.
A tender document for selection of Insurance Company for implementation of AB PM-JAY/AB PM-JAY SEHAT was floated. Pre- Bid meeting was held on 23-11-2021 at NHM Office Old Secretariat Srinagar, in which the following five insurance companies participated including IFFCO TOKIO General Insurance Co. Ltd, Reliance General Insurance Company Ltd, Bajaj Allianz General Insurance Company Pvt. Ltd, United India Insurance Company and National Insurance Company.
It was found that four Insurance Companies have submitted their bids including Bajaj Allianz General Insurance Company Pvt. Ltd, National Insurance Company, IFFCO Tokio General Insurance Company, Oriental Insurance Company, the meeting was apprised.
The committee had deliberation as per GFR 2017. The procurement process for selection of an insurance service provider for implementation of ABPMJAY/ABPMJAY SEHAT has followed the “transparency, competition, fairness and illumination of arbitrariness in the procurement process/NIT has been advertised widely. Further it was ensured that the qualification criteria indicated is very minimum and used the same qualification criteria notified by National Health Authority.
The text of the bidding document wasself-containing and comprehensive without any ambiguities besides all the clarifications, modifications have been notified to the bidders and also placed on the www.jktenders.gov.in. The bidders are provided sufficient time to prepare and submit their bids, in this case, 22 days of time has been provided.
As stipulated in NIT a pre bid meeting was organised and the minutes of meeting was circulated. The technical bids were opened publicly as stipulated in bidding document. Bids received were evaluated as per the criteria notified in NIT, the meeting discussed.
Amidst a technical evaluation carried out by Central Tender Committee, it was found that three out of four bidders viz: IFFCO Tokio General Insurance Company, Bajaj Allianz General Insurance Company, National Insurance Company are meeting the requirements and hence qualified in the technical evaluation stage.
The financial bids were opened on 08-01-2022 PM and the IFFCO Tokio General Insurance Company Ltd. was found to be lowest (L1) bidder with the quoted rate of Rs 1840 per family (Annexure B).
Since the policy with Bajaj Allianz GIC was expiring on 25th December 2021, the State Health Agency, J&K was compelled to seek an interim arrangement to ensure no disruption in services to the people of J&K. In normal course of time, the tendering process takes a minimum of one month to complete and in order to ensure that there is no disruption of the services, it was deemed proper that a suitable arrangement be established with the current insurer in compliance of the directions received.
In furtherance, the State Health Agency also requested Bajaj Allianz GIC to consider the request for extending the current policy from 26th December 2021 onwards. In response, the Bajaj Allianz GIC intimated that they are ready to continue to implement the scheme for the duration requested on the price quoted by them @ Rs 3,261.60 per beneficiary family unit, on Pro-Rata basis for the period for which coverage is requested as they have already quoted this bid price in the new tender process, as was stated in the council meeting.
In order to avoid any break in the services provided under the Scheme, SHA J&K as per the deliberation stated above entered into an agreement with Bajaj Allianz General Insurance Company to continue the services as insurer on Stop Loss basis till selection of new Insurance Company is finalized. The Insurance Company shall not share any risk of loss of claims and entire claims outgo shall be borne by the Government of J&K and National Health Authority (For AB PM-JAY). Insurance Company shall be paid an administrative cost @ 15% on the discovered premium of Rs. 849 of previous policy period (26th December, 2020– 25th December, 2021) for the interim arrangement starting from 26-12-2021 till the finalization of new insurer is selected through a proper tendering process. The proposed period of coverage was originally for 30 days only.
Thus, in the situation where the existing contract was expiring and the Flagship scheme of the UT was facing disruption, State Health Agency J&K accepted the company’s offer to run the Scheme on Stop Loss basis in public interest with 15% administrative charges, as earlier.
The tender for Policy 5th was floated well within time but the premium rates quoted by L1 was very high. Therefore retendering was done by SHA J&K. As such there was a need of an interim arrangement with the existing insurance company to continue AB PM- JAY/ AB PM-JAY SEHAT Scheme without disruption in the public interest till the time new insurance company was taken on board. The very fact that 69,000 and more persons derived benefits of the Scheme during the Interim Arrangement is a testimony to the public interest which was served, as was culminated in the said meeting.
The Council further deliberated upon different aspects of the working of the health agency to make it more effective. It discussed agenda items including Long term sustainability of AB-PMJAY Sehat scheme, Claim utilization guidelines, augmentation of staff in the SHA besides other items of importance for the SHA.