Nagaland is the first State in the country to implement Health Benefit Package 2.1 under Ayushman Bharat- Pradhan Mantri Arogya Yojana (AB-PMJAY) that includes organ transplant.
AB-PMJAY was launched in Nagaland on September 23, 2018, while the Health Benefit Package 2.1 is being implemented since April 2021.The scheme covers 1,664 treatment procedures across 26 disciplines. Till date, 2.6 lakh e-cards have been issued under the scheme and approximately 20,000 patients requiring hospitalisation have been covered at a total cost of over Rs 26 crore.
Informing this to media on the occasion of third anniversary of AB-PMJAY at Hotel Vivor here on Thursday, health & family welfare minister S Pangnyu Phom said the scheme had covered only 41% of the targeted families, who benefited immensely by availing its benefits either in Nagaland or in other States. Besides issuing 2.6 lakh e-cards, altogether 2,33,328 households have been covered in Nagaland under PMJAY. According to health department, there are a total of 9,33,312 eligible household in the state.
Further, Pangnyu said building and other construction workers registered with the labour department too would be covered under AB-PMJAY, adding that 8,584 new families would be added in the State’s list of beneficiaries.
* State to cover over 1.63 lakh households by March 2022 under ‘Aapke Dwar Ayushman’
* Rs. 26 cr disbursed under AB-PMJAY scheme
He said Nagaland State Rural Livelihood Mission would partner with State health agency (SHA) PMJAY to spread awareness about AB-PMJAY through self-help groups (SHGs) and e-card generation through block data operators.
Mentioning that Aapke Dwar Ayushman (Ayushman scheme at doorsteps) was another new initiative, the minister remarked that to carry out enrolment drives in villages and increase e-card generation, SHA-PMJAY along with various partner agencies would carry out outreach drives till March 2022 aiming to reach at least 70% of the total targeted families (1,63,329 households).
He also acknowledged SHA AB-PMJAY team led by H&FW principal secretary AS Bhatia for successful implementation of the scheme in the State. He thanked insurance company partners and others including NGOs for participating in PMJAY e-card generation.
In his keynote address, Bhatia claimed that the scheme had immensely benefited the people in the State, especially those from the poor socio-economic background, adding that the feedback received was praise-worthy.
He said 98 hospitals were empanelled under AB-PMJAY. Including 14 private hospitals, district hospitals, army hospital units, community health centres (CHCs) and some primary health centres having good in-patient service.
Bhatia said that under AB-PMJAY services were cashless and money should not be charged while availing treatment. He admitted that there was a fraud case, which was investigated and the matter has since been resolved.
Later, addressing a press conference here, joint director &SNO AB-PMJAY Dr Kika Longkumer said that insurance company ‘Oriental Insurance Ltd’ offered health coverage of Rs 5 lakh per year per family for secondary and tertiary healthcare hospitalization.
Dr. Kika said the scheme was portable and there were 821 cases of hospitalisations at hospitals located outside Nagaland, while there were 239 cases of hospitalisation within the State.
Further, a total of 9,950 claims amounting to Rs 12 crore were received and approved during the financial year 2019-20 and in 2020-21, the figures were 7,252 claims and Rs 10 crore.
Technical consultant (PwC) Alongla Aier said the health department has installed kiosks at all the empanelled hospitals to facilitate treatment of AB-PMJAY card holders.
She said Dimapur district has the highest number of coverage, followed by Kohima and other districts.
On the delay in release of money in previous years by the insurance company, Aier admitted that there were some hiccups in the past and the State government could not release the its share. However, as on today, she claimed that no case was pending with either the State government or the insurance company.
Aier informed the media that if beneficiaries have any grievance like denial of treatment by empanelled hospitals, charging of money for treatment while availing benefits under the scheme, they can lodge complaints on Central Grievance Redressal Management System(CGRMS) portal (http://cgrms.pmjay.gov.in/) or can call 14555.
The officials said families identified as poor and vulnerable by Socio-Economic and Caste Census (SECC) 2011 data were eligible to apply for AB-PMJAY.
Also, beneficiaries of the erstwhile Rashtriya Swasthya Bima Yojana (RSBY) who had renewed their cards till 2016/2017 were eligible.
On fraud cases, Dr Sao Tunyi consultant monitoring & evaluation claimed that there were few cases, which were investigated, penalty imposed and fraudulent withdrawal amounts recovered from the fraudsters by the State’s Anti-Fraud Unit.