Only 13,372 beneficiaries in State out of 2,33,328 targeted
Kohima, February 14: The Health and Family Welfare Department is implementing National Health Protection Mission (NHPM) / Pradhan Mantri lan Arogya Yojna (PMJAY), which was launched as part of the Ayushrnan Bharat programme on September 23, 2018 together with the rest of the country.
Under the scheme a total of 1,534 health packages (1350 notified packages of Government of India and 184 State notified packages) comprising treatment for almost all secondary and tertiary ailments are included, informed State Nodal Officer NHPM Dr Kikameren Longkumer during the media workshop Vartalap at East Gate Hotel here today.
He said that with the aim to reduce the Out-of-Pocket expenditure on hospitalization thereby prevent impoverishment and to alleviate the barriers to healthcare in view of burden on health expenses, the NHPM / PMJAY was launched as a part of the Ayushrnan Bharat.
He said that it also aims to promote access to quality health care particularly for the poor and vulnerable sections. The scheme will subsume the two on-going centrally sponsored schemes viz. Rashtriya Swasthya Bima Yojana (RSBY) and Senior Citizen Health Insurance Scheme (SCHIS), he said.
He said families figuring in the Socio Economic & Caste Census (SECC) 2011 and existing RSBY Beneficiary Families are eligible to avail the benefit.
Beneficiary Family Unit will comprise of all members in that family with no cap on family size and age of the family members, he said, adding that any addition in the family will be allowed only in case of marriage and/or birth/ adoption.
The total targeted family of the State is 2,33,328 wherein the beneficiary family is entitled to a benefit cover of upto Rs 5 lakh per family per year for hospitalization expenses, including pre & post hospitalization expenses as well as coverage of all pre-existing conditions from the beginning of the policy, he said.
The benefit is cashless & paperless and can be availed from any of the empaneled public or private hospitals across the country, he said. However, the National Portability will be available only for the GOI notified packages, he said adding that the beneficiary can avail the facility in any empanelled hospital of the country.
Hospital Empanelment: For effective implementation of the Mission, all public hospitals with inpatient facilities from Community Health Centre (CHC) are being empanelled. However, in order to take the facility closer to the people and to avoid congestion of the higher hospitals, the empanelment is extended to functional PHCs.
Private Healthcare Providers (both for profit and not for profit) subject to fulfillment of empanelment criteria, are eligible for empanelment under PMJAY, he said adding that EHCPs shall be entitled to the following performance-linked incentives to promote continuous improvement in quality and patient safety, based on successive milestones: o Hospitals qualifying for NABH entry-level accreditation will receive an additional 10% over and above the base package rate. Hospitals qualifying for full accreditation will receive an additional 15% over and above the base package rate. o To promote equity in access, hospitals providing services in aspirational districts will receive an additional 10% over and above the base package rate. o Teaching Hospitals running PG/ DNB courses would receive an additional 10 % over and above the base package rate.
Mode of Implementation:
In the State, the scheme is implemented in Insurance mode wherein Apollo Munich Insurance Company has been selected for the implementation, he said adding that the Insurance Contract between the Apollo Munich Insurance Company and the State Government was signed on July 25, 2018.
The premium against the Benefit Cover of Rs. 5 lakhs for the current Policy is Rs. 444 per family per year.
All Hospital Claims are to be cleared within 2 weeks, he said adding that for any delay in the payment of Hospital Claims to the Hospital, the Insurance Company will pay a penalty of I% per week of delay to the Hospital.
For any delay in the payment of Premium to the Insurance Company, a penalty of 1% per week of delay will be paid to the Insurance Company, he said.
On the present status of implementation in the State, Dr Kika said 59 hospitals have been empanelled – which include 54 public hospitals, such as all the 11 district hospitals and CHCS, PHCs have already been empanelled while 5 Private hospitals – Faith Hospital, CIHSR, House of Hope (ECS), lmpur Christian Hospital and Bethel Medical Centre are empanelled under the scheme.
Presently he said 13,372 families have been verified and issued eCards while 131 claims have been made amounting to Rs. 13.12 lakhs as on date.
(Page News Service)