Guarantee 100% saturation to provide free medical care to the poorest of the poor: CS Mehta tells officials

Chief Secretary Dr. Arun Kumar Mehta today chaired the 5th Board Meeting of the National Health Agency (SHA) and also reviewed its performance regarding the implementation of the ‘Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) / AB-PMJAY Sehat here in UTAH.
The meeting was attended by the Additional Chief Secretary, Finance; Commissioner Secretary, Labor and Employment; Secretary, Health; secretary, IT; Heads of Medical Colleges, Srinagar/Jammu; Kashmir/Jammu Health Directors, Nodal Officer, SHA; SGNO, SHA; and other officers from relevant departments.
Officers based in Jammu participated in the meeting via video conference.
Dr. Mehta urged agents to ensure that each person is facilitated to obtain the available benefits. He asked them to work to enroll each person in the scheme so that the final person would receive free medical care as provided by the scheme.
The Chief Secretary also urged health authorities to work on creating patient medical histories from those of students in our schools. He urged them to ensure that every person can register for the program at their doorstep. He argued that the program should be fully saturated in both urban and rural areas.
He urged them to hold quarterly Board meetings for timely confirmation of decisions taken during this period. He asserted that the auditing and accounting of the scheme should be strengthened at all levels to maintain transparency in the effective implementation of this social protection scheme.
Dr. Mehta advised the health agency to consider requests from other states to make the program more sustainable and promising for beneficiaries. He asked them to develop the best sustainable model in consultation with different stakeholders to extend maximum benefits to needy UT patients.
The ACS, Finance argued that the administration was doing its best to extend uninterrupted health benefits to the people. He reiterated that it is the administration’s effort to design policy that is in the best interests of the people.
At this meeting, the Board gave approval to SHA to introduce the “e-RUPI Concept” as a pilot project in selected UT tertiary care hospitals. It was stated that the main purpose of using e-RUPI is to reduce out-of-pocket expenses (OOPE) incurred by beneficiaries for diagnostic tests not performed in these government-run health facilities.
The meeting was informed that among the 196,149 claims received amounting to Rs 353.74 crore, 147,180 claims amounting to Rs 236.84 crore had already been disbursed with 35,536 claims under process in various EHCPs.
It was further revealed that 25.74 lakh eligible beneficiary families have been insured for the current insurance period. It has been announced that a premium 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 people in the 20 districts of J&K. The highest average claim size of Rs 18,004 was recorded during this policy period from March 15 to August 31 this year, as informed during the meeting.
Earlier at the 4th board meeting of the National Health Agency, J&K held on 08.11.2021, it was decided that the National Health Agency, J&K will continue with the new appeal process tender using the model tender document issued by the National Health Authority.
A tender document for the selection of the insurance company for the implementation of AB PM-JAY/AB PM-JAY SEHAT has been launched. The pre-offer meeting was held on 23-11-2021 at NHM Office Old Secretariat Srinagar attended by five following insurance companies 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 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 briefed.
The committee deliberated in accordance with GFR 2017. The procurement process for the selection of an insurance service provider for the implementation of ABPMJAY/ABPMJAY SEHAT followed “transparency, competition, fairness and highlighting of arbitrariness in the procurement/ILS process has been widely publicized, furthermore it has been ensured that the qualification criteria given are very minimal and used the same qualification criteria notified by the National Health Authority.
The text of the tender documents was complete and complete, without any ambiguity. Along with all the clarifications, the changes have been notified to the bidders and also placed on the website Bidders have sufficient time to prepare and submit their bids, in this case 22 days has been granted.
As stipulated in the NIT, a pre-offer meeting was held and the minutes of the meeting were distributed. The technical offers were publicly opened as stipulated in the tender documents. The bids received were evaluated according to the criteria notified in NIT, the meeting discussed.
During a technical evaluation carried out by the Central Tenders Committee, it was found that three out of four bidders, namely: IFFCO Tokio General Insurance Company, Bajaj Allianz General Insurance Company, National Insurance Company meet the requirements and are therefore qualified during the technical evaluation phase.
Financial bids were opened on 08-01-2022 PM and IFFCO Tokio General Insurance Company Ltd. proved to be the lowest bidder (L1) with the quoted rate of Rs 1840/- per family (Appendix B).
As the policy with Bajaj Allianz GIC expired on December 25, 2021, the National Health Agency, J&K was compelled to seek an interim arrangement to ensure there was no disruption of services to J&K residents. Normally the tendering process takes a minimum of one month and in order to ensure that there is no disruption of services, it has been deemed appropriate that a suitable arrangement be established with the current insurer in accordance with the directives. received.
In addition, the National Health Agency has also requested Bajaj Allianz GIC to consider the request to extend the current policy from December 26, 2021. In response, Bajaj Allianz GIC has hinted that it is ready to continue to implement the scheme for the duration requested at the price quoted by him @ Rs 3,261.60 per beneficiary family unit, pro rata for the period for which coverage is requested as they have already quoted this offer price in the new bidding process, as discussed at the board meeting.
In order to avoid any interruption of the services provided under the program, SHA J&K, in accordance with the aforementioned deliberation, has entered into an agreement with Bajaj Allianz General Insurance Company to continue the services of insurer on the basis of Stop Loss until until the selection of the new insurance company is finalized. . The insurance company will not share any risk of loss of claims and all claims will be borne by the government of J&K and the national health authority (for AB PM-JAY). The insurance company will receive an administrative charge of 15% on the uncovered premium of Rs. 849 of the previous insurance period (26 Dec 2020-25 Dec 2021) for the provisional arrangement from 26-12-2021 until ‘on finalization the new insurer is selected through an appropriate tendering process. The period of cover offered was originally only 30 days.
So, in the situation where the existing contract was expiring and UT’s flagship program was facing disruption, the J&K National Health Agency accepted the company’s offer to run the program based on the Stop Loss in the public interest with administrative costs of 15%, as before.
The 5th policy was tendered well on schedule, but the premium rates quoted by L1 were very high. Therefore, the re-tendering was done by SHA J&K. As such, it was necessary to enter into an interim agreement with the existing insurance company to continue AB PM-JAY/AB PM-JAY SEHAT Scheme without disruption in the public interest until such time as the new insurance company insurance has been taken on board. The very fact that 69,000+ people have benefited from the scheme during the interim arrangement is a testament to the public interest that has been served, as culminated at the said meeting.
The Council then deliberated on various aspects of the functioning of the health agency to make it more efficient. He discussed agenda items including the long-term sustainability of the AB-PMJAY Sehat program, claims usage guidelines, SHA staff augmentation, as well as other important items for the SHA.