Irfan Tramboo
Srinagar, Dec 4: While the “unwarranted exit” of IFFCO Tokio General Insurance Company remains sub judice, the State Health Agency (SHA) has processed over 60,000 claims under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) SEHAT scheme in J&K over the past two months, amounting to over Rs 100 crore.
The settlement of claims, officials said, has been carried out through an alternative mechanism adopted by the Government to ensure a hassle-free process, without the involvement of the insurance company.
According to official details, 60,929 cases amounting to Rs 106.23 crore, along with 378 portability cases totaling Rs 83.25 lakh, have been successfully processed.
Officials explained that portability cases refer to those in which patients availed healthcare services at empaneled hospitals across the country.
CEO of SHA, Sanjiv M. Gadkar, stated that crossing Rs 100 crore in just two months demonstrates the dedication and efficiency of his team in enabling patients to access healthcare services across J&K.
“We are focused on ensuring timely claim payments to all empaneled hospitals so that patient care is not affected and the process remains smooth,” he said.
Officials emphasized their commitment to the timely and transparent disbursement of funds to empaneled hospitals across J&K, in line with court directives.
According to the figures, there are a total of 253 empaneled hospitals under the scheme in J&K, including 120 private hospitals and 133 public facilities.
It is worth noting that earlier this year, the unwarranted and contractually unauthorized exit of IFFCO Tokio, which was managing the scheme, caused delays in claim disbursals, leading to issues for hospitals operating in the private sector.
When the matter was taken to court, the insurance company was directed to continue with the existing arrangement. However, the company challenged the order and refused to comply.
But now, in collaboration with the Health and Medical Education (H&ME) Department, the SHA devised an alternative mechanism to ensure the scheme’s continuity.
Officials clarified that, as of now, the insurance company has no role in payments, as the matter remains sub judice, following their appeal against the court order.
Further, following the company’s non-compliance with the court order, the H&ME Department also approached the Insurance Regulatory and Development Authority of India (IRDAI), urging strict action against the insurer for attempting to disrupt healthcare services in the Union Territory.
Among those most affected by the insurer’s exit were patients requiring regular dialysis due to kidney diseases. As an immediate relief measure, the Government accommodated these patients in public hospitals.
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