J&K becomes first UT for free treatment up to Rs 5 lakh a family

Among all states and Union Territories (UTs) across India, Jammu and Kashmir has become the first to provide free medical treatment up to Rs 5 lakh to 100 per cent of its population.

Lieutenant Governor Manoj Sinha announced on Friday that the UT’s highest decision making body, Administrative Council, had accorded sanction to the tentatively titled J&K Health Scheme to provide universal health insurance relief of Rs 5 lakh a year each family irrespective of the family’s size besides age, number and morbidities of its members.

This is for the first time in India that any state or UT has covered hundred per cent of its population for the benefits provided under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to the below poverty level population.

“AB-PMJAY is for a limited number of the family members and only for the below poverty level population. J&K UT’s scheme will be applicable to all families. The Centre is providing financial support of around Rs 125 crore to the UT government as premium to an insurance company on behalf of 15 lakh uncovered families even as 5.97 lakh families are already covered under AB-PMJAY. We have asked J&K’s Financial Commissioner for Health Atal Dulloo to choose a new name for this scheme so as to enable us to transfer money to an appropriate account,” a Central government official said.

While announcing the scheme on Friday, Sinha had asked the people of Jammu and Kashmir to suggest the most suitable name for the new healthcare scheme under which patients would get cashless medical treatment up to Rs 5 lakh a family in one year at 23,300 hospitals already empanelled by the government across the country. The tertiary care Sher-e-Kashmir Institute of Medical Sciences (SKIMS) Soura, Sri Maharaja Hari Singh Hospital of Srinagar, Sri Maharaja Gulab Singh Hospital of Jammu, all Medical College Hospitals of J&K including GMC Srinagar and its associate hospitals, Kashmir’s top maternity hospital Lal Ded and the two Super Specialty Hospitals in Srinagar and Jammu are among the 218 hospitals and private nursing homes empanelled in Jammu and Kashmir.

FC Health and Medical Education Atal Dulloo said that the packages of life-consuming diseases such as cancer and kidney failure and treatment of Covid-19 were also covered under the scheme. He explained that all high-end treatments of oncology, cardiology and nephrology would be covered from day one; the high-end diagnostic treatments during hospitalization would also be covered. The scheme shall cover three days of pre-hospitalization, full hospitalization period, and 15 days of post-hospitalization including diagnostic care and expenditure on medicines. A ‘State Health Agency’ would be soon launching a beneficiary registration drive to distribute Golden Cards (e-cards) amongst the beneficiaries.

The Socio-Economic Caste Census (SECC) 2011 data will be used for identification of families for the scheme while the families suffering from any of the deprivations defined under SECC are already covered under AB-PMJAY. “However, under J&K Health Scheme, the remaining families including those who do not suffer from any deprivation will also be covered. Any family left out from the database of SECC 2011, will also be included,” Dulloo said. According to him, the annual financial implication for JK Health Scheme would be Rs 123 crore.

Dulloo said that the insurance company (Bajaj Allianz General Insurance) would also arrange for the Third Party Administrator to ensure that there were no fraudulent or inflated claims by the hospitals. He revealed that the Centre had given permission to the selected insurance company to use the database and IT system of National Health Agency.

Sources in the UT administration said that earlier this year the government had floated e-tenders to select an insurance company for implementation of the J&K Health Scheme. Financial bids were opened on August 11, 2020. While the New India Assurance Company had quoted a premium of Rs 948 per family, Bajaj emerged as the first lowest with its quoted rate of Rs 849..