Morung Express News
Kohima | February 14
The Gauhati High Court, Kohima Bench has asked Nagaland Private Doctors Association (NPDA) to continue providing all facilities to eligible beneficiaries under AB-PMJAY and Chief Minister Health Insurance Scheme (CMHIS) as an interim in the interest of public so that health care system in the State remains uninterrupted.
Hearing a Public Interest Litigation filed by a health activist on hindered implementation of the AB-PMJAY/CMHIS scheme in the State and non-payment of claims to empanelled hospital under the scheme by concerned Insurance Company, the division Bench of Justice LS Jamir and Justice Kakheto Sema also said the matter will be heard in 4 weeks while directing petitioners to notify respondents who had not appeared during the day's hearing.
The respondent parties include the State of Nagaland, Health and Family Welfare Department, Nagaland Health Protection Society (NHPS), Future Generali Indian Insurance Co. Ltd, Unit, Nagaland Private Doctors Association (NPDA) and the Union of India.
After taking receipt of the submission and to enable health services across the state to function smoothly, the court also stayed the letter of the NPDA whereby the association earlier decided to temporarily suspend Ayushman PM-JAY/CMHIS services starting from February 15, 2025, due to the non-payment of claims by Future Generali Insurance.
Hearing the crux of the case, Advocate for the petitioner, Kezhosano Kikhi submitted to the court that AB-PMJAY Scheme was implemented in the year 2018 and later converged with CMHIS, which, later on, came to be known as AB-PMJAY/CMHIS in the State of Nagaland, which was launched in the year 2022. The AB-PMJAY Scheme aims at providing a cashless health cover of Rs.5 lakh per family member per year for secondary and tertiary care hospitalization to over 12 crore poor and vulnerable families in the country.
The CMHIS is a flagship public health insurance initiated by the Government of Nagaland to provide cashless treatment to the eligible beneficiaries for Government Employees, Pensioners, and Indigenous Inhabitants or Permanent Residents of Nagaland who are not covered under the AB-PMJAY Scheme.
The advocate also added that for further implementation of the Scheme, a National Tender was flouted whereby the Future Generali Indian Insurance Company Ltd. was selected and a MOU was executed between the Nagaland Health Protection Society (NHPS) and the Future Generali Indian Insurance Company Ltd in June last year.
"During the course of implementation of the said AB-PMJAY/CMHIS Scheme, there were allegations of fraud, misuse and lack of accountability, whereby the Future Generali Indian Society stopped paying the claims of all the empanelled hospitals in the State of Nagaland," it added.
Accordingly, the Nagaland Private Doctors Association addressed a letter on February 11 to the NHPS where it said that the NPDA has decided to temporarily suspend Ayushman PM-JAY/CMHIS services starting February 15, 2025, due to the non-payment of claims by Future Generali Insurance.
The NDPA said that despite repeated appeals, their legitimate dues remain unpaid, leaving them unable to function without financial resources and being labelled to public accusations. In the letter it also resolved that no new agreements for the resumption of Ayushman PMJAY/CMHIS services will be signed without NPDA's final approval.
Respondent appearing for the NHPS also submitted that the society has already intimated the insurance company to clear the bills with regard to the genuine bills; however, till date the company is yet to comply with the request.
After hearing these submissions, the bench directed the counsel appearing for the respondents to furnish extra copies of the PIL and asked the petitioner to take steps for service of notice on the Nagaland Private Doctors Association and Future Generali Indian Insurance Company Ltd by registered post with A/D within one week from February 14 along with a notice to the Central Government.
The court also listed the matter to 4 weeks.
