Our Correspondent
Kohima | September 23
Nagaland have availed benefits of 20,000 hospitalizations amounting to a total of Rs 26 crores under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMIAY).
This was communicated to the media persons via a press conference by medical department during the observance of 3rd anniversary of Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) here today at Hotel Vivor.
AB PMJAY is a government funded health insurance scheme for deprived households which were launched on September 23, 2018.
It provides up to Rs 5 lakh health insurance cover per household per year for hospitalized treatment through a network of empanelled hospitals across the country.
The beneficiary eligibility criteria are as per the deprivation and occupational categories under Socio-Economic and Caste Census 2011 (SECC 2011).
Also beneficiaries of the erstwhile Rashtriya Swasthya Bima Yojana (RSBY) who had renewed card till 2016/2017 are eligible.
A total of 2,33,328 households are covered in Nagaland.
There are 98 empanelled hospitals in Nagaland implementing the scheme which includes 14 private hospitals.
A card holder can avail benefit from any empanelled hospital across the country.
As on 22 September, 41% of the targeted households are reached with Ecard.
Under the Aapke Dwar Ayushman initiative, it is targeted to cover at least 70% of the households by March 2022.
State Health Agency PMJAY and various partner agencies such as Common Service Centers, UTITSI, Clairvoyance Technologies Pvt Ltd, data operators of NSRLM, and various NGOs will undertake enrollment drives to generate Ecard.
If a household is found to be eligible, a personal ID document (Aadhaar card) and a family document (Ration Card or certification by village / ward authority) are required to process a PMJAY card.
Under the scheme, beneficiaries from Nagaland have availed benefits of 20,000 hospitalizations amounting to a total of Rs 26 crores.
There are 1664 treatment procedures available.
Nagaland first to implement Health Benefit Package 2.1
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A total of 821 hospitalizations were availed from hospitals located outside the state while hospitals in the state provided treatment for 239 hospitalizations for beneficiaries coming from other states.
Building and other Construction Workers registered under the Department of Labor are in the process of being included as beneficiary households of the scheme.
Accordingly 8584 new households will be added in the state.
Fraud control and grievance redressal are important components of PMJAY.
Automated triggers to detect suspected fraud, routine mandatory case audits, Ecard audits, field investigations, and beneficiary call audits are undertaken to detect fraud.
Penalty actions and recovery of fraudulent amounts have been imposed on fraudsters by State Anti Fraud portal Unit. Beneficiaries can file grievance through the CGRMS (hltps: //cgrms.pmjay.gov.in/) for denial of treatment by empanelled hospital, charging of money for treatment while availing benefit under the scheme, etc.
