Nagaland Health Protection Society informs on Ayushman Bhara
Nagaland Health Protection Society informs on Ayushman Bharat Pradhan Mantri Jan Arogya Yojna and Chief Minister Health Insurance scheme
Thavaseelan K, explained that the society is the implementing agency of the AB PM-JAY with annual insurance cover of INR 5 lakh per household and CMHIS with annual insurance cover of INR 20 lakh per household for employees and pensioners and INR 5 lakh per household for families who are not covered under AB PM-JAY or not a government employee or pensioner
DIMAPUR — The
Nagaland Health Protection Society (NHPS), which is the implementing agency of
Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (AB PM-JAY) and Chief Minister
Health Insurance Scheme (CMHIS), informed that out of the total premium of INR
92.00 crore payable, an amount of INR 90 crore (upto 3rd installment of state
share and 2nd installment of central share) have been paid to the insurance
company as of date. It added that there was no default on payment of premium to
the insurance company.
An update from the CEO of Nagaland Health Protection Society
(NHPS), Thavaseelan K, explained that the society is the implementing agency of
the AB PM-JAY with annual insurance cover of INR 5 lakh per household and CMHIS
with annual insurance cover of INR 20 lakh per household for employees and
pensioners and INR 5 lakh per household for families who are not covered under
AB PM-JAY or not a government employee or pensioner.
He stated that CMHIS is financed by converting 50% of the
monthly medical allowance of employees and pensioners and the corpus is
maintained by the Finance department in a dedicated savings bank account. He
added that any additional expenditure beyond the insurance cover of INR 20 lakh
per household for government employees is reimbursed through the salary head of
the concerned department.
Thavaseelan informed that AB PM-JAY is financed by the
central and state governments in the ratio 90:10. However, the central share
for premium is capped at 90% of INR 1052 per household and any excess amount
beyond the ceiling is paid by the state government in addition to the 10% state
share.
He stated that for the policy year 2024 - 25, the state
government's share is 51% and the central government's share is 49%.
The schemes are implemented in insurance mode and the
insurance company is selected through a national competitive tender open to all
Insurance Regulatory and Development Authority of India (IRDAI), a registered
health insurance companies operating in the country.
He stated that selection process follows the lowest cost
(L1) method in compliance with the tendering guidelines issued by the National
Health Authority (NHA) for selecting insurers. The selected insurance company
is responsible for claims processing, approval of claims and payment of claims
to the empanelled hospitals.
For the current policy period (April 2024 – March 2025), the
implementing insurance company is Future Generali India Insurance Co. Ltd
(FGI).
The discovered premium payable to the insurance company was
INR 1950 per household for insurance cover of INR 5 lakh (AB PM-JAY and CMHIS
general category) and the premium for CMHIS (EP) was INR 3860 per household for
insurance cover of INR 20 lakh.
He stated that the premium is payable in 3 installments and
premium payments are made to the insurance company immediately upon fund
release by the government as insurance coverage cannot commence without upfront
premium payment as per IRDAI regulations.
He further stated that out of the total premium of INR 92
crore payable, a total of INR 90 crore (upto 3rd installment of state share and
2nd installment of central share) have been paid to the insurance company as of
date. He, therefore, stated that there was no default on payment of premium to
the insurance company.
As of February 16, 2025, the following claims have been
processed by the insurance company:
For PMJAY:
i. A total of 30,379 claims amounting to INR 57.34 crore
have been approved.
ii Of these, 22,914 claims totaling INR 42.71 crore have
been paid to various hospitals.
For CMHIS:
i A total of 17,501 claims amounting to INR 72.32 crore have
been approved.
ii Out of these, 11,638 claims totaling Rs. 47.20 crore have
been paid to various hospitals.
It stated that public health insurance schemes operates on
the core principle of risk-pooling resources to provide financial security
against unforeseen medical expenses and preventing out of pocket expenditure
for hospitalised care and promoting access to quality healthcare for the
people.
Given the limited resources, it urged all stakeholders
including beneficiaries, empanelled hospitals, insurance companies etc., to
utilise the scheme's benefits judiciously and ethically. It added that rational
use and diligent implementation would ensure the long-term sustainability of
the noble initiative.
In this regard, it urged all stakeholders for responsible
utilisation and adherence to ethical practices.
For further information and clarification, citizens are
encouraged to call the NHPS Helpline (Toll-Free No: 1800-202-3380) or email at
nhps@cmhis.nagaland.gov.in.
