SHA addresses concerns regarding
AB-PMJAY SEHAT scheme
SRINAGAR, NOVEMBER
19: The State Health Agency, apropos the concerns raised in the report
published in a daily newspaper today, regarding the AB-PMJAY SEHAT scheme, has
issued a clarification.
According to a
communication received here today in this regard, the report presents an
incomplete picture, overlooking substantial efforts made since October 2024 to
address challenges and improve implementation of the scheme.
Since October 2024,
the State Health Agency, J&K has processed over 54,000 cases across private
and public hospitals, underscoring the commitment to healthcare providers and
beneficiaries. Some delays may be due to EHCP’s not adhering to the guidelines
issued by the National Health Authority. Many cases are submitted without
mandatory documents required for claim processing, which slows down the entire
workflow and wastes productive hours at multiple levels. To address this, the
State Health Agency, J&K has repeatedly requested all Empanelled Health
Care Providers to ensure submission of complete and accurate documentation.
The SHA is strictly
following the Honorable High Court’s directions, ensuring no claims are
unfairly deducted or rejected. All hospitals are assured that sufficient funds
are available to process all claims, and every valid claim will be paid without
delays. To further reassure all EHCP’s, the SHA is actively working to clear
all pending payments and has set a clear deadline to complete this process by
the end of December 2024.
Despite the
challenges faced due to the actions of dishonoring the contractual obligations
by the Insurance Service Provider IFFCO Tokio Insurance Company Ltd, the SEHAT
scheme is a vital lifeline for the people of J&K, easing the financial
burden of healthcare expenses while offering free access to necessary medical
services.
The SHA has
appealed to all valued stakeholders, including private hospitals to collaborate
with the SHA in addressing these issues.
“The government of
Jammu and Kashmir remains fully committed towards resolving operational
challenges and ensuring the scheme benefits every eligible resident of the
region”, maintained the document.