Blitz BUREAU
NEW DELHI: The J&K High Court has intervened after all private hospitals in the union territory decided to refuse patients under the national health insurance programme, Ayushman Bharat Yojana, from September 1.
Private hospitals in J&K jointly decided to refuse patient admissions from September 1 claiming that multiple crores of outstanding under this programme had not been paid by IFFCO TOKIO general insurance company to them resulting in huge financial implications for these hospitals.
The high court has now directed IFFCO TOKIO general insurance company to continue with the existing arrangement as per the terms and conditions of the contract agreement regarding Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana-SEHAT (AB-PMJAY-SEHAT) pending resolution of dispute with the UT government by the arbitrator.
The direction has been passed in a petition filed by the Government of J&K wherein it was submitted that the Government launched Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana-SEHAT to provide free of cost Universal Health Coverage to all its residents, including the serving and retired employees and their families.
The scheme is intended to provide the same benefits that were available under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), a Government of India scheme, that provides annual health insurance cover of Rs 5 lakh per family on a floater and cashless basis through an established network of health care providers.
The scheme was introduced with the objective of reducing catastrophic health expenditure and improving access to quality health care of the domiciles of the UT of J&K.
The eligible beneficiary families under this scheme are to be provided with health coverage through a network of Empanelled Health Care Providers (EHCPs). The government decided to implement the scheme to provide health insurance to defined categories of families eligible in the UT of Jammu and Kashmir. As a result, the bidding process was commenced by the government, through State Health Agency (SHA) by issuing the tender document and the respondent company emerged as the successful bidder.
Consequently, a contract for a maximum period of three years came to be executed between the parties on March 10, 2022. Since the beneficiary families are to be provided health coverage through a network of EHCPs, a separate Tripartite Agreement also came to be executed between the parties and EHCPs in terms of Clause 6 of the contract.
The contract between the parties is to subsist till March 14, 2025, but the respondent vide its letter dated November 1, 2023, served a notice that it was not interested in further renewal of the contract after the expiry of the policy period ending March 14, 2024.
