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.