The Nagaland Health Protection Society (NHPS) has informed that the services under the Pradhan Mantri Jan Arogya Yojana (PM-JAY) and the Chief Minister Health Insurance Scheme (CMHIS) have not been suspended.
In a public notice, the NHPS informed that the miscommunication from the Insurance Company (FGI) had been rectified and that all empanelled hospitals have been duly informed that services under PM-JAY and CMHIS remain active and operational.
It also clarified that “these services are fully functional unless an individual hospital has unilaterally decided to suspend these services in violation of the signed MoU.”
Therefore, the NHPS has advised all stakeholders, including hospitals, not to put out hasty notices without first confirming from the competent authority.
For any concerns or clarifications, the NHPS can be contacted at Toll-Free No: 1800-202-3380.
Further, the NHPS informed that a total of Rs. 53.64 Crores for claims under AB PM-JAY & CMHIS (General) and Rs. 34.54 Crores for claims under CMHIS (EP) has been paid to various empanelled hospitals during FY 2023-24. For the current fiscal year 2024-25, Rs. 38.92 Crores for claims under AB PM-JAY & CMHIS (General) and Rs. 33.52 Crores under CMHIS (EP) have already been disbursed within Nagaland. Claims paid for treatment availed outside Nagaland amount to Rs. 3.99 Crores under PM-JAY and Rs. 3.81 Crores under CMHIS (EP) in FY 2023-24, and Rs. 1.95 Crores under PM-JAY and Rs. 10.16 Crores under CMHIS (EP) for FY 2024-25.
It explained that the utilization of premiums is growing annually at a compounded rate of 17%, reflecting the increasing popularity of these schemes, which benefit patients across the state. However, there have been reports of alleged fraud and abuse/misuse, including financial exploitation of vulnerable patients by certain empanelled hospitals.
Such practices jeopardize the sustainability of these schemes, the NHPS said, while informing that the Health Department has initiated investigation to examine all such allegations and ascertain the commitment of any fraud or abuse by hospitals. Strict actions will be imposed on any hospital found violating guidelines or statutory compliance. In the meantime, the incumbent Insurance Company (FGI) is committed to release the claims amount of genuine cases, it said.
Cashless Services
Furthermore, the NHPS has clarified that both PM-JAY and CMHIS schemes provide cashless services for beneficiaries at empanelled hospitals and beneficiaries are not required to make any upfront payment for treatments covered under the scheme unless the patients ask for services not entitled. Instead, the treatment costs are directly settled between the empanelled hospital and the insurance company. This ensures that financial barriers do not prevent eligible households from accessing quality healthcare services.
The NHPS has therefore urged beneficiaries to verify their eligibility and visit any empanelled hospital for cashless treatments.
