J&K Households To Get Rs 5 Lakh Free Health Insurance Cover

J&K signed an MoU with Bajaj Allianz General Insurance Company for implementation of Ayushman Bharat- AB-PMJAY) in the UT early this month. KO Photo

Jammu: Jammu & Kashmir Administrative Council Monday accorded sanction to the Jammu & Kashmir Health Scheme which provides for free of cost Universal Health Coverage to the tune of Rs five lakh to each family of the recently carved out Union Territory.

The decision was taken at the council meet with Lt Governor Girish Chander Murmu in chair. The insurance cover will be in convergence with Ayushman Bharat-PMJAY, an official spokesman said.

Now, around 1.25 crore residents of J&K will be provided the same benefits as are provided under Ayushman Bharat-PMJAY.

At present, 5.95 lakh families numbering 31 lakh persons are eligible for benefits under Ayushman Bharat-PMJAY.  Around 15 lakh additional families will be covered under the Jammu & Kashmir Health Scheme.

Under this Universal Health Coverage, the beneficiaries shall be entitled to free health insurance cover of Rs 5 lakh per family per year on floater basis and there is no restriction on family size, age or gender. All pre-existing illnesses shall also be covered besides; cashless services shall also be available in all the empanelled hospitals.

The beneficiaries under the scheme shall have access to 20,853 (public and private) hospitals across the country and avail benefits with facility of inter-state portability. In J&K, 159 (public and private) hospitals are empanelled at present. It shall provide coverage to 1469 medical and surgical packages/procedures including life consuming diseases, such as, cancer and kidney failure.

Treatment for oncology, cardiology and nephrology related illness will be covered from day one including high-end diagnostic procedures during hospitalization. The beneficiaries shall also be eligible for coverage of 3 days pre-hospitalization and 15 days post hospitalization expenses.

As per the decision of the Administrative Council, all employees, pensioners and their family members are also covered under the Jammu & Kashmir Health Scheme. The employees shall continue to get Rs 300 per month as medical allowance to take care of OPD treatment.

Identification of the illegible families for getting registered for the Health Scheme will be made on the basis of socio-economic census 2011. However, the families/persons that have been left out in the census can be enrolled on the basis of a defined process.

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