Kohima: Under the Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), beneficiaries from Nagaland has availed benefits of 20,000 hospitalisation to a tune of Rs 26 Crore, Nagaland health minister S Pangnyu Phom informed.

“Nagaland was among the first states to launch AB-PMJAY on this day in 2018,” Phom said during the Ayushman Bharat Diwas third anniversary ceremony at Hotel Vivor in Kohima on Thursday.

AB-PMJAY is a government-funded health insurance scheme for deprived households providing up to Rs 5 lakh health insurance cover per household per year for hospitalized treatment through a network of empanelled hospitals across the country.  

The state has 98 empanelled hospitals implementing the scheme of which 14 are private hospitals. The PMJAY aims to reduce out-of-pocket expenditure on medical care among poor, deprived and vulnerable families. 

Y Watimongba, a beneficiary from Dimapur, shared how he was diagnosed with Cancer in 2020. “After two days of stomach-ache, the doctors detected cancer saying that I have to undergo operations. Fortunately, they told me about the AB-PMJAY and I undertook my treatment for four circles. I feel like I took rebirth and today I am standing in front of you all,” he told the gathering.

Amardeep Singh Bhatia, IAS, principal Secretary of health & family welfare, and CEO of AB-PMJAY, informed that there are 1,664 treatment procedures available. 

As per a data provided by the health department, there are a total of 9,33,312 eligible household in the state. The amount of claims that the department submitted is around Rs 28 crore and the amount of claims paid is Rs 26 crore.

For Nagaland, a total of 2.6 lakh e-cards have been issued, a total of 41% of the targeted families. The state aims to achieve 70% coverage by March 2022 under Ayushman Aapke Dwar initiative.

Phom informed that building and other construction workers registered under the Department of Labour will soon join the scheme, and accordingly 8584 new families will be added in the state.

He said that integration with the National Food Security Act (NFSA) data is also under process through which the Aadhaar seeded ration cards will be linked to PMJAY portal to ease the enrolment process and improve the coverage.

The health minister added that the Nagaland State Rural Livelihood Mission (NSRLM) will be partnering with the State Health Agency PMJAY to spread awareness about the scheme through Self Health Groups (SHGs). 

Dr Kika Longkumer, joint director & SNO AB-PMJAY informed that the implementation of the scheme in Nagaland is carried out through insurance model. 

He said that so far, over 200 patients from outside the state has availed the benefit from the state and over 300 patients from Nagaland has availed the benefit outside the state as benefit under the scheme is portable.

Another health official informed that automated triggers has detected suspected frauds. In Nagaland, one hospital has been has been detected for engaging in fraudulent activities where penalty actions and recovery of fraudulent amounts have been imposed on the fraudsters by the State Anti Fraud Unit. . 

To monitor such frauds, the health official informed that routine mandatory case audits, ecard audits, field investigations, and beneficiary call audits are undertaken to detect fraud. 

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