Over 1.06 lakh claims settled under Ayushman Vay Vandana scheme, Rajya Sabha told

Time of India

6 days ago

New Delhi: More than 1.06 lakh claims have been settled under the
Ayushman Vay Vandana scheme
since its launch in October last year, Minister of State for Health Prataprao Jadhav told the Rajya Sabha on Tuesday.
The government on October 29 expanded Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (
AB-PMJAY
) to provide free
treatment benefits
of up to Rs 5 lakh per year to all
senior citizens
aged 70 years and above through Ayushman Vay Vandana cards.
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Under portability feature of AB-PMJAY, eligible beneficiaries can access
healthcare services
across a network of 31,466 empanelled hospitals in the country irrespective of their place of residence, Jadhav said in a written reply.
This portability feature is available to both AB-PMJAY and Vay Vandana scheme beneficiaries. The Vay Vandana scheme beneficiaries can also avail treatment at a network of 14,194 private healthcare providers, the minister said.
The
National Health Authority
(NHA) has issued
hospital empanelment
and management guidelines for empanelment of hospitals under AB-PMJAY.
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In a separate reply, Jadhav said that settlement of claims is an ongoing process.
Under AB-PMJAY, claims are settled by respective State Health Agencies (SHA). The NHA has laid down guidelines for payment of claim to hospitals within 15 days of claims submission for the intra-state hospitals and within 30 days in case of portability claims (hospitals located outside state).
Claims are required to be settled within the timeline specified under the scheme, Jadhav said in the written reply.
Notable improvements have been recorded in the overall average Turnaround Time (TAT) for claim settlements year on year. Regular review meetings are organized to take stock of the progress with regards to the claims, he said.
Further, capacity building activities are organised for efficient claims settlement.
As per the terms and conditions of empanelment, hospitals cannot deny treatment to eligible beneficiaries of the scheme. In instances other than treatment denial due to exclusion by the empanelled hospital, beneficiaries can lodge grievances, Jadhav said.
Under AB-PMJAY, a three-tier
grievance redressal system
at district, state and national level has been created to resolve the issues faced by beneficiaries in utilizing healthcare services.
At each level, there is a dedicated nodal officer and Grievance Redressal Committees to address the grievances.
Beneficiaries can file their grievances using different mediums including web-based portal Centralized Grievance Redressal Management System (CGRMS), Central and state call centers (14555), email, letter to State Health Agencies, etc.
Based on the nature of grievance, necessary action including providing of support to the beneficiaries in availing treatment under the scheme, is taken, the minister stated.
Further, to improve hospital participation,
health benefit packages
used under AB-PMJAY have been revised and rationalized five times since the launch of the scheme, he said.