Last Updated on November 14, 2021 at 8:38 pm
The Government of J&K introduced AB-PMJAY, SEHAT Scheme which provides free health insurance cover to all the citizens of J&K for Rs 5 lakhs per family per year on floater basis.
Subsequently, circular instructions were issued vide No. FD-Code/63/2021-734 dated 31/08/2021 regarding consideration of medical reimbursement claims under the J&K Civil Services (Medical Attendance and Allowance) Rules, 1990 post launch of Ayushman Bharat PM-JAY-SEHAT Scheme.
Finance department of J&K has issued a circular stating, “Consequent upon the above, it has come to the notice of the Finance Department that difficulties have been faced by various beneficiaries for reimbursement of expenditure incurred on the treatment of life consuming diseases outside hospital/institute and on OPD basis”.
The issue has been examined in consultation with the Health & Medical Education Department and Chief Executive Officer, State Health Society, ABPMJAY, J&K, which have clarified as under:- “As per the Health Benefit Packages (HBP) 2.0 issued by National Health Authority (NHA), there are 1574 treatment packages covered under Ayushman and AB-PM-JAY-SEHAT. Accordingly, secondary & tertiary care in-patient services including day care procedures are covered. This may include IPD/day-care-based treatment of life consuming diseases. However, OPD services, prescription given by doctor on OPD Basis and standalone diagnostics are not covered under the scheme” the circular read
“Bharat PM-JAY Accordingly, it is clarified that the medical expenses incurred on the treatment of life consuming diseases outside hospital/institute shall continue to be reimbursed in terms of Rule 5(5) of the J&K Civil Services (Medical Attendance and Allowance) Rules, 1990” the circular by Finance Department stated.
