Healthcare & RSBY Reports

Mizoram State Health Care Scheme  & AB-PMJAY REPORTS 2020-21

1. The Mizoram State Healthcare Scheme strengthens and gaves social security to each bonafide entitled residents enrolled under the scheme by providing health insurance coverage up to 2 lakhs, with each family enrolling themselves by a minimal user charge of ₹ 100 for BPL families and ₹ 1,000 for APL families for all ailments requiring hospital admission and selected 26 OPD cases.

          During the financial year 2020-21, there is an increase in quantity of enrolled families as compared to the previous year. The details of comparative enrollment and financial report is given in table 1.A and 1.B as shown below:

       Table. 1. A: No. of enrolled families under State Healthcare Scheme.

     Table. 1. B: Detail of claim scrutinized and financial disbursement.

1. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) 

  AB PM-JAY is a Centrally sponsored health insurance scheme for Socio-economic Caste Census (SECC) derived families as well as Rastriya Swasthya Bima Yojana (RSBY) families. It provides access to health care services for the beneficiary at all empanelled hospitals through cashless mechanism mitigates catastrophic expenditure on medical treatment. There are 87empanelled hospitals in the State of which 80 hospitals come under public sector and 7 hospitals under private sector. At present, 355225 Golden Cards are already issued and the year wise number of golden Cards issued and financial disbursement is given in table 2.A and 2. as shown below.       

    Table. 2. A: No. of Golden Cards (Individual) issued under AB PM-JAY.

     Table. 2. B: Detail of claim scrutinized and financial disbursement.

3).   State Govt. Employee Medical Reimbursement.

       Screening of Medical Reimbursement bills of Govt. Servants and their dependents is also undertaken. During 2020-21, 12163 Medical Reimbursement bills were scrutinised and approved. Prior to screening of MR bills, the average financial outgo was approximately ₹100-120 crores. Screening by MSHCS has reduced the financial outgo by approximately ₹40 crores as it detects frauds, over billing, deduction of out-dated cash memo’s, etc and has discouraged such malpractices. The details of claims are shown as below:

       Table. 3: Detail of claim scrutinized.