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.

 

No. of enrolled families under State Healthcare Scheme

Sl. No.

District

2019-2020

2020-2021

1

Aizawl

38469

56822

2

Champhai

3214

9301

3

Kolasib

4207

9449

4

Lawngtlai

3062

6620

5

Lunglei

6116

14697

6

Mamit

1930

5292

7

Serchhip

2386

7260

8

Siaha

1631

4279

Total

61015

113720

 

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

 

Claim scrutinized and financial disbursement

Treatment/Claims

Count

Claim

 Amount (₹)

Approved Amount (₹)

Deducted Amount (₹)

Within State

14067

46,85,73,706

38,19,46,854

8,66,26,852

Outside State (REFER)

205

1,97,80,683

1,79,67,519

18,13,164

Rejected

191

94,83,635

NA

NA

Total

14463

49,78,38,024

39,99,14,373

9,79,23,651

  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.

 

No. of Golden Cards (Individual) issued under AB PM-JAY 

Sl. No.

District

2018-19

2019-20

2020-21

(upto June, 2021)

1

Aizawl

36752

50459

2249

2

Champhai

37969

37617

1304

3

Kolasib

19441

19348

952

4

Lawngtlai

2732

15544

1767

5

Lunglei

8462

46330

2056

6

Mamit

7426

12856

1391

7

Serchhip

2863

11846

630

8

Siaha

17353

17148

730

Total

132998

211148

11079

Total Overall

355225

 

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

 

Claim scrutinized and financial disbursement

Treatment/Claims

Count

Claim Amount (₹)

Approved Amount (₹)

Deducted Amount (₹)

Within State

14137

17,07,01,198

15,46,56,634

1,60,44,564

Outside State (REFER)

40

2,69,240

2,50,890

18,350

Total

14463

17,09,70,438

15,49,07,524

1,60,62,914

 

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. 

 

Claim scrutinized

Treatment/Claims

Count

Claim Amount (₹)

Approved Amount (₹)

Deducted Amount (₹)

Within State

11173

52,39,76,470 

    46,46,83,261 

 5,92,93,209 

Outside State (REFER)

943

 15,55,29,986 

    14,39,86,388 

1,15,43,598 

Rejected

47

         37,48,503 

-

      37,48,503 

Total

12163

    68,32,54,959 

    60,86,69,694 

7,45,85,310