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| SEHAT Health Insurance Scheme of J&K | | | Dr. Daleep Pandita
Getting good quality healthcare at affordable cost is not only our fundamental expectation but also our ultimate need. Lack of technically efficient hospitals equipped with competent expertise, that too at exorbitant charges, only add to the agony of patients care, particularly at rural level which constitute majority of our population.
Earlier government of India ( GoI ) pre attempted this vital issue by covering its poor population particularly people living below poverty line, those are listed as per Socio – economic Caste Census of the year 2011 ( SECC – 2011 ) through Ayushman Bharat - Pradhan Mantri Jan Arogya Bima Joyna ( AB-PMJAY ). It is world’s largest health insurance scheme, which provide free of cost medical treatment to these families upto Rs five lacs undertaken at government and specifically designated hospitals all across the country.
Taking forward this concept, GoI obliged the people of Jammu and Kashmir by announcing the extension of this scheme to its all residents, irrespective of economic status and caste and creed, including its employees and pensioners, traders and bussinemen, be it unemployed or employed or old and young, professional or non professional, is popularly known as SEHAT Health Insurance Scheme. It has assumed higher importance under the ongoing COVID-19 pandemic for various forms of its treatment.
This paperless and cashless scheme, implemented through e-card commonly known as “ Golden Card ” issued to head of the family, covering its all family members, as mentioned in their ration card, for an amount of Rs. Five lacs, on floater basis extended to one or all the members of family, for a period of one year. Ration card for authenticating the resident of J&K and Aadhar card for identifying the beneficiary, are the two main documents required for taking this insurance cover besides domicile certificate and photograph as supporting evidences. It can be availed at nearest Common Service Centre through their network of 5000 centers spread all over J & K , besides Khidmat Centres, Community Health Centres, District Health Society, Associated Hospitals, Nodal offices of Relief and Rehabilitation department or through designated offices of State Health Agency, without paying any premium amount.
It is important that no prior health examination or any type of prior medical tests are required to be undertaken for getting enrolled in this scheme. Even all types of pre existing ailments or any kind of pre existing diseases are covered under this scheme. It has no age bar covering infants up to senior citizens and most importantly there is also no limit on the size of a family too.
This social benefit scheme also covers expenses up to three days of pre - hospitalisation like charges spent on diagnosis and laboratory investigations and 15 days of post - hospitalisation expenses like charges spent on medicines after the discharge from hospital. But expenses incurred on the treatment of a disease caused due to consumption of banned drugs or intoxication or as a result of any unlawful or criminal activity are not covered under this scheme. Similarly costs incurred on cosmetic or on ornamental treatment or on tonics not forming the part of actual treatment or any other medicines not prescribed, are also not payable.
Interestingly, the benefits under this scheme are portable and can be undertaken in any of the empanelled hospitals of AB-PMJAY scheme all across the country, those can be easily located on its website / portal.
This ambitious SEHAT health insurance scheme can prove a game-changer as far as healthcare in J&K is concerned but its effective and honest implementation at all levels in a system overweighed by corruption and capitalism is the main key to its success.
Adequate monitoring and anti fraud mechanism from the government side need to be placed strongly, to maintain check and balance on quality and cost of treatment, is the need of hour. To resist the temptation to inflate insurance claims, irrational and over use of medical intervention besides unethical practices at the health institutions is the next step to be critically monitored by its implementers. At the end, sincerity, true consciousness and morality of the people will ultimately lead to the success of this scheme in J&K. |
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