Nagaland government confirms uninterrupted PM-JAY, CMHIS services amid miscommunication

The Nagaland Health Protection Society has addressed recent concerns regarding the suspension of services under the Pradhan Mantri Jan Arogya Yojana (PM-JAY) and the Chief Minister Health Insurance Scheme (CMHIS) by certain empanelled hospitals in the state. 

The Department reassured the public that both health insurance schemes are fully operational and that the services have not been suspended.

A statement from the Department clarified that the confusion arose from a miscommunication from the Insurance Company (FGI), which has now been resolved. 

The miscommunication led to some confusion, but the Department has confirmed that all empanelled hospitals have been instructed to continue offering services under the PM-JAY and CMHIS schemes without interruption.

“Services under both schemes remain active unless a hospital decides unilaterally to suspend them, which would constitute a violation of the signed Memorandum of Understanding (MoU),” the Health Protection Society stated.

The department also highlighted the significant financial disbursements made for treatment under both schemes. For the fiscal year 2023-24, a total of Rs. 53.64 crores for claims under AB PM-JAY and CMHIS (General) and Rs. 34.54 crores for claims under CMHIS (EP) were paid to empanelled hospitals. For the ongoing fiscal year 2024-25, Rs. 38.92 crores for PM-JAY and CMHIS (General), and Rs. 33.52 crores under CMHIS (EP) have already been disbursed within Nagaland. Furthermore, claims paid for treatment outside Nagaland amounted to Rs. 3.99 crores under PM-JAY and Rs. 3.81 crores under CMHIS (EP) in FY 2023-24, and Rs. 1.95 crores under PM-JAY and Rs. 10.16 crores under CMHIS in FY 2024-25.

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The department also acknowledged that the utilization of premiums for both schemes has been growing annually at a compounded rate of 17%, signaling the increasing popularity and success of these healthcare programs, which have benefited patients across Nagaland.

However, the Department raised concerns regarding allegations of fraud and abuse/misuse of the schemes, including financial exploitation of vulnerable patients by certain empanelled hospitals. The Health Protection Society warned that such practices jeopardize the sustainability of the health insurance programs and announced that an investigation has been initiated to examine these allegations. Strict action will be taken against any hospital found violating the established guidelines or statutory compliance.

The Department reiterated that both the PM-JAY and CMHIS schemes provide cashless services to beneficiaries, ensuring that eligible households can access quality healthcare without financial barriers. Beneficiaries are not required to make any upfront payments for treatments covered under the schemes, except for services that are not entitled. In such cases, the treatment costs are directly settled between the empanelled hospital and the insurance company.

To facilitate easy access to treatment, beneficiaries are encouraged to verify their eligibility and visit any empanelled hospital for cashless services. For any assistance or clarification, the public can contact the toll-free helpline number: 1800-202-3380.

In a public advisory, the Department cautioned all stakeholders, including hospitals, against issuing premature notices regarding service suspensions without confirmation from the competent authorities. Such actions could create unnecessary confusion and concern among the public. 

Additionally, citizens were urged to report any unethical practices observed in the empanelled hospitals to ensure the integrity of the health insurance schemes.