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Mukh Mantri Sehat Bima Yojana: ‘Safe exit’ to health insurance company under AAP govt lens

Patiala: The “unilateral” decision of the previous Charanjit Singh Channi’s Congress government in Punjab to terminate the contract of Ayushman Bharat – Mukh Mantri Sehat Bima Yojana (AB-MMSBY) – with a private insurance firm a week before the model code of conduct came into force ahead of the 2022 state assembly polls without taking action against the company has come under the AAP government scanner.

More than 45 lakh families in the state are not able to get cashless treatment for the past six months under the flagship health insurance scheme that was launched on August 20, 2019. Under the scheme, financial health protection was being provided to 65% population in the state, giving entitlement-based cashless health insurance cover of 5 lakh per family per year in government and empaneled private hospitals.

The contract was terminated on December 29, 2021, which would have otherwise come to an end on August 18, 2022, citing that the company was taking more than the stipulated 15 day’s time for clearing the payments of hospitals.

In a note to chief minister Bhagwant Mann (HT has access to it), Punjab health secretary Ajoy Sharma said after the termination, the insurance firm was absolved of all liabilities, putting the patients in the lurch. Since the termination of the contract, most of the empanelled private as well as some government hospitals have stopped treating the patients under this scheme.

Following the health secretary’s note, CM Mann has asked him to submit a detailed file for further action.

The note further reads that permission was not taken from state finance department before terminating the contract. Had it been done, the finance department would have disagreed as it has potentially put an extra burden of almost 600-700 crore on the state exchequer and has benefited the insurance company by that much amount, reads the note.

As per the agreement, the department should have given a 30-day notice to the company to make corrections and heavy penalties could have been imposed. However, no such thing was done. Rather, the company has been benefited by terminating the contract immediately, reads the note.

The health secretary confirmed that he has flagged the irregularities. “But I cannot disclose these as the matter is pending with the chief minister. But I can say that it caused a huge loss to the state exchequer and left the patients in the lurch,” said Ajoy Sharma. “I feel the pain when cancer, kidney and other patients are denied treatment due to the apathy of the department,” he said.

Soon after the termination of the contract, the department floated tenders afresh and received the most suitable bid at triple the price of the premium earlier. While the contract with the previous firm was done at 1,050 per beneficiary, it received the fresh bid for a premium of 3,000-plus per beneficiary, reads the note.

While then health minister OP Soni could not be contacted despite repeated attempts, a senior government official said: “It’s tip of the iceberg. Before passing immediate termination order, the Punjab government and the health department didn’t even think about the 45 lakh families who were receiving treatment under the scheme.”

Former principal secretary, health, Raj Kamal Chaudhary said: “I had recommended blacklisting the firm but nothing was done. The termination notice was issued by the state health agency by even not sending a file to me. The state health agency can explain why it didn’t send the file back to me for approval of the draft of termination or any legal issues before sending it to the insurance firm. I had also asked to send the file to the finance department, which was also not adhered to.”


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