Maharashtra govt to rope in 800 hospitals under cashless health insurance scheme, new tenders soon

The state-run insurance scheme, Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY), covers 2.25 crore families and provides a medical cover of Rs 1.5 lakh. It works along with the BJP’s flagship scheme, PMJAY, which covers 83 lakh families (3.7 crore population) belonging to socio-economic caste census (SECC) in Maharashtra. The PMJAY covers 1,220 procedures and provides medical insurance of Rs 5 lakh.

Using a combination of insurance and trust mode, Maharashtra has been implementing both the state as well as the national schemes. With new tenders, the state government is also preparing to pay hospitals more for certain procedures, for instance, a kidney transplant will fetch hospital Rs 3 lakh instead of Rs 2.5 lakh, dialysis will be Rs 1,100 instead of Rs 700, while certain kind of fracture treatment cost will escalate from Rs 15,000 to Rs 20,000. Officials are hopeful with higher package cost, more hospitals will empanel with the cashless insurance scheme.

Since September 2018, when PMJAY was launched, 4.17 lakh procedures have been conducted for beneficiaries. Government estimates indicate at least 38 per cent of them belong to SECC and are getting benefit under PMJAY. State has spent Rs 79 lakh on procedures costing more than Rs 1.5 lakh under PMJAY.

While multiple hospitals have shown reluctance to join PMJAY quoting lesser packages offered by government and low profit margins, Dr Sudhakar Shinde, CEO of the MJPJAY, said at least 1,500 small-scale hospitals are on the wait list to get empanelled.

“Once the new tender is finalised we will be able to enrol more hospitals,” he said.