Maharashtra’s social health scheme gets Rs 80 crore insurance refund – The Times of India – 18th October 2018

The state’s free health insurance scheme for the poor got a windfall when, after a three-month tussle with
a national insurance company, it got a refund of Rs 80 crore on Wednesday. The money was supposed to
be used for information, communication and education (IEC) to popularize the Mahatma Jyotiba Phule
Jan ArogyaYojana (MJPJAY) among the 2.23 crore family beneficiaries.
About 2% of the premium was to be used for IEC purposes, said Dr .Sudhakar Shinde, who heads the
MJPJAY scheme and oversees the implementation of the Centre’s Ayushman Bharat scheme in
Maharashtra.
After using Rs 26 crore in the first couple of years, the insurance company failed to carry out any IEC
exercises. As per the MoU between the state and the National Insurance Company, the latter is supposed
to carry out IEC work after consulting the MJPJAY society. But this wasn’t done, said Dr .Shinde.
The society worked out that Rs 64 crore meant for IEC over six years hadn’t been used. “I wrote to the
company and met its board seeking a refund, but was told that the money had lapsed,” he added.
In July first week, the MJPJAY society, instead of giving a premium of Rs 384 crore, sent a cheque with Rs
64 crore as “adjustment” towards IEC payment. This started a long battle between the two entities, with
the company finally agreeing to a refund of Rs 64 crore and another Rs 15 crore adjustment in the next
premium.
“But there was a moment when the company said it would stop accepting preapprovals for surgeries. It
was tough,” he added. Efforts to contact officials of the National Insurance Company were in vain. TOI has
a copy of the letter sent by the company to MJPJAY on October 15, showing the “refund of unspent IEC—
schedule of payment”.
The refund can be used to finance operations not covered under MJPJAY. The state is among the few that
offer local as well as central schemes. While MJPJAY covers operations of up to Rs 1.5 lakh, the central
Ayushman Bharat offers a Rs 5 lakh cover. While the Centre pays 60% of the costs, the state puts in the
remaining 40%. The insurance refund could be used for this purpose.

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