PMJAY faces legal hurdles, brings uncertainty over ‘Golden Card’ Scheme in J&K

SHAKEELA ANDRABI

SRINAGAR: The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana-Golden card scheme-launched to provide healthcare coverage to all residents of Jammu and Kashmir, is facing legal hurdles, putting thousands of patients in distress.
Notably, the IFFCO-TOKIO General Insurance Company opted out of the contract with the State Health Agency (SHA) in November 2023, a year ahead of its three-year term contract. The contract, executed on March 10, 2022, was originally supposed to run until March 14, 2025. Prior to this, the scheme was implemented through private insurer Bajaj Allianz GIC, whose contract ended in 2022.
However, according to the sources the company cited financial losses for exiting the contract. The SHA requested IFFCO-TOKIO to continue the contract “in the interest of patient care,” but the insurer refused, prompting a High Court petition by the SHA to stay the termination.
In its plea, the government urged the court to order the insurance company to fulfill the contract until its expiry on March 14, 2025, citing the importance of “patient care” and public well-being. The plea sought directions to be issued to the company to restrain from opting out of the Contract of Insurance.
The government said that approximately 1200-1500 procedures take place daily in the Union Territory and the general public heavily relies on these schemes for adequate treatment, leading to improved and well-organized patient care.
However, the petition was dismissed by the bench on February 2, inviting more trouble for the SHA and the beneficiaries across the Union Territory.
The Ayushman Bharat PM-JAY SEHAT scheme was launched by the Prime Minister on December 26, 2020. Over the years, thousands of patients have benefited from the scheme, which has emerged as a ray of hope for numerous other poor families who cannot afford health treatment at prestigious and premier medical institutes of the country. Over one crore beneficiaries have been registered in the UT.
The IFFCO – TOKIO, General Insurance Company in their letter dated November 1st, 2023 informed that they would like to serve a notice expressing that they are not interested in further renewing the contract after the expiry of the present policy, which ends on 14th March, 2024 as per Clause 9.1c of the contract agreement dated 10th March, 2022.
Sources revealed that amid the conflict between the two parties, the government has decided to remove four common surgeries (Gallbladder, Hemorrhoids, Fissure in Ano, and appendicitis) from the list of free surgeries.
These procedures, according to officials, will be done in government hospitals only. Sources said that although the hospitals empanelled under the scheme are still providing the benefits of the golden card but many have decided to suspend new admissions due to delayed payments from the government. Notably, over 239 hospitals were empanelled under the scheme.
Chief Executive Officer (CEO), State Health Agency, Jammu and Kashmir said that the dispute will not have any impact on the scheme and the patients continue to take benefits from it.
“Our call centers are open, we didn’t receive any complaints so far,” he said, adding, “From day one I am saying that this (dispute) has nothing to do with the scheme and we are doing everything which is required”.
However, hospital owners maintain that the government needs to clear the air. “There is a lot of ambiguity in the scheme. We aren’t sure whether to proceed with cases or not,” said an owner of a private hospital, wishing not to be named.
The future of the much needed scheme is in uncertainty as it faces a number of challenges, with legal disputes posing a significant threat to its continuity and effectiveness.